Bladder tumors

It is a diagnostic technique that allows parts of the human body to be visualized on a screen and analyzed using sound waves (ultrasound) emitted by a special probe. It is a simple, noninvasive examination that is performed by placing the probe on the patient’s abdomen.

Ultrasonography makes it possible to assess size and morphology of the bladder and to reliably distinguish between benign and malignant lesions. To obtain satisfactory ultrasound images, it is necessary that the patient’s bladder be well distended and thus full of urine.

The examination is performed at the Division of Radiodiagnostics and usually takes about 10 minutes.

CT scan, a diagnostic technique that uses X-rays to create highly detailed, three-dimensional images of various areas of the body, is used to ascertain the presence of a tumor in the bladder and whether it has spread to the lymph nodes and other nearby organs (for example, in the ureters, the channels that connect the kidneys to the bladder).

The examination requires a contrast agent that is injected into the vein. It is performed on an empty stomach at the Division of Radiodiagnostics and lasts about a quarter of an hour, during which time the patient should remain as still as possible.

It is an examination that allows the urologist to directly visualize the internal structure of the bladder. Through the urethra, that is, the channel that carries urine to the outside of the body, a thin, flexible probe, equipped with a camera, is introduced into the bladder, allowing the doctor to inspect the inside of the organ and possibly even take suspicious tissue samples (biopsies) that will then be analyzed.

The examination is performed on an outpatient basis and takes only a few minutes.

Bladder cancer can present in different stages and with different characteristics that make it more or less aggressive. The accurate assessment of tumor characteristics, carried out by the anatomopathologist by means of thehistologic examination, is therefore critical to the selection of the most appropriate treatment course for the individual patient.

By microscopically examining tissues taken by means of a biopsy (outpatient or in the operating room), the anatomopathologist identifies the type of tumor: in 75% of cases, bladder cancer is superficial (urothelial carcinoma) i.e., limited to the most superficial layers of the bladder, while in 25% of cases it is infiltrating, that is, it tends to develop outside the bladder and invade other organs.

The anatomic pathologist then defines the appearance and growth pattern of the tumor (papillary or invasive) and how deep the infiltration of the disease is within the bladder mucosa. It then determines the stage and grade of the tumor.

Surgery for bladder cancer consists ofremoval of only the tumor nodule (transurethral bladder resection) in the case of superficial and early-stage cancer, orremoval of the entire bladder (radical cystectomy) in the case of more extensive and aggressive cancer.

Transurethral bladder resection (TURB)

It is a conservative surgery that involves removing the tumor endoscopically, passing through the urethra (the channel that connects the bladder with the outside). This procedure, which takes place under spinal or general anesthesia, is performed in the operating room.

Using a tubular instrument equipped with optical fibers introduced into the bladder along the urethra, the surgeon visualizes the tumor and removes it from the bladder surface with an electrosurgical scalpel.

The patient will then be fitted with a catheter, which he or she will have to wear for several days after the procedure. Hospitalization is usually completed 48 hours after surgery, and after a few weeks the patient can resume normal physical activity.

Radical cystectomy

This surgery involves the removal of the entire bladder and lymph nodes. At the Candiolo Institute, it can be performed with a minimally invasive approach and with the use of robotic surgery if indicated: through six tiny incisions of about 1 centimeter , laparoscopic instruments are inserted and operated by the surgeon via an external console.

Thanks to three-dimensional, high-definition vision and the elimination of human tremor, the surgery is performed with extreme precision and preserves nerve and muscle tissue whenever possible. For the patient, this implies faster recovery, fewer complications and a short hospital stay.

Specifically, cystectomy with robotic surgery, in most cases, spares the nerves critical for erection in men and preserves the uterus, ovaries, and vagina in women, preserving the sexual functions of both.

Bladder removal involves creating an alternative route by which to eliminate urine(urinary detour). It can be external, through an opening in the abdominal wall(stoma) connected to a pouch, or the surgeon can create an internal urine reservoir (neobladder) using a portion of the intestine that is connected to the urethra. The neovesicle needs to be emptied periodically, and the patient will have to learn a new way of urinating: specific rehabilitation is planned for this.

