Bladder Cancer

Bladder cancer, also known as bladder cancer, develops in the bladder, the sac-shaped organ in the pelvis that stores urine produced by the kidneys. There are two types of bladder cancer classified according to the propensity of the tumor to invade or not invade the deep layers of the bladder wall, namely:

1. Non-infiltrating bladder carcinoma: the carcinoma remains confined to the superficial layers of the bladder wall and very often does not demonstrate any propensity to infiltrate the deep layers; it represents the most frequent form of bladder cancer. 70% of bladder tumors are non-infiltrating at diagnosis. However, some of them can develop aggression and invade the deep layers. In this case, we are talking about infiltrating bladder cancer;
2. Infiltrating bladder carcinoma: this carcinoma can originate with invasive characteristics by immediately infiltrating the deep tissues (the muscular layer) of the bladder wall, thus causing metastasis to the lymph nodes and distant organs; in some cases, as already mentioned, a non-infiltrating bladder carcinoma can acquire aggressive characteristics and become infiltrating after a certain period.

Anatomy of the Bladder

The bladder is a hollow organ located in the pelvis. It comprises three layers of tissue: the epithelium, the muscle, and the connective tissue.

Risk factors

Bladder cancer, in general, can be influenced by several risk factors, including:

• Tobacco smoking: smoking significantly increases the risk of developing bladder cancer;
• Exposure to Chemicals: Exposure to chemicals such as arsenic and hair dyes can increase the risk;
• Age and Sex: the risk increases with age, and men have a greater risk than women;
• Family History: those who have first-degree relatives with bladder cancer have a slightly higher risk;
• Radiation Exposure: Exposure to past radiation, such as that used to treat other types of cancer, may increase your risk.

Symptoms

Blood in the urine (haematuria) is the most frequent symptom. It can occur in isolation or without further symptoms or be associated with frequent or urgent urination or pain or burning during urination.

Diagnosis

Diagnosing bladder cancer involves several tests, including:

• Urinalysis: your urine will be examined to detect the presence of blood or abnormal cells;
• Cystoscopy: This test involves inserting a flexible tube (cystoscope) through the urethra to examine the inside of the bladder directly;
• Endoscopic tumor resection: If suspicious tissues are detected during cystoscopy, they will be resected and then examined under a microscope to confirm the presence of the tumor and its infiltrating or non-infiltrating characteristics.

Non-infiltrating bladder cancer: Staging

Staging of noninfiltrating bladder cancer is critical in determining treatment. It is possible with complete endoscopic resection of the tumor during operative cystoscopy. The histological examination report can, therefore, indicate the presence of the following:

1. Carcinoma in Situ (CIS): tumor cells are present only on the internal surface of the bladder;
2. Ta (Non-infiltrating tumor): the cancer is present only in the internal lining of the bladder;
3. T1 (Tumor invading connective tissue): The cancer has invaded the connective tissue under the lining of the bladder but has not reached the muscle layer.

Infiltrating bladder cancer: staging

The histological examination of endoscopic resection of the bladder tumor may reveal a carcinoma infiltrating the deep layers of the bladder wall:

1. Stage T2: the tumor has invaded the muscular layer of the bladder;
2. Stage T3: the tumor has invaded surrounding tissues such as the prostate, vagina, or pelvic wall;
3. Stage T4: the tumor has invaded adjacent organs such as the abdominal wall or rectum.

Treatment of noninfiltrating Bladder Cancer

Treatment of noninfiltrating bladder cancer depends on staging and may include:

• Transurethral resection of the tumor: in addition to staging, resection, if complete, can be the only effective therapy;
• Intravesical Immunotherapy: using drugs such as bacillus Calmette-Guérin (BCG) to stimulate the immune system to fight cancer in the bladder;
• Intravesical Chemotherapy: Using chemotherapy drugs directly into the bladder to destroy cancer cells.

Monitoring and follow-up of noninfiltrating Bladder Cancer

After treatment, it is essential to monitor the patient regularly to evaluate the response to treatment and detect any recurrence. It may include periodic urinalysis, follow-up cystoscopies, and other imaging tests.

Noninfiltrating bladder cancer is a condition that requires careful management and regular follow-up to prevent recurrence and monitor response to treatment. It is essential to consult a urologist experienced in the treatment of bladder cancer to plan the best therapeutic approach for each patient.

Treatment of infiltrating Bladder Cancer

Treatment of infiltrating bladder cancer depends on the stage and may include:

Radical Cystectomy: surgical removal of the bladder and, sometimes, surrounding organs such as the prostate, uterus, or abdominal wall;

Reconstruction Surgery: After Cystectomy, reconstruction of the urinary system may be necessary with techniques such as the creation of a neobladder or the use of a ureteral conduit to divert urine;

Chemotherapy: using chemotherapy drugs before or after surgery to reduce the size of the tumor and prevent recurrence;

Radiotherapy: Using high-energy radiation to destroy cancer cells in the bladder.

Monitoring and follow-up of infiltrating Bladder Cancer

After treatment, it is essential to monitor the patient regularly to evaluate the response to treatment and detect any early relapses. It may include periodic urinalysis, follow-up cystoscopies, and other imaging tests. Risk management may also include symptom management and psychological support to deal with the emotional aspects of bladder cancer.

Infiltrating bladder cancer is a severe condition that requires timely and appropriate treatment. It is essential to consult a urologist experienced in the treatment of bladder cancer to plan the best therapeutic approach for each patient. Early diagnosis and multidisciplinary treatment can significantly improve the recovery prospects and quality of life of patients suffering from this disease.