Bladder cancer (CaB)

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bladder cancer

What is it?

O bladder cancer (CaB) presents as an expansive lesion in the bladder. In 90% of cases, bladder neoplasms present as urothelial carcinomas. Thus, 70% of cases are represented by non-muscle invasive carcinoma (pTa, pT1 and CIS) and in the others by invasive muscle carcinoma (pT2, pT3 and pT4).

Symptoms of Bladder Cancer

The main symptom of CaB is the bleeding in the urine - hematuria. Usually, hematuria presents clots of intermittent and painless onset, however, it is important to note that their disappearance does not rule out the possibility of CaB.

Other symptoms may also be associated, such as the presence of urinary tract infection or urinary obstruction caused by prostatic growth. In men, enlargement of the prostate gland can obstruct the urethra passing through the prostate. As a result, this obstruction can cause weakened voiding fluid, difficulty in starting the jet, interrupted urination and incomplete bladder emptying. In such cases, it is common for the patient to wake up at night to urinate.

Patients with irritative urinary symptoms who do not present urinary tract infection, may be with carcinoma on-site (CIS). This diagnosis is extremely important as this lesion may develop into invasive bladder carcinoma. Therefore, patients with muscle-invasive cancer may present the disease at a distance (metastasis). Therefore, these patients present with presenting symptoms, such as pain due to the expansive effect and general systemic symptoms, such as loss of appetite, weight and anemia.

Risk factors

The most important is smoking, which occurs in 70% of cases - smokers present a risk between 3 and 4 times greater than non-smokers. This risk increases with the number of cigarettes consumed, duration of smoking and degree of inhalation. In addition, the other risk factors are caused by occupational activities that require contact with aromatic amines, anilines, dyes, rubber, solvents, petroleum derivatives, besides the use of drugs such as phenacetin, cyclophosphamide and radiotherapy.

The disease can also occur in people with chronic urinary tract infection, calculus or foreign body of the bladder, cystitis Schistosoma hematobium, congenital diseases such as urachal persistence and bladder exstrophy, pelvic and ureter tumors. The most frequent mutations occur in certain genes, such as: p53, RB1, PTEN and repair genes. Therefore, the risk increases significantly in cases where the association of multiple factors exists.

Diagnosis

Diagnosis is usually initiated after the onset of hematuria, but should be preventive in patients who have contact with carcinogens to the urothelium. Imaging tests can diagnose bladder injury, such as ultrasonography, tomography, and resonance imaging. These tests assess the extent of locoregional disease and the body. Thus, it is called the extent of disease by the staging body of the disease. Histological diagnosis is confirmed by cystoscopy with biopsy of the tumor, suspected urothelium or endoscopic tumor resection.

Treatment bladder cancer

Patients with invasive non-muscle tumor are treated by endoscopic tumor resection. In this surgery, an endoscopic device is used to reach the bladder via the urethral pathway and remove the tumor with a loop that cuts into small fragments. It's the call endoscopic resection of the prostate. The advantage of this surgery is that, practically, it does not cause complications. Therefore, according to the clinical history and the anatomopathological result, if the invasion of the bladder muscle is not confirmed, the patient is considered to have non-muscle invasive disease. Therefore, you may receive intravesical, chemotherapeutic or immunotherapeutic (lyophilized BCG) treatment.

Muscle-invasive tumor carriers are partially treated by endoscopic resection to confirm histological diagnosis and muscle invasion. Depending on the extent of the disease, these patients may undergo neoadjuvant chemotherapy (preoperative) or radical cystectomy (surgery in which the bladder and neighboring organs are resected in monoblock) associated with extended pelvic lymphadenectomy.

Reconstruction of the urinary tract can be done by incontinent shunt (definitive urostomy pouch placed in the abdomen) or by the construction of an orthotopic reservoir, ileal neobediga. Some patients may undergo adjuvant (postoperative) chemotherapy.

Prevention of Bladder Cancer

A prevention is performed with monitoring of high risk patients by contact with potentially carcinogenic substances to the urothelium. These workers should wear contact protection with these substances, both for the skin and for the respiratory and digestive tract. Smoking is a stimulant of urothelial changes, including the initiators of the neoplasia.

Patients with known risk factors should urinate freely and without post-void residue. Urine contains carcinogens that stimulate chronic urothelial changes that predispose the onset of neoplasia. Therefore, one should combat LUTS, whether with medication or prostate surgery. Residual urine after urination can not be allowed and if diagnosed should be resolved. Urine stimulates changes in the urothelium that cause cancer.

Basic Food Measures

Patients with CaB should be instructed to drink plenty of fluids to urinate frequently (less contact of the urothelium with carcinogens). In addition, you should avoid spicy, canned foods and preferably, consume food without pesticides. They should also maintain a balanced diet, with many green, low-fat, low-calorie fruits and vegetables. Moreover, they should ingest supplemental doses of vitamins, green tea and foods containing lactobacilli.

However, if you would like to know more about this and other diseases of the genitourinary tract, access our content area for patients to understand and gain knowledge. Culture always makes a difference. You will be surprised! In it you can choose the subject you are interested to know. Select what you are looking for.

Reference

https://www.auanet.org/guidelines/bladder-cancer-non-muscle-invasive-guideline

https://www.auanet.org/guidelines/bladder-cancer-non-metastatic-muscle-invasive-guideline

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