Bladder cancer is definitely a male disease. In women, however, its diagnosis is more difficult, which postpones the implementation of appropriate treatment. Marcelina Dzięciołowska talks about bladder cancer with urologist Stanisław Szempliński from the European He alth Center in Otwock.
Marcelina Dzięciołowska: Doctor, bladder cancer affects both women and men, although women are much less common - is it true?
Dr. Stanisław Szempliński:Yes, definitely less often. About 7 percent are ill. men and about 2 percent. women. Looking at it differently, it is the fourth malignant neoplasm that occurs in men. It is preceded by lung cancer, prostate cancer and colon cancer. In women, this cancer ranks 14th.
Does this mean that the ladies are more secure?
Not really, unfortunately women are more often diagnosed with more advanced cancers. This is because in women, the symptom related to blood in the urine or genital tract is either not that alarming or it does not appear to be so alarming. Women who are used to monthly bleeding often underestimate hematuria. That is why they later visit urologists or gynecologists for diagnosis. Despite the fact that this cancer is more common in men, ladies should also be alert.
Does genetics matter in bladder cancer?
There are no hard data to confirm that in a wider population there is no familial bladder cancer, but there are other factors that are clearly associated with the incidence of this cancer.
What are these factors?
The first is cigarette smoking - both active and passive. It is much more common in smokers - this is the first and main risk factor!
And the others?
Another factor that may contribute to the occurrence of this cancer is work, mainly in the rubber and chemical industries. There, compounds are released that are inhaled by workers and can cause this type of cancer. In modern branches of this industry, when the principles of occupational he alth and safety are followed,in these endangered conditions, workers wear masks, and fewer and fewer of these neoplasms are observed. Nevertheless, we do have patients whose bladder cancer incidence can be related to labor factors.
You mentioned hematuria - are there any other symptoms that should light a lamp in your head and signal that this is the time to get tested?
It must be emphasized that blood in the urine is by far the most common symptom of bladder cancer. Each hematuria should be clarified and decided whether it is caused by a tumor of the bladder or upper urinary tract or if it has some common cause.
What symptoms are less frequent?
Pain while urinating, as well as burning sensation and discomfort, which were not there before, are much less common symptoms. The third symptom that is very rare is urinary retention, which is the inability to pass urine. However, in 70 percent. of cases it is hematuria.
What tests can diagnose a bladder tumor?
Fortunately, this basic diagnostics is not particularly sophisticated. A normal ultrasound scan with a full bladder shows most lesions that are more than 5 millimeters in diameter. Most of the bladder tumors that are significant in terms of size can be detected by ultrasound. This is, of course, a preliminary study.
What other tests are performed to diagnose bladder cancer?
In addition, we perform a cytology test of urine sediment - it is a test in which the urinated urine must first be centrifuged, and then cancer cells are searched for in it. The examination that verifies and confirms the diagnosis is cystoscopy with specimen collection for histopathological examination.
To sum up - there are three studies that give a complete picture of the situation.
Normal diagnostic mode for a patient with suspected bladder tumor includes ultrasound, cytology of urine sediment, and if the lesion is greater than 3 centimeters, it is also extended to computed tomography. Magnetic resonance imaging is also performed more and more frequently. This examination very well assesses the depth of the tumor's infiltration into the bladder wall and assesses the lymph nodes and what the upper urinary tract looks like. These imaging studies make this possible.
What next?
With such examinations, the patient goes to the hospital, where a cystoscopy is performed. Sometimes, if we are sure that there is a tumor in the bladder, we immediately decide to perform pre-urethral resection of the bladder tumor. During thisDuring the procedure, specimens are taken from the tumor and most often the entire tumor is excised at the same time. Then the specimens are sent for histopathological examination.
On this basis, the histopathologist determines whether the tumor is cancerous or malignant, and if so, to what stage it is and how deeply it penetrates the bladder wall. The further treatment depends on this information.
Conversations with doctors show that even such distinct symptoms as hematuria, which are hard to overlook, are not a sufficient signal for many men to be examined. Do men really ignore the basic symptoms and go to the urologist when the symptoms are already bothersome?
This question is very legitimate and worth emphasizing, especially in the context of the campaign to raise awareness about men's he alth. It's hard to make a big generalization, but men are not used to paying attention to their he alth. Whether it is due to upbringing or embarrassment in front of the doctor - I do not know. However, those who are aware of the passage of time and the risks associated with the fact that they live in a polluted environment, that they use a diet saturated with chemical preservatives, and there are also various stimulants - some of these men read and are aware that that she should be tested and that is what she does.
And the second part?
The latter - perhaps a larger group of men disregard the symptoms. Such patients often enter the office and say that they have never visited a doctor and treat it as a kind of pride and advantage. The truth is, however, that such patients, despite the apparent feeling of full he alth, often receive treatment, or should be treated, for high blood pressure, diabetes and other conditions that they ignore.
