Bladder cancer

Bladder cancer is the second tumor in frequency of the genitourinary tract. Transitional cell carcinoma is the most common of the different types of bladder tumors. The incidence of this tumor increases with age and is more common in men.

Causes of bladder cancer

The risk factor's Most associated with this tumor are tobacco, exposure to aromatic amines, solvents, dyes and paints, and certain drugs such as cyclophosphamide.

Repetitive exposure and use of catheters can eventually lead to bladder tumors.

Irradiation by radiation therapy for tumors in other locations of the pelvic floor it is also associated with the appearance of a bladder tumor.

Types

Classically there are two types of tumors:

• Superficial tumors: They do not affect the muscular layer of the bladder, are multifocal and recur very frequently. They require strict control.
• Infiltrating tumors: They invade the muscular layer of the bladder with a great capacity to spread to lymph nodes and blood, requiring radical treatment.

Symptoms

The symptoms that bladder tumors usually give are basically hematuria and on occasion voiding syndrome (irritation, frequency). Hematuria is usually monosymptomatic, without any other type of discomfort and is usually self-limited. Much less frequently the patient may present and even pelvic pain.

When the disease is widespread and very advanced, it can occur in the form of asthenia, weight loss and loss of appetite, with bone pain if there is metastatic involvement of the bone or specific discomfort in the area where the tumor metastasizes.

Diagnosis

The first imaging test to be performed is due to its innocuousness, and due to its high detection rate. The diagnostic power is directly related to the size of the lesion. PFor tumors between 5 and 10 mm the detection rate is 82% and for tumors larger than 1 cm. is 100%. The detection rate drops to 38% in tumors smaller than 5 mm. Ultrasound allows us to know exactly the number, location, size and morphological appearance of the tumor and its implantation base.

It can also be performed for the concomitant study of the upper urinary tract, because on many occasions there are bladder tumors associated with tumors of the upper urinary tract. Diagnostic cystoscopy should be reserved for cases with a doubtful differential diagnosis, although it is the test that can give the diagnosis with greater reliability, it is a bloody test, because it is performed in outpatient without anesthesia. The cystoscope (rigid or flexible) is inserted through the urethral meatus and the entire bladder mucosa is directly visualized.

Once the bladder tumor has been diagnosed, for the extension study can be performed CT or MRI to assess regional lymph node involvement or metastatic involvement of other organs. MRI allows better visualization of perivesical fat, but CT is preferred as an extension study.

Treatment

The initial treatment of a bladder tumor is through transurethral resection (TUR) of the tumor. A camera workpiece (endoscopy) is inserted through the urethra to resect and remove the tumor. Later it is analyzed and it is decided if it is superficial or infiltrating. If it is superficial, high-grade or recurrent, it is sometimes necessary undergo endovesical chemotherapy or immunotherapy to decrease the risk of disease recurrence and progression after TUR. If it is infiltrating, a radical cystectomy is performed removing the entire bladder and diverting the urine to the intestine, in the form of a neobladder or ileal conduit (stoma to skin). When the tumor is aggressive, systemic chemotherapy may be required after surgery.

Precautionary measures

The elimination o suspension of exposure to carcinogens known, such as tobacco, amines or dyes should be the main preventive measures that these patients should take. A high intake of water is also recommended for a very dilute diuresis and to avoid exposure and contact of carcinogens with the bladder.