Visible bleeding in the urine; discomfort when urinating, such as pain and burning; increased frequency or urgency to urinate are symptoms to raise the alert of possible bladder cancer, the organ that stores urine before it is eliminated from the body. During urination, the bladder muscles contract and urine is passed through the urethra.
“Even in the early stages, this type of tumor can already cause some symptoms. The main symptom of the disease is visible bleeding in the urine, so it’s that patient who comes to the office saying that he saw blood in the urine, which we call hematuria. Another indication is discomfort when urinating. Changes such as urgency to urinate or increased urinary frequency are also symptoms that we should investigate”, warns urologist Rafael Ribeiro Meduna, a member of the board of the Brazilian Society of Urology of São Paulo.
In more advanced cases of the disease, symptoms such as weight loss, tiredness, weakness, loss of appetite, bone pain and inability to urinate may occur. However, these symptoms are also common in other conditions such as urinary tract infection, benign prostate enlargement, overactive bladder, and kidney and bladder stones.
“It’s important to remember that these symptoms don’t mean you have a bladder tumor. There are other diseases that are even a little more common than bladder cancer, which also cause symptoms such as an enlarged benign prostate, a urinary tract infection, bladder stones and even an overactive bladder.”
Awareness
July is marked by the awareness campaign for early diagnosis and treatment of bladder cancer. The month is dedicated to the campaign so that people, with or without a history of the disease in the family, start to seek medical advice and follow-up, in addition to performing periodic exams.
The drop in the number of diagnoses worries specialists. This is because, with the pandemic, many patients stopped performing routine exams. To measure the size of the damage caused by the pandemic in the diagnosis of new cases of cancer, the Brazilian Society of Urology (São Paulo section) carried out a survey in partnership with health institutions in the State of São Paulo, responsible for the care of patients in the Unified System of Health (SUS).
The results showed that the pandemic generated an average reduction of 26% in the number of new cases, encompassing kidney, prostate and bladder tumors, compared to diagnoses made in 2019 and 2020.
The Hospital das Clínicas of the State University of Campinas (Unicamp), for example, observed a drop of 52% in cases of bladder cancer and 63% in kidney cancer. Hospital AC Camargo Cancer Center said the reduction was 24% for bladder tumors and 29% for kidney tumors. Data for kidney cancer from the Hospital São Paulo of the Federal University of São Paulo (Unifesp) showed a reduction in the diagnosis of new cases of 35% – 40 cases were computed in 2019, against 26 in 2020.
“With the whole issue of the pandemic, there was a great fear of the population, in addition to the guidance of health institutions so that there was social distance. As a result, there was a significant reduction in the number of medical consultations, evaluations, exams and consequently there was a decrease in diagnoses”, regrets the doctor.
According to the National Cancer Institute José Alencar Gomes da Silva (Inca), the number of new cases of bladder cancer, estimated in 2022 for Brazil, is 7,590 cases in men and 3,050 in women.
Risk factors
The main risk factor for developing the disease is smoking, responsible for about 50% of cases. The risk is directly related to the duration and intensity of smoking.
“Cigarettes contain several chemical substances that are carcinogenic, that is, they induce the appearance of a tumor and in the specific case of the bladder, after these substances are inhaled, they are absorbed by the lung and will fall into the bloodstream and then will be filtered by the kidney. It will produce urine, as if it were contaminated with these chemicals, and then it will be stored in the bladder, which is a urine reservoir. These chemical substances will spend hours there in the bladder, causing an aggression to the vesical surface, which will provide an environment to be able to develop a tumor in the patient”, explains Meduna.
Even people who don’t smoke but live with someone who smokes, called passive smoking, also have an increased risk of bladder cancer. Other associated factors, but to a lesser extent, are prolonged occupational exposure to chemicals called aromatic amines that can be carcinogenic (especially in industries that process paints, dyes and petroleum derivatives) and chronic bladder irritation, such as infections and stones.
The main prevention for bladder cancer is not smoking. Workers, who are in daily contact with chemicals, must wear personal protective equipment for greater safety during work. Healthy lifestyle habits, proper nutrition, physical exercise are also a form of prevention.
treatments
In addition to the physical examination and analysis of the clinical history, to make a more accurate diagnosis, the doctor may order some imaging tests (ultrasound, computed tomography or magnetic resonance).
The most important diagnostic test for evaluating bladder cancer is cystoscopy. With this exam, the doctor can evaluate the inside of the patient’s bladder with a camera. Bladder cancer treatment is indicated according to the degree of disease, depth of tumor invasion of the bladder wall, and whether it invades other organs.
In the case of early tumors, the treatment performed is transurethral resection of the bladder, known as “bladder scraping”. In some cases, this treatment may be associated with the application of drugs such as BCG, chemotherapy or immunotherapy into the bladder.
“The onco BCG is an immunotherapy that aims to create, with the immune system, conditions to reduce the recurrence and progression of the tumor. It is important to remember that this treatment is not suitable for everyone, so it will depend a lot on the stage of the disease. That’s why it’s important, whenever you have this diagnosis, to consult specialists to evaluate the best treatment for each patient”, emphasizes the urologist.
In tumors that invade the bladder muscles, radical cystectomy (removal of the entire bladder) is the most appropriate form of treatment, which may be preceded by chemotherapy in some situations. As an alternative treatment to total bladder removal, a combination of bladder scraping, chemotherapy and radiation therapy may be used.
In general, this alternative treatment is intended for patients with many health problems who are unable to perform the complete removal of the bladder. In the case of more advanced tumors with the presence of metastases (invasion of other organs), the most appropriate treatment is chemotherapy or immunotherapy. “The recommendation is still valid: the sooner the problem is diagnosed, the more chances of cure the patient will have”, concludes the specialist.
