Bladder cancer

"Bladder cancer

Diagnosis

As with any form of cancer, the chances of bladder cancer cure are dramatically increased by early diagnosis. The detection and staging of the tumor require the joint use of clinical, instrumental and laboratory tests.

Considering the numerous risk factors, it is first of all fundamental a "thorough personal and work medical history, associated with a" careful evaluation of the symptoms and possibly with "rectal or vaginal exploration. With this last procedure, the doctor, after wearing a thin glove disposable, gently inserts a lubricated finger into the vagina and / or rectum, palpating the anterior region to identify the presence of any abnormal masses.

Traditional urinalysis (search for blood, proteins, glucose, urine culture, specific antibodies, etc.), together with their cytological examination, can provide very important diagnostic clues. In particular, during urinary cytology, the sample is examined under an optical microscope to look for abnormal cells; the test has good specificity (when it is positive it is likely that it is bladder cancer), but it is not very sensitive (a negative test does not exclude the presence of the tumor).

Additional information may derive from instrumental examinations such as urography, pelvic ultrasound, scintigraphy (to highlight any bone metastases) and abdominal-pelvic CT.

Among all the diagnostic techniques, however, cystoscopy remains the pivotal examination in the diagnosis of bladder neoplasms; during this procedure, a thin tube equipped with a camera and a light source at the end (cystoscope) is inserted into the urethra and traced back to the At this level, the micro-camera transmits detailed images of the organ, allowing the urologist to identify any suspicious lesions. During the examination, even small samples of abnormal mass (biopsy) can be taken, to be examined under a microscope to search for neoplastic cells. In many cases, as we will see better in the following chapter, cystoscopy has both diagnostic and therapeutic value at the same time, since it allows the entire tumor lesion to be removed.

Staging

Based on the diagnostic results, vascular cancer is classified into stages of increasing severity. In general, the more advanced the tumor is, the greater the penetration of the neoplasm into the bladder musculature. The bladder wall is in fact made up of three layers of different tissues. The innermost one, the mucous tunic consists of a transitional lining epithelium (tissue in which the number of layers and the shape of the cells vary depending on whether the bladder is full or empty) and a own cassock of connective. More externally we find the tunica muscularis, which with its smooth muscle bundles continues deep into a connective lining called serous tunic. Although different severity scales are found in the literature, a general indication can be the following:

Stage 0: the cancer is confined to the most superficial layer (mucous membrane) of the organ and has not invaded the underlying muscular layer;
Stage I: the tumor cells have invaded the underlying layer (lamina propria), but without affecting the muscular layer;
Stage II: unlike the previous case, the carcinoma has invaded the bladder wall in depth (muscular tunic);
Stage III: Cancer cells have invaded surrounding tissues and may have reached the prostate in men and the vagina or uterus in women;
Stage IV: Cancer cells have invaded local lymph nodes and may have involved other organs, such as lungs, bones and liver, through the lymphatic circulation.

Treatment

For further information: Drugs for the treatment of Bladder Cancer

The treatment of bladder cancer depends on the tumor form and its stage of development, as well as on the general health condition of the patient. If the carcinoma has not invaded the deep layers of the bladder wall, surgery is usually carried out to remove the tumor mass, which in less severe stages can be performed transurethral. In this case the malignant formation is destroyed by inserting into the urethra, after locoregional anesthesia, a flexible cytoscope capable of conveying an anomalous destructive electric current or high-energy laser on the formation. It is therefore a minimally invasive operation, normally free from significant complications. To support these treatments, the doctor can opt for local chemotherapy interventions, which involve the instillation in the bladder of various substances capable of destroying the neoplastic formations.

Another type of therapy commonly used in association with endoscopic treatments is immunotherapy. With this relatively recent technique, we try to improve the body's immune response against cancer cells; for this purpose, attenuated bacterial strains are administered directly into the bladder, such as the one responsible for tuberculosis (suitably inactivated).

In the most serious cases, that is when the carcinoma has invaded the deep layers, the optimal therapeutic choice presents important difficulties, is very invasive and often determines a significant worsening of the patient's quality of life (use of the bladder catheter). Often a multiple treatment is necessary, combining different therapeutic techniques. Among these, a prevalent role is played by major surgery performed under general anesthesia, through which it is possible to remove only the portion of the bladder that contains the neoplasm (partial or segmental cystectomy) or the entire sac (total cystectomy) together with the lymph nodes (radical cystectomy). In men, the total and radical removal of the bladder is accompanied by the removal of the prostate and seminal vesicles, while in women it is associated with the removal of the uterus, ovaries and the anterior part of the vagina. At the same time it is necessary to reconstruct the structural continuity of the urinary tract, in order to allow the "elimination of" urine to the outside. In this regard, the surgeon can use a small section of intestine to reconstruct a urinary duct or a small bag, which can be drained through a catheter made to come out of a hole created in the abdomen and connected to a collecting bag. In selected cases, this artificial bladder can be connected with the urethra, allowing the patient to urinate similar to that of normal subjects without the bondage of the urine collector bag.

If necessary, as happens in the forms that have already metastasized, the treatment of bladder cancer can be combined with general chemotherapy and radiotherapy.