My aunt, 63, was diagnosed with bladder cancer. We had never heard of it and in the family we are all very worried, although the doctors were calming because they told us it was at an early stage and classified it as superficial, so it has not yet infiltrated the bladder walls. What are the best therapies for you? And what are the chances of finally recovering?
He answers Renzo Colombo, urologist, vice president of the Italian Society of Uro-Oncology (SIUrO) and coordinator of the Uro-Oncology Area at the San Raffaele Hospital in Milan
Bladder cancer a still little known disease and also for this reason, during the month of May, all over the world, patients, families and medical staff mobilize for an awareness campaign that aims to highlight the main aspects concerning this neoplasm and promote awareness of the symptoms, improve early diagnosis and stimulate greater investment in research. Although it is often underestimated, with approximately 25,500 new cases diagnosed (20,500 among men and 5,000 among women) in 2020 in Italy bladder cancer is the fifth most frequent form of cancer in our country and its numbers are growing. It affects all age groups, mainly after the age of 50, and smokers are at higher risk because tobacco is responsible for about half of all urinary tract cancers.
Do not neglect the blood of the urine
As for survival, five years after diagnosis, about 80% of patients live in our country: the chances of recovering definitively, and of doing it with a minimally invasive surgery, are greater if (as in the case of the aunt) early diagnosis, but few people know how to recognize the symptoms. The main sign is blood in the urine, or hematuria, which must be considered a real alarm bell. Other possible indicators, although rarer, may be the need to urinate more frequently or recurrent infections: in all these cases, without delaying, it is good to speak immediately with your doctor who will indicate if a visit with a urologist specialist is necessary and which tests are useful to do. To make the complete diagnosis they are needed cytology (looking for cancer cells in the urine), ultrasound of the urinary tract and cystoscopy, which is performed under local anesthesia and, if necessary. allows to perform biopsies.
Post-surgery relapses are frequent
Treatment options depend on the stage of the disease that settles with a transurethral endoscopic resection, also called TURB. If detected in the early stages, i.e. without infiltration of the muscular layer of the bladder wall, the tumor is treated with conservative surgery by endoscopic resection, with the removal of the lesion only, trying to preserve the integrity and functionality of the organ as much as possible. Local relapses after conservative treatment are unfortunately very frequent, but can be effectively prevented with iIntravesical instillations of chemotherapy or immunotherapy drugs such as the Calmette-Gurin bacillus (BCG): in practice, the drug is placed directly into the bladder via a catheter. There radical cystectomy, i.e. the removal of the bladder, adjacent tissues and lymph nodes, is instead performed when the tumor has extended to the muscle wall or affects a large part of the organ (alternatively, in special cases, radiotherapy can be used alone or in combination with chemotherapy). Finally, when the tumor generates metastases it is necessary to resort to chemotherapy, available in different combinations of drugs, but today we also have several immunotherapy medicines, a valid opportunity especially in cases with contraindications to standard chemo.
June 23, 2021 (change June 23, 2021 | 16:03)
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