Bladder cancer is the fourth most common urological cancer in men and the second most frequent cancer affecting the urinary tract. Bladder cancer begins when cells in the urinary bladder start to grow uncontrollably. As more cancer cells develop, they can form a tumor and spread to other areas of the body. At the time of diagnosis, 70% of patients are experiencing non-muscle-invasive bladder cancer.

STAFF

At the IEO bladder cancer is treated by a multidisciplinary team consisting of specialists in:

• Urogenital and Head and Neck Tumors Medical Treatment
• Urologic Surgery
• New Drugs and Early Drug Development for Innovative Therapies
• Department of Pathology and Laboratory Medicine
• Department of Medical Imaging and Radiation Sciences

The causes of bladder cancer are unknown, but some potential risk factors that can promote its onset can be identified:

• Smoking is the most important risk factor. The incidence of bladder cancer is directly related to the years of exposure, the number of cigarettes smoked and early age of starting smoking.
• Chronic exposure to certain substances, particularly benzene derivatives and aromatic amines can develop bladder cancer.
• Urinary schistosomiasis, a parasitic infection endemic in Africa, Asia, South America, associated with the development of squamous cell type bladder cancer.

• A high proportion of upper urinary tract urothelial carcinomas (60%) are invasive at the time of diagnosis. The diagnosis of upper urinary tract urothelial carcinomas, especially in early stages, is difficult and in many cases fortuitous. Typical bladder cancer symptoms such as hematuria and flank pain are unspecific, and a lumbar mass is only detectable in 10–20% of all cases and reflects an advanced tumor stage

Bladder cancer symptoms.

Although bladder cancer can be completely asymptomatic at onset, one bladder cancer symptom is macro-haematuria (blood in urine). In cases of suspected bladder cancer, diagnostic procedures are based on ultrasound, radiology (urography and CAT), magnetic resonance and endoscopic methods, such as cystoscopy. The latter is the introduction of a fibre optic instrument into the bladder through the urinary tract and allows evaluation of the inside of the bladder and potentially taking samples of suspicious bladder cancer for analysis. A further diagnostic aid for bladder cancer is provided by searching for bladder cancer cells in the urine sample via urinary cytology. CAT, PET and bone scintigraphy are also useful for evaluating whether the bladder cancer has spread beyond the bladder, involving other organs. 

Available surgical treatments of bladder cancer include transurethral resection (TURV), an often-decisive treatment for small non-infiltrating bladder cancer and cystectomy (removal of the organ). The therapeutic approach also includes the possibility of combined interventions employing chemotherapy and radiotherapy before, after or as an alternative to surgery with the intent of preserving the bladder in selected cases. 

Intravescical treatment with chemotherapeutic agents have high efficacy in metastatic non-infiltrating carcinoma. In advanced stage bladder cancer, the therapeutic approach is polychemotherapy with the aid of several drugs.