Radiation therapy can be an alternative to cystectomy surgery in cases of infiltrating tumor that has not yet grown outside the bladder and for patients who are inoperable due to other coexisting diseases.

Radiation treatment is performed after endoscopic resection and in combination with chemotherapy and allows for complete elimination of any remaining disease cells within the bladder, without removing it.

Radiation therapy is administered through the use of a machine that directs a targeted beam of radiation from outside the body directly onto the bladder at daily doses. Therapy is conducted on an outpatient basis and typically involves 5 to 7 sessions per week (Monday to Friday) for 4 to 7 weeks. Each session can last 10 to 30 minutes, but the actual irradiation takes only a few minutes.

The latest generation of radiation therapy devices are also available at the Candiolo Institute, allowing treatment to be carried out with extreme precision, in a shorter time (as little as a week) and with mild side effects:

• • 3D conformal radiotherapy, i.e., shaped to the tumor

• • Intensity-modulated radiation therapy, where the radiation dose is even more precisely distributed around the tumor

• • Image-guided radiotherapy, which allows the patient’s natural movements, such as breathing, to be followed.

• • Adaptive Radiotheraphy, which allows the irradiation area to be adapted in real time according to the patient’s anatomical features and the movements of the surrounding areas.

The Candiolo Institute is one of the few centers in Europe equipped with two pieces of equipment for Tomotherapy, a form of very high-precision radiotherapy, as well as a True Beam accelerator, which allows very targeted treatments to be performed in a short time.

Immunotherapy involves the use of drugs that can restore the immune system’s ability to attack and destroy cancer cells.

For high-grade bladder cancer but still confined to the bladder, a drug containing bacillus Calmette-Guerin (BCG) -the same one used to vaccinate against tuberculosis-is used, which, instilled in the bladder, stimulates the patient’s immune system to eliminate cancer cells. It can be administered, in combination with chemotherapy, after transurethral resection to reduce the risk of return of disease, or before cystectomy to reduce tumor size.

BCG vaccine is administered directly into the bladder through a catheter and left for several hours before being excreted. Instillations can be performed at weekly or monthly intervals for a period of 1 to 3 years.

Other immunotherapy drugs are used to treat advanced or metastatic bladder cancer. In these cases they are administered intravenously.

In particular, the immunotherapy drug Pembrolizumab is being studied, which, administered before surgery, appears effective in shrinking or disappearing the tumor.

The term chemotherapy refers to drugs that eliminate cancer cells by exploiting their faster rate of reproduction than healthy cells. Because it interferes with the replication mechanisms of cells, chemotherapy also damages healthy cells in the body causing major side effects that fortunately disappear once the treatment is over.

In superficial bladder tumors, chemotherapy is used in combination with immunotherapy after transurethral resection in order to eliminate any residual cancer cells and reduce the risk of disease recurrence.

Administration is by intravesical instillation: the chemotherapy drug, in liquid form, is introduced directly into the bladder through a catheter inserted into the urethra and kept inside for at least an hour before being expelled.

Typically, multiple instillations are performed at first weekly and then monthly intervals, but the pattern may vary depending on the characteristics of the tumor and the drug used.

The procedure is performed on an outpatient basis, is quick and generally not painful.

In infiltrating tumors, on the other hand, chemotherapy is administered intravenously. It can be used-even in combination with immunotherapy-both before cystectomy surgery or radiation therapy in order to reduce tumor size and after surgery.

It is administered through treatment cycles at variable intervals (weekly, tri-weekly). Sessions are performed on an outpatient basis and can last from minutes to hours depending on the drugs used.

In advanced or metastatic cancers, chemotherapy combined with immunotherapy is used to slow the spread of the disease and to treat metastases

All cancer treatments involve side effects that impact the patient’s quality of life more or less severely. Treatments for bladder cancer, especially bladder removal in cases of infiltrating cancer, involve major side effects that change the way people cope with daily life.

The physicians and nurses on the multidisciplinary team are available to provide the patient with all the support he or she needs to manage the various side effects he or she will face both in the course of treatment and in resuming normal activities.

