Bladder
cancer

Bladder Cancer

Bladder cancer is the 7th most common tumour in men. Its incidence in Europe is of 19.1 and 4.0 per 100,000 people/year in men and women respectively and its risk increases rapidly with age.

Tobacco is the greatest risk factor associated with bladder cancer, responsible for approximately 50% of cases. The industrial exposure to enamels, dyes, heavy metals and hydrocarbons (aromatic amines, polycyclic aromatic hydrocarbons and chlorinated hydrocarbons) is responsible for 10% of these tumours, conforming the second risk group, although this has been decreasing due to the improvements in industry safety.

The most common presentation is with hematuria (blood in the urine) but can occur with micturitional discomfort with irritation that is persistent, which sometimes can be confused with infections and cystitis, which delays diagnosis of the tumour. When faced with these symptoms, it is necessary to suspect and actively investigate the possibility of a tumour of the urinary tract. This is done in a systematic manner with ultrasound or urography (IVU or UroCT) , cystoscopy and urine cytology. Definitive diagnosis is only possible with cystoscopy, resection of the tumour and an anatomopathological report, which informs of the type of tumour, its degree and the extension in bladder wall depth. Current imaging techniques available at the IVO, such as the image system STORZ SPIES, have improved the image and consequently the diagnosis of these tumours.

Depending on depth, tumours are classified as superficial or non-muscle-invasive bladder cancer (NMIBC), approximately 75% to diagnosis, and invasive or muscle-invasive bladder cancer (MIBC), representing 25%. .

After the resection and diagnosis by the pathologist, superficial tumours can continue with endoscopic control, based on their risk of recurrence. Multiple tumours, those that are large in size and the recurrent ones (those that have reappeared) can benefit from adjuvant treatments with intravesical mitomycin or epirubicin. Tumours with a high degree are treated with intravesical immunotherapy (Bacille Calmette-Guerin), to reduce the risk of recurrence and progression. At the IVO, a strict intravesical adjuvant protocol is followed that, in addition to standard treatments, also includes innovative systems of instillation, such as hyperthermia and EMDA, that improve the administration of these drugs.

When the tumours are muscle-invasive, the standard treatment is radical surgery that can be performed either using a laparoscopic or an open approach, followed by the most current reconstruction techniques. In addition, at the IVO, in very selected cases, conservative treatment can be considered, with bladder preservation as an alternative to radical cystectomy.

At the IVO we have specialized professionals with broad experience in the treatment of this type of cancer. Even in advanced cases, when the disease is widespread outside the bladder, a palliative treatment is still possible. The management of these patients requires a multidisciplinary approach including urology, medical oncology, radiology and, occasionally, radiation oncology, palliative medicine and home care.

 

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© 2015 IVO Fundación Instituto Valenciano de Oncología

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