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Bladder cancer

Bladder cancer

Bladder cancer is the 2nd most common cancer of the urinary system, after prostate cancer. In men, it is 4 times more common than in women. Due to high risk of recurrence, regular lifelong review with ultrasound and cystoscopy is necessary. In aggressive stages random biopsies and CT scan are needed.

Causes - risk factors

There is no clear etiology. However, there are some risk factors that increase the chances of its occurrence such as:

  • Smoking: it is the most common risk factor and affects at least 80% of cases, also presenting a high rate of recurrence.
  • Occupational exposure to chemicals (paints, plastics, leather, printers and hair products) accounts for 10% of all cases.
  • Other risk factors: radiation, chronic bladder infection, chemotherapy with cyclophosphamide.


Painless gross or microscopic hematuria is the most common symptom of the disease. Remarkable is the fact that even a single episode of hematuria, without any recurrence, can hide bladder cancer. Other less common symptoms of the disease are painful urination, frequency, urgency, weakness and weight loss.

Diagnosis and Staging

Diagnosis is made by cystoscopy and Bladder Biopsy. If the disease is diagnosed, it is very important to perform staging with CT scan and bone scanning to investigate metastatic disease. Bladder cancer is staged as:

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The type of treatment depends on the stage of the disease and the general condition of health of the patient.

  • Surgical removal (TURBT): tumor(s) removal and cauterization.
  • Intravesical immunotherapy with BCG: a Tiemman catheter is inserted and the doctor injects weakened BCG bacterial strains into the bladder, which kill cancer cells.
  • Intravesical chemotherapy: It is done in the same way as immunotherapy, but with fewer and milder side effects. A single injection (within 24 hours) after transurethral resection of the tumor(s) reduces the recurrence rate by destroying tumor cells floating in the bladder, thereby preventing their implantation in areas of injured urothelium.
  • Radical cystectomy: complete removal of the bladder, lymph nodes, as well as the prostate with the seminal vesicles in men, while the uterus, appendages and part of the vagina in women. It is a severe operation with many days of hospitalization. Afterwards, a stoma is placed or we create a new cyst from a part of the small intestine (neocyst).
  • Systemic chemotherapy: given in metastatic disease or in some cases, before surgery. In general, it does not have a very significant contribution to the patient's survival.
  • Chemotherapy combined with radiation: applied to patients who refuse or whose general condition does not allow them to undergo cystectomy.