Is there any bladder cancer prevention? Is it valid?
Research, panels and discussions on this topic prove that this research doesn't make much sense. It would be enough to sensitize patients that when blood appears in the urine, it is absolutely necessary to see a doctor. Timely initiated diagnostics lead to prompt diagnosis and urological intervention. In the initial stage of the disease, we are able to heal most of the patients.
Has there been any recent revolutions in the treatment of bladder cancer?
Treatment for bladder cancer changes over the years. There are new drugs, better diagnostics. Ultrasound machines are available in virtually every urology and he alth care clinics, so these neoplasms can be easily detected. Detecting and controlling is also getting easier. In the case of tumorsfor non-advanced patients, regular cystoscopes are used, which were once associated with pain during the examination.
What does it look like today?
Currently, flexible cystoscopes are used, which allows for comfortable performance of this examination in clinics without pain.
What else?
There are newer and newer chemical drugs in the treatment of this type of cancer. Until now, preoperative chemotherapy relied on cisplatin - an old cancer drug used in chemotherapy. A new drug has been introduced for some time - pembrolizumab, which has good effects of chemical treatment and gives a much better prognosis, we see a beautiful response to treatment with these drugs.
And the operation?
Even this large operation with excision of the bladder, i.e. radical cystectomy has also changed significantly. In many places, it can be performed laparoscopically, which translates into a shorter stay in the hospital and less pain, faster possibility of mobilizing the patient after surgery. In some patients, a substitute bladder can be made from the intestine. Patients in whom we do not do this have the so-called a urostomy, i.e. they have an implanted ureters to the skin or such a pocket from the intestine for urine.
How do patients react to it?
It has its good and bad sides, but it certainly changes the patient's perception of himself as a human being, his body. This is not immediately accepted. In some patients, however, a substitute intestinal bladder can be made, which means that the perception of one's own body is undisturbed and the person feels that he is the same person as before the surgery. It is a difficult and demanding operation that we also perform in Poland.
No major breakthrough in the treatment of bladder cancer has been made in recent times, but small steps are being taken to reduce mortality and help patients stay in better shape and live longer.
Technological progress creeps faster into some branches of medicine and slower to others, but it is still progress that increases possibilities and gives more opportunities.
Definitely yes.
What would you like to say to people who are afraid of research?
First of all, bladder cancer is a serious disease and should be avoided. Do not smoke cigarettes, see a urologist when you find hematuria! Performing basic research is neither painful nor tedious! There is really no need to be afraid of having an ultrasound or passing urine for examination. Further procedures that are already taking place in the hospital are performed under anesthesia and are also absolutely acceptable.Disregarding the symptoms and postponing the visit to the urologist most often leads to delayed diagnosis and, consequently, to a worse prognosis!
Expert
Stanisław Szempliński, MD, PhD, FEBU - Deputy Head of the Urology Department of the European He alth Center Otwock, II Urology Clinic of the Postgraduate Medical Center. A graduate of the Medical Academy in Warsaw. He obtained the title of specialist urologist, FEBU (Fellow of European Board of Urology) in 2008 at the Urology Clinic of the Medical Center of Postgraduate Education in Warsaw. The doctoral thesis en titled: "Critical evaluation of the own prostate mapping biopsy scheme in men whose cancer is suspected only due to an increase in the concentration of PSA in the blood serum", was awarded the prestigious prof. Tadeusz Krzeski, for the best thesis defended in 2010. He has participated in numerous domestic and foreign courses, incl. at the Sorbonne in Paris at the Pitié-Salpétrière Hospital Urology Clinic under the supervision of prof. Pierre Mozer. In the years 2011-2013 he was the deputy head of the Urology Department at the Międzyleski Specialist Hospital in Warsaw, and from 2013 to 2016 he was the head of the Clinical Department of Urology at the Independent Public Clinical Hospital. prof. W. Orłowski. Since December 2016, he has been associated with the European He alth Center in Otwock. He is a member of the Polish and European Association of Urology. From 2022, he is also an examiner of the PTU (Polish Society of Urology). He is an assistant professor in the Second Department of Urology at the CMKP. He conducts specialization courses for doctors specializing in urology. He is the author of numerous scientific works. In 2016, he performed the first fusion biopsy of the prostate gland in Poland using a set for flexible fusion of magnetic resonance and ultrasound images. In 2022, he was appointed the Deputy Head of the Urology Department of the European He alth Center in Otwock. He specializes in the qualification and performance of fusion biopsy of the prostate gland, laparoscopic treatment of prostate cancer, laser enucleation of prostate adenoma and HIFU (focal therapy of small neoplastic lesions of this gland). He also performs radical excision of the urinary bladder to create a substitute intestinal bladder. For urologists, he conducts practical workshops on fusion biopsy and laparoscopic techniques. Privately, he is passionate about sailing and skiing.