Bladder cancer: accurate diagnosis and treatment that preserves quality of life

Diagnosis, cystoscopy, intravesical chemotherapy and surgery for bladder cancer in São Paulo

Bladder cancer - Overview

Bladder cancer is the second most common malignant tumor of the urinary system, second only to prostate cancer.

The most common symptoms are: burning on urination, blood in the urine, lower abdominal pain and weight loss. However, most cases are diagnosed at early stages and without symptoms.

The main risk factors for bladder cancer are:

• Smoking
• Chronic exposure to petroleum derivatives
• Chronic urinary tract infections
• Radiation therapy to the pelvic region
• etc.

Diagnosis can be made with imaging tests, urine testing for cancer cells or an endoscopic examination of the bladder. A biopsy is needed to identify the tumor type, aggressiveness and depth of invasion.

Treatment depends on the number of lesions, their aggressiveness and the stage at which the disease was detected.

Endoscopic removal of all lesions may be combined with instillation of an immunotherapy agent (BCG) into the bladder to reduce the risk of recurrence.

When the tumor has already invaded the bladder muscle, complete removal of the organ may be recommended, together with reconstruction of the urinary tract.

Clínica Uro Onco has a team of specialists and an integrated care team dedicated to the prevention, diagnosis and treatment of men and women fighting bladder cancer.

If you are looking for information about bladder cancer, you are in the right place! Here on our website, we have a complete YouTube playlist with explanatory and informative videos on the subject.

Bladder cancer is a type of cancer that affects the bladder, an organ of the urinary system that stores urine until it is eliminated from the body. Bladder cancer can be aggressive, but it can be treated successfully if detected early.

Our complete YouTube playlist was created to answer questions and provide accurate information about bladder cancer. In it, you will find videos on the symptoms, risk factors, treatment options and prevention of this type of cancer.

Don’t wait any longer — visit our complete YouTube playlist now. Stay informed about everything you need to know about bladder cancer and improve your chances of preventing or treating this type of cancer. Don’t put it off: open our playlist now and stay informed!

Calculate your risk of bladder cancer recurrence

What is recovery like after TURBT?

Recovery after transurethral resection of a bladder tumor (TURBT) may vary depending on the size and location of the abnormal tissue removed, as well as the patient’s overall health. In general, patients can expect a relatively quick recovery after TURBT.

After the procedure, the patient may need to stay in the hospital for a short time to recover from anesthesia and to make sure the bladder is working properly. The doctor may prescribe medication to help relieve pain and other uncomfortable symptoms.

During recovery, the patient may need to follow some special instructions, such as:

• Drinking plenty of fluids to help flush the bladder and prevent urinary tract infections
• Avoiding strenuous activity for a period determined by the doctor
• Using a temporary urinary catheter to drain the bladder until it is working normally again

In general, most patients can return to normal activities a few days after TURBT, but it may take a few weeks for the bladder to fully return to normal function. It is important to follow the doctor’s instructions and to contact the doctor if any problem or uncomfortable symptoms arise during recovery.

Treatment options for bladder cancer

Transurethral resection of bladder tumor (TURBT) is a surgical procedure performed to remove tumors or other abnormal growths from the bladder. During TURBT, the surgeon inserts an instrument called a cystoscope through the urethra (the tube that carries urine from the bladder out of the body) and removes the abnormal tissue. TURBT is usually performed under general or regional anesthesia and is a relatively simple procedure that takes about an hour or less.

Radical cystectomy is a more invasive surgical procedure that involves removing the entire bladder as well as other nearby organs, such as the cervix and the pelvic lymph nodes. Radical cystectomy is usually performed in more advanced cases of bladder cancer and may be followed by radiation therapy or chemotherapy to reduce the risk of cancer recurrence.

Chemotherapy is a type of treatment that uses drugs to kill cancer cells or inhibit their growth. It can be given orally or intravenously and is usually used together with other treatments, such as surgery or radiation therapy. Chemotherapy may be needed to treat advanced bladder cancer or to reduce the risk of cancer recurrence after surgery.

Immunotherapy is a type of treatment that uses the patient’s own immune system to fight cancer. It can be given intravenously or by injection under the skin and is usually used together with other treatments, such as surgery or radiation therapy. Immunotherapy can be effective in treating advanced bladder cancer or in reducing the risk of cancer recurrence after surgery.

Is there an alternative to radical cystectomy that avoids removing the bladder in patients with cancer?

Radical cystectomy is a surgery that removes the bladder and part of the urinary tract in patients with bladder cancer. Some alternative treatment options may be considered in certain situations, such as radiation therapy, chemotherapy and immunotherapy. However, every case is unique, and the ideal treatment depends on many factors, including the type and stage of the cancer, the patient’s overall health and other factors.

Radiation therapy is a treatment that uses ionizing radiation to destroy cancer cells. It may be a treatment option for bladder cancer patients who cannot tolerate surgery or for those with advanced bladder cancer that cannot be removed surgically.

