Overall, around 2100 new cases are estimated annually in our country. Bladder cancer is a neoplastic disease that results from an uncontrolled growth of cells that make up the bladder. There are several types of bladder cancer, the most common being, in more than 90% of patients, urothelial carcinoma. “About 75% of patients have a superficial tumor at diagnosis, that is, without invasion of the bladder wall”, explains Cátia Faustino, an oncologist at IPO-Porto and member of the board of the Portuguese Society of Oncology.
There are several possible symptoms of bladder cancer, but being not specific to the disease, they can easily be confused with another clinical condition. “Hematuria, that is, blood loss through the urine, is the most frequent symptom, but it can also occur in benign situations such as urinary tract infection or kidney stones”, explains Cátia Faustino. However, she warns, this symptom should serve as a warning and be properly evaluated by the attending physician, who may advise the performance of other complementary diagnostic tests. Other possible complaints are urinary changes, such as increased urinary frequency, pain or burning when urinating, or weak urinary stream. Although these complaints are associated with benign clinical conditions, they must be properly evaluated. It is critical not to ignore any suspicious signals.
But after all, who are the people who should be more attentive to the warning signs? “People with risk factors, such as smoking or environmental exposure to chemicals [como por exemplo, os que são usados na indústria de corantes], with a personal history of urothelial cancer or with a known genetic predisposition”, highlights the oncologist. “About half of all bladder cancer cases stem from tobacco,” she adds. There are other non-modifiable risk factors, such as age, where the risk increases with age, or gender, as bladder cancer is more prevalent in men. With regard to genetic syndromes, Cátia Faustino highlights Lynch syndrome, in which the highest risk of developing bladder cancer is established.
How to diagnose?
After clinical suspicion by the attending physician, some complementary diagnostic tests are requested, such as urine analysis, which may include a search for malignant cells (urinary cytology). “A cystoscopy is also performed to visualize the inside of the bladder. If there is a suspicious area in this exam, the patient will undergo surgery (endoscopic resection) to remove this lesion, whose analysis will determine whether it is bladder cancer”, explains the oncologist. Other tests that may be necessary for the diagnosis and staging of the disease are CAT or MRI.
In this, as in other oncological diseases, early detection can lead to a clear improvement in the prognosis of patients. “However, unlike breast cancer or colorectal cancer screenings, which are well established, the current scientific evidence is insufficient to recommend a systematic, population-based bladder cancer screening in asymptomatic adults, having into account the benefit versus any damage.” Cátia Faustino’s explanation is easy to understand. “While, on the one hand, the impact on survival with the use of potential screening tests (such as urine summary analysis or urinary cytology) for bladder cancer has not been demonstrated in people with no symptoms or no history of bladder cancer, on the other hand, a false-positive result is a potential generator of anxiety, anguish and can lead to futile invasive tests, which can cause other complications.”
After confirmation of bladder cancer, treatment depends on the stage of the disease and may include surgery, as mentioned above, but also chemotherapy, immunotherapy or radiotherapy. The prognosis is associated with the stage of the disease at which the diagnosis is made. “In superficial bladder tumors, which are the majority of cases, the success rate is high. In the case of metastatic disease, that is, when the malignant cells have already spread to other parts of the body, the treatment is not curative and the prognosis is more reserved, although there are currently therapeutic options that have increased the survival and quality of life of patients. patients”, says the oncologist.
Raise awareness and alert
Awareness-raising campaigns, world days and months dedicated to a particular disease make it possible to reach a large number of people. In the case of bladder cancer, in particular, they can alert to the existence of the disease, “but also contribute to the awareness of the signs and symptoms, as well as reinforce information about risk factors, such as smoking”, says Cátia Faustino. . These campaigns are fundamental in demystifying the disease in society, he underlines, “translating into a positive impact on the life of patients with bladder cancer”. On the other hand, “they contribute to health literacy, encourage the reduction of harmful exposure and anticipate earlier diagnoses in the presence of suspicious symptoms”.
Cancer patient associations provide their own space for sharing experiences and experiences, which “allows cancer patients and survivors to create support and mutual help networks and feel that they are not alone or alone in facing the challenges of the disease. The synergy between the medical and scientific community, patients and their families and civil society constitutes an essential vertex for progressively breaking taboos that are still so deeply rooted and associated with oncological disease”, concludes Cátia Faustino.