In total, about 2100 new cases are estimated each year in our country. Bladder cancer is a neoplastic disease that results from uncontrolled growth of the 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 the time of diagnosis, that is, without invasion of the bladder wall”, explains Cátia Faustino, oncologist at IPO-Porto and member of the board of directors of the Portuguese Society of Oncology.
There are several possible symptoms of bladder cancer, but not being specific to the disease, they can easily be mistaken for another clinical condition. “Hematuria, i.e. loss of blood through urine, is the most common symptom, but it can also occur in mild situations such as a urinary tract infection or kidney stones” , explains Cátia Faustino. However, he warns, this symptom must serve as a warning and be properly assessed 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 while urinating, or weak urinary stream. Although these complaints are associated with benign clinical conditions, they should be properly assessed. It is essential not to ignore suspicious signals.
But after all, who are the people who should pay more attention 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”, emphasizes the oncologist. “About half of all cases of bladder cancer are due to tobacco,” he adds. There are other non-modifiable risk factors, such as age, where the risk increases with age, or gender, with bladder cancer being more common in men. Regarding 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, certain additional diagnostic tests are requested, such as urinalysis, 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 on this examination, the patient will undergo surgery (endoscopic resection) to remove this lesion, the analysis of which will determine if it is bladder cancer, “explains the oncologist Other tests that may be needed 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 marked improvement in the prognosis of patients. “However, unlike screening for breast cancer or colorectal cancer, which are well established, current scientific evidence is insufficient to recommend routine, population-based screening for bladder cancer in asymptomatic adults, given the benefit versus possible damage. Cátia Faustino’s explanation is easy to understand. “If, on the one hand, the impact on survival of the use of possible screening tests (such as summary urine analysis or urinary cytology) for bladder cancer has not been demonstrated in people with no symptoms or history of bladder cancer, on the other hand On the other hand, a false positive result is potentially conducive to anxiety, anguish and can lead to futile invasive tests, which can lead to 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 radiation therapy. The prognosis is associated with the stage of the disease at which the diagnosis is made. “In superficial bladder tumours, which are the majority of cases, the success rate is high. In the case of metastatic disease, that is to say when the malignant cells have already spread to other parts of the body, the treatment is not curative and the prognosis is more guarded, although it There are currently treatment options that have increased survival and quality of life for patients… for patients,” explains the oncologist.
Raising awareness and alerting
Awareness 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 awareness of the signs and symptoms, as well as reinforce information on risk factors, such as smoking,” explains Cátia Faustino. . . These campaigns are fundamental to demystifying the disease in society, he stresses, “resulting in a positive impact on the lives of bladder cancer patients”. On the other hand, “they contribute to health literacy, encourage the reduction of harmful exposures and anticipate earlier diagnoses in the presence of suspicious symptoms”.
Cancer patients’ associations offer their own space for sharing experiences and experiences, which “allows cancer patients and survivors to create networks of support and mutual aid and to feel that they are not alone or alone in the face of the challenges of the disease. The synergy between the medical and scientific community, patients and their families and civil society is an essential summit to gradually break down the taboos still so deeply rooted and associated with oncological diseases”, concludes Cátia Faustino.