Chemotherapy is a treatment that uses drugs to kill cancer cells. It can be given inside the bladder or intravenously and can be used alone or in combination with other treatments, such as radiation therapy.

Chemotherapy may be an option for patients with advanced or recurrent bladder cancer that does not respond well to surgery or radiation therapy.

Immunotherapy is a type of treatment that uses the body’s immune system to fight cancer. It can be given orally or intravenously and can be used alone or in combination with other treatments. Immunotherapy may be an option for patients with advanced or recurrent bladder cancer that does not respond well to surgery, radiation therapy or chemotherapy.

It is important to remember that every case is unique and the ideal treatment depends on many factors. Patients should discuss treatment options with their doctor to determine the best treatment plan for their specific case. (1–14)

1. Matulay JT, Kamat AM. Advances in risk stratification of bladder cancer to guide personalized medicine. F1000Research. 2018;7:F1000 Faculty Rev-1137.

2. Nazzani S, Mazzone E, Preisser F, Bandini M, Tian Z, Marchioni M, et al. Comparison of Perioperative Outcomes Between Open and Robotic Radical Cystectomy: A Population-Based Analysis. J Endourol. August 2018;32(8):701–9.

3. Robertson AG, Kim J, Al-Ahmadie H, Bellmunt J, Guo G, Cherniack AD, et al. Comprehensive Molecular Characterization of Muscle-Invasive Bladder Cancer. Cell. October 2017;171(3):540-556.e25.

4. Kamat AM, Sylvester RJ, Böhle A, Palou J, Lamm DL, Brausi M, et al. Definitions, End Points, and Clinical Trial Designs for Non–Muscle-Invasive Bladder Cancer: Recommendations From the International Bladder Cancer Group. J Clin Oncol. June 1, 2016;34(16):1935–44.

5. Peyton CC, Tang D, Reich RR, Azizi M, Chipollini J, Pow-Sang JM, et al. Downstaging and Survival Outcomes Associated With Neoadjuvant Chemotherapy Regimens Among Patients Treated With Cystectomy for Muscle-Invasive Bladder Cancer. JAMA Oncol. November 1, 2018;4(11):1535.

6. Steinberg G, Bahnson R, Brosman S, Middleton R, Wajsman Z, Wehle M. Efficacy and safety of valrubicin for the treatment of Bacillus Calmette-Guerin refractory carcinoma in situ of the bladder. The Valrubicin Study Group. J Urol. March 2000;163(3):761–7.

7. Oddens J, Brausi M, Sylvester R, Bono A, van de Beek C, van Andel G, et al. Final Results of an EORTC-GU Cancers Group Randomized Study of Maintenance Bacillus Calmette-Guérin in Intermediate- and High-risk Ta, T1 Papillary Carcinoma of the Urinary Bladder: One-third Dose Versus Full Dose and 1 Year Versus 3 Years of Maintenance. Eur Urol. March 2013;63(3):462–72.

8. Cauberg ECC, Kloen S, Visser M, de la Rosette JJMCH, Babjuk M, Soukup V, et al. Narrow Band Imaging Cystoscopy Improves the Detection of Non–muscle-invasive Bladder Cancer. Urology. September 2010;76(3):658–63.

9. Grossman HB, Speights VO. Neoadjuvant Chemotherapy plus Cystectomy Compared with Cystectomy Alone for Locally Advanced Bladder Cancer. N Engl J Med. 2003;8.

10. Necchi A, Anichini A, Raggi D, Briganti A, Massa S, Lucianò R, et al. Pembrolizumab as Neoadjuvant Therapy Before Radical Cystectomy in Patients With Muscle-Invasive Urothelial Bladder Carcinoma (PURE-01): An Open-Label, Single-Arm, Phase II Study. J Clin Oncol. December 2018;36(34):3353–60.

11. Yoshida T, Kates M, Fujita K, Bivalacqua TJ, McConkey DJ. Predictive biomarkers for drug response in bladder cancer. Int J Urol [Internet]. August 2019 [cited August 5, 2019]; Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/iju.14082

12. Hautmann RE, Volkmer BG, Gust K. Quantification of the survival benefit of early versus deferred cystectomy in high-risk non-muscle invasive bladder cancer (T1 G3). World J Urol. June 2009;27(3):347–51.

13. Wan JCM. Survival Outcomes of Early versus Deferred Cystectomy for High-Grade Non-Muscle-Invasive Bladder Cancer: A Systematic Review. Curr Urol. June 2020;14(2):66–73.

14. Veskimäe E, Espinos EL, Bruins HM, Yuan Y, Sylvester R, Kamat AM, et al. What Is the Prognostic and Clinical Importance of Urothelial and Nonurothelial Histological Variants of Bladder Cancer in Predicting Oncological Outcomes in Patients with Muscle-invasive and Metastatic Bladder Cancer? A European Association of Urology Muscle Invasive and Metastatic Bladder Cancer Guidelines Panel Systematic Review. Eur Urol Oncol. October 2019;S2588931119301440.