When bladder cancer makes no noise

«Bladder cancer is the fifth most common cancer in Italy and, among men, it is the fourth most frequent cancer. About 30,000 people a year are affected by this disease», says Dr. Cinzia Ortega, Director of the Complex Oncology Unit at the Michele and Pietro Ferrero Hospital in Verduno.

This type of cancer originates in the urothelium, the layer of cells lining the inside of the bladder. In its early stages, it can develop silently, without obvious symptoms, and it mainly affects people around the ages of 65–70. At this age, aging and the accumulation of risk factors over time, such as smoking and certain toxic exposures, increase the likelihood of developing the disease. «Men are the most affected: the male-to-female ratio is about four to one. However, in recent years there has been a slight increase in incidence among women due to factors such as aging, lifestyle habits, and especially smoking. In women, smoking is a somewhat more significant risk factor because, at a young age, some girls take up the habit of smoking».

Warning signs of bladder cancer

Bladder cancer is often underestimated because the initial symptoms are vague and easily misinterpreted.

The presence of small traces of blood in the urine or sporadic episodes may go unnoticed, as can burning or discomfort during urination, symptoms that are often confused with common conditions such as cystitis. «When these signs are not recognised at an early stage, that is where the problem lies. The diagnosis, in fact, will come late, when much more significant symptoms have appeared, symptoms that do not regress and instead negatively impact quality of life and daily activities». One of the most important signs of bladder cancer is the presence of blood in the urine, which may make the urine slightly pink. However, blood is not always visible to the naked eye and may only be detected through routine laboratory tests, such as urinalysis, followed by further investigations like urine cytology. These tests can identify the presence of altered urothelial cells and then, with subsequent examinations, allow suspicious lesions to be detected at an early stage.

Not to be forgotten are «persistent irritative symptoms, or that do not resolve after treatment, for example with a urinary tract disinfectant, and that persist over time and therefore require further investigation».

Risk factors

The main risk factor is smoking, due to all the toxic substances in cigarettes that are deposited in the bladder with the urine, causing significant local inflammation that persists over time. This «can predispose to the development of tumours inside the bladder, at the level of the inner bladder wall, the urothelium».

Another risk factor involves exposure to chemical substances such as aromatic amines, «which in the past were mainly present in companies dealing with dyes, rubber, leather, and in textile and metallurgical industries». Today, working conditions have changed significantly thanks to protective measures, but many elderly people may still develop the disease as a result of past exposures that were neither recognised nor adequately protected against.

Prevention remains fundamental. «Reducing cigarette smoking or eliminating it altogether. Drinking water frequently because, by stimulating diuresis, it cleanses the bladder wall and prevents toxic substances from remaining inside the bladder».

A multidisciplinary approach to bladder cancer

Today, the management of bladder cancer is based on a multidisciplinary approach, involving different specialists to optimise diagnosis and treatment and improve patients’ life expectancy.

«From a diagnostic point of view, we have a whole series of tests that allow us to reach a diagnosis and then structure the diagnostic and therapeutic pathway for our patient. There are non-invasive tests such as urine cytology».

If tumour cells with particular alterations are detected, a second step is taken. «An abdominal ultrasound is performed to assess whether there are problems at the bladder level. Usually, if growths are observed inside the bladder or ultrasound images are not convincing, second-level tests are carried out, such as cystoscopy. That is, the bladder is examined using optical fibres and, if necessary, a small sample of suspicious tissue is taken. In this way, a diagnosis can be reached: non–muscle-invasive cancer, which can be resected and then treated with local intravesical therapies to reduce the risk of recurrence, or muscle-invasive cancer, which requires a much more aggressive treatment».

In the latter case, when the tumour infiltrates the bladder muscle, the strategy changes. Treatment often begins with preoperative medical therapy, such as chemotherapy or immunotherapy, followed by the actual surgical procedure, «which usually involves removal of the bladder and the creation of specific urinary diversions depending on the patient».

Based on the patient’s characteristics, the type of tumour, and its stage, the urologist chooses the most suitable solution. «In cases of more localised tumours, it is possible to reconstruct a neobladder, avoiding the need for an external bag to collect urine that protrudes from the abdomen. The major issue with these procedures is the possible need for an external urinary diversion».

Managing one’s health: prevention and monitoring

Beyond diagnosis and surgical treatments, there are concrete strategies that every patient can adopt to reduce the risk of recurrence and to monitor their health effectively.Certain behaviors and warning signs should be considered a priority, as they have a direct impact on disease progression and the possibility of timely intervention. «Stop smoking. Quitting smoking is extremely important. Do not ignore the presence of blood or pink-colored urine. Stay hydrated, drinking plenty of fluids is essential. Undergo check-ups if a symptom appears that we do not understand. Any symptom that is even slightly different from our usual daily life, the best choice is to consult your doctor».