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Everything you need to know about bladder cancer

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

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

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

Bladder cancer accounts for 3.3% of all tumors, being more frequent in men (4.7%) than in women (1.6%).

In Spain, according to the Spanish Association Against Cancer (AECC), about 12,200 cases are diagnosed 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 frequent tumor in men after lung, prostate and colorectal tumors.

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

It is usually monosymptomatic (not associated with other symptoms) and self-limiting (it subsides spontaneously after fluid intake). It is true that the presence of blood in the urine does not always mean the presence of a tumor, since other pathologies such as urinary tract infections, lithiasis, etc. can be the cause of hematuria. However, it is essential to be evaluated by a urologist in case of bleeding in the urine.

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

When bladder carcinoma is at an advanced stage, symptoms such as difficulty or impossibility to urinate, lumbar pain or bone pain may appear.

There are multiple risk factors for developing bladder tumors. The main and preventable one is smoking.

People who smoke 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 bladder inflammation due to the presence of catheters, repeated urinary tract infections or bladder stones.
  • Schistosoma Haematobium infection o This is a parasitic infection endemic to 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 disease.
  • Patients who have received radiation therapy to the pelvis may develop bladder tumors.

Most cases are diagnosed in the 60-70 age group and are mainly related to tobacco use.

The main diagnostic tests for early detection of bladder cancer are ultrasound of the urinary tract and urine cytology (analysis of cells in suspension in the urine).

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

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

Once the existence of the tumor has been confirmed, it will be removed. transurethral resection under epidural anesthesia. This procedure consists of introducing an instrument with an electric scalpel through the urethra to remove the lesion for subsequent analysis and correct identification. Once the cell aggressiveness has been assessed and the bladder wall infiltrated in certain cases, we proceed with the search and localization of possible metastases by imaging tests (thoracoabdominal-pelvic CT and bone scintigraphy). In tumors with superficial infiltration of the bladder wall, the following is sufficient transurethral resection (TUR) and subsequent bladder instillations with locally acting and very well tolerated drugs (Mitomycin C or BCG). These instillations are performed periodically and on an outpatient basis, introducing a fine urethral catheter into the bladder through which the drug is administered. Subsequent check-ups are essential. In non-metastatic tumors with deep infiltration of the bladder wall, the treatment of choice consists of removing the bladder, prostate and seminal vesicles in men and bladder, uterus and ovaries in women (radical cystectomy) and the neighboring lymph nodes (bilateral iliobturator lymphadenectomy). In the same intervention, the urine is diverted to the exterior:
  • Cutaneous ureterostomy: ablation of the ureters directly to the abdominal wall. It requires a collecting bag.
  • Ileal conduit: opening of the ureters into a segment of intestine that empties into the abdominal wall. It requires a collecting bag.
  • Ureterosigmoidostomy: opening of the ureters to the terminal portion of the large intestine in such a way that urine would be eliminated together with feces through the anus.
  • Orthotopic diversion (neobladder): opening of the ureters to a segment of the intestine that is placed in continuity with the urethra, through which urine would be eliminated.
Each of these referrals carries certain specific advantages and risks that should be carefully discussed before making a final decision as they will influence the prognosis and postoperative quality of life.
doctor juan carlos ramirez urologist

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

Put yourself in the hands of our team of specialists in uro-oncology.

Dr. Patricia Ramirez

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