In particular, patients who have undergone cystectomy are given all the knowledge and assistance on how to manage the external urinary shunt or neobladder , and are offered a rehabilitation course for full recovery of urinary and sexual function.

The impact of bladder cancer in a person’s life also affects the psychological sphere: in fact, getting cancer is always a traumatic event that affects all dimensions of a person and can generate anxiety, fear, anger, and depression.

In addition to this , the patient with bladder cancer sometimes also has to deal with sexual dysfunction and incontinence problems that can further impair his or her self-esteem.

Along with cutting-edge therapies, there must therefore always be psychological support in the treatment and care pathway of bladder cancer to help the patient manage not only physical pain but also psychological pain.

Therefore, at the Candiolo Institute, each patient in need is offered qualified psychological support to help him or her cope positively with the diagnosis, treatment, and side effects of therapies and to redefine their social and work roles.

You can also participate in psychological support groups to compare yourself with others who have gone through or are going through the same experience.

To ensure timely and direct support and rice timely answers to concerns and questions, a dedicated helpline is in place at the Candiolo Institute for all patients.

Monday through Friday, from 8 a.m. to 5 p.m., you can contact the secretariat of the Oncology Day Hospital at 011.993.3775, reporting the need for urgent consultation.

The patient will be quickly put in touch with their medical specialist for clear answers and immediate support.

The cancer patient is a person with complex needs who requires multidisciplinary support not only for the cancer disease but also for all related issues.

At the Candiolo Institute, patients who need or request it can access specialists in different areas to receive nutritional support, physical therapy, pain therapy, and management of other associated conditions.

The Social Service Department of the Candiolo Institute conducts information and orientation interviews for patients and their families on how to access services in the area and how to obtain welfare and social security benefits provided by law (disability, benefits for aids and prostheses, work leave, etc.).

The service operates on Wednesdays and Fridays from 9 a.m. to 1 p.m. (phone: 011 9933059).

With the conclusion of the course of treatment, the follow-up period begins during which, through a series of examinations and visits, the side effects of the therapies performed and their effectiveness are monitored and the patient’s recovery is assessed.

Follow-up visits are especially important to intercept any recurrences early, so that appropriate therapy can be intervened.

In fact, thechance of recurrence after a first bladder tumor is quite high, so careful surveillance is necessary.

The frequency of follow-up visits depends on the stage of the disease, treatments, and the patient’s health status.

In general, if the patient has had a superficial tumor, a cystoscopy should be performed every three months for two years, then every six months for two years, and finally annually, each time associated with urinalysis.

After radical bladder removal (cystectomy), various examinations are indicated, which may vary depending on symptoms and medical findings, and should be performed initially every six months, then once a year.

Due to the high number of cases treated each year, the Candiolo Institute is a national reference for taking care of esophageal cancer. Our experience enables us to deal with even the most complex situations, always with a personalized approach built on the clinical and personal profile of each patient.

Establishing the treatment plan always starts with an accurate and timely diagnosis. Patients have access to state-of-the-art imaging technologies that allow accurate assessment of the extent of the disease.

In addition, the Institute offers advanced and sophisticated laboratory investigations, including molecular and genomic analyses, which are critical for identifying biological features of cancer and guiding therapeutic decisions.

When indicated, surgery is performed with minimally invasive techniques (laparoscopic or thoracoscopic), which reduce operative trauma, promote faster recovery, and improve postoperative quality of life. Every treatment choice is defined within the GIC, ensuring a consistent and integrated approach.

As an IRCCS, the Candiolo Institute combines clinical practice with a strong vocation for scientific research. Patients can be evaluated for inclusion in active clinical trials, which represent a real chance to access innovative therapies not yet available in standard practice. Collaboration between care and research is a distinctive value that translates into concrete opportunities for the patient.

The Interdisciplinary Care Group takes care of the person at every stage: from diagnosis to treatment to follow-up, with attention to nutritional support, psychological health, and reintegration into daily life. The organization of checkups, visits and treatment is designed to ensure continuity and serenity, always valuing the human dimension of care.