Cancer of Bladder


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Everything you need to know about bladder cancer

He bladder cancer It is a disease that occurs due to abnormal growth and replication of tumor cells in the bladder.

Most bladder tumors begin in the most superficial layer, the urothelium, and as they grow they can invade the deeper layers of the bladder (submucosa or muscular). This increases the risk of spread to other locations, therefore which may require more invasive treatments.

The risk of bladder cancer It increases after age 55 and with some risk factors.

Bladder cancer represents 3.3% of all tumors, being more common in men (4.7%) than in women (1.6%).

In Spain, according to the Spanish Association Against Cancer (AECC), some 12,200 cases annually, which represents 11% of male tumors (10,700 cases) and 2.4% of female tumors (1,500 cases). The incidence in our country is one of the highest in the world, being the 4th most common tumor in men after lung, prostate and colorectal.

The main symptom is hematuria (bleeding in the urine).

Generally this is monosymptomatic (it is not associated with other symptoms) and self-limited (it subsides spontaneously after ingesting liquids). It is true that the presence of blood in the urine does not always reflect the presence of a tumor, since other pathologies such as urinary infections, lithiasis, etc. can be the cause of hematuria. However, It is essential that you be evaluated by a urologist in case of bleeding in the urine.

In some cases it can be associated with other symptoms such as increased frequency of urination (both during the day and at night) or urgency to urinate. These symptoms can also appear in the case of urinary infections or other pathologies, so they should be evaluated by a urologist to carry out a correct study of them.

When bladder carcinoma is in an advanced stage, symptoms such as difficulty or inability to urinate, lower back pain or bone pain may appear.

exist Multiple risk factors for developing bladder tumors. The main and preventable one is tobacco.

Smokers have up to three times the risk of developing bladder cancer than those who have never smoked.

Other risk factors are:

  • Exposure to chemicals such as aromatic amines. These are found in some professions such as the textile industry (use of dyes), painters, printers, hairdressers, etc.
  • Chronic inflammation of the bladder due to the presence of catheters, repeated urinary infections or bladder stones.
  • Schistosoma Haematobium infection o It is an infection caused by a parasite that is found endemically in Africa and the Middle East. It mainly produces squamous cell carcinomas of the bladder (a rare and more aggressive entity)
  • Genetic causes: Lynch syndrome, retinoblastoma gene mutation or Cowden's disease
  • Patients who have received radiation therapy to the pelvis may develop tumors in the bladder

Most cases are diagnosed in the decade between 60-70 years of age and are fundamentally linked to tobacco consumption.

The main diagnostic tests to detect bladder cancer early are ultrasound of the urinary system and urine cytology (analysis of cells suspended in urine).

Other tests that help us in the diagnosis are urine culture, andl urine analysis and in some cases, bladder tumor marker testing.

Once the tumor has been diagnosed or if the previous tests have not been able to make a diagnosis, but there is still a high suspicion, other tests can be performed such as a URO-CT or a cystoscopy (minimally invasive test that consists of reviewing the bladder inside using a flexible and thin instrument that has a camera at the tip and that allows us to obtain images of the inside of the bladder).

Once the existence of the tumor is confirmed, it will be removed. transurethral resection under epidural anesthesia. This intervention consists of the introduction through the urethra of an instrument equipped with an electric scalpel with which the lesion is removed for subsequent analysis and correct identification. Once the assessment of cellular aggressiveness and infiltration in certain cases of the bladder wall has been carried out, we proceed to search and localization of possible metastases using imaging tests (thoracoabdominopelvic CT and bone scan). In tumors with superficial infiltration of the bladder wall, it is sufficient transurethral resection (TUR) and subsequent bladder instillations with drugs of local action and very good tolerance (Mitomycin C or BCG). These instillations are performed periodically and on an outpatient basis, introducing a thin urethral probe into the bladder through which the drug is administered. Subsequent reviews are essential. In non-metastatic deep infiltration tumors of the bladder wall, the treatment of choice consists of remove the bladder, prostate and seminal vesicles in men and the bladder, uterus and ovaries in women (radical cystectomy) and neighboring lymph nodes (bilateral iliobturator lymphadenectomy). In the same intervention, the urine is diverted to the outside:
  • Cutaneous ureterostomy: opening of the ureters directly to the abdominal wall. Necessary collection bag.
  • Ileal conduit: opening of the ureters to a segment of intestine that empties into the wall of the abdomen. Necessary collection bag.
  • Ureterosigmoidostomy: opening of the ureters to the terminal portion of the large intestine in such a way that urine would be eliminated along with feces through the anus.
  • Orthotopic bypass (neobladder): opening of the ureters to a segment of the intestine that is in continuity with the urethra, through which urine would be eliminated.
Each of these derivations carries certain specific advantages and risks that must be carefully discussed before making a final decision as they will influence the prognosis and postoperative quality of life.
doctor juan carlos ramirez urologo

Bladder cancer is a pathology that appears in both men and women, being the 4th most common today.

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Dr. Patricia Ramírez

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