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- Non\u2013muscle-invasive (superficial) bladder cancer:<\/b> The tumour is confined to the innermost layers of the bladder lining. It accounts for most initial diagnoses and has a favourable prognosis, although it requires close surveillance due to the risk of recurrence.<\/li>\n
- Muscle-invasive bladder cancer:<\/b> The tumour has progressed and invaded the deep muscle layer of the bladder wall. This is a more serious situation, with an increased risk of spread (metastases) to lymph nodes or other organs, requiring more aggressive treatments.<\/li>\n<\/ul>\n
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![\"\"](\"https:\/\/furriel-urologia.pt\/wp-content\/uploads\/2026\/01\/cirurgia-300x207-1.png\")
\t\t\t\t\t\t\t\t\t\t\t\t\t<\/p>\nMain Risk Factors<\/h3>\n
The development of this condition is strongly linked to prolonged exposure to harmful chemicals which, after being filtered by the kidneys, become concentrated in the urine stored in the bladder. The main risk factors include:<\/p>\n
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- Smoking:<\/b> By itself, this is the main risk factor. Smokers are 3 to 4 times more likely to develop bladder cancer than non-smokers. Chemicals in tobacco smoke enter the bloodstream, are filtered by the kidneys, and severely damage the urothelium.<\/li>\n
- Occupational \/ Industrial Exposure:<\/b> Workers in industries that use dyes, paints, rubber, leather, plastics, and certain chemical solvents (aromatic amines) have an increased risk.<\/li>\n
- Age and Sex:<\/b> It is significantly more common in people over 60\u201365 years of age and affects men about 3 to 4 times more often than women.<\/li>\n
- Chronic Bladder Irritation:<\/b> Recurrent urinary tract infections, prolonged use of urinary catheters, or a history of bladder stones may slightly increase the risk.<\/li>\n<\/ul>\n
\t\t\tSymptoms of Bladder Cancer\t\t<\/p>\n
Unlike prostate cancer, bladder cancer often presents early through visible changes in the urine.<\/p>\n
The most common and characteristic warning sign is:<\/p>\n
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- Haematuria (Blood in the Urine):<\/b> Occurs in around 80\u201390% of cases. It is typically painless<\/b> and intermittent<\/b> \u2014 the urine may appear visibly reddish or pink one day and return to normal the next, which leads many patients to mistakenly delay seeking medical advice.<\/li>\n<\/ul>\n
As the tumour grows or spreads, other symptoms related to irritation of the organ may appear, often mistaken for a simple urinary infection:<\/p>\n
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- Urgent need to urinate (urinary urgency<\/i>);<\/li>\n
- Increased urinary frequency (going to the bathroom more often);<\/li>\n
- Pain or burning when urinating (dysuria<\/i>);<\/li>\n
- Pain in the pelvic region or lower back (common in more advanced stages).<\/li>\n<\/ul>\n
\t\t\tDiagnosis of Bladder Cancer\t\t<\/p>\n
In the presence of clinical suspicion or the appearance of blood in the urine, urological investigation should be immediate and structured to rule out or confirm malignancy.<\/p>\n
Initial Tests<\/h3>\n
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- Urine tests:<\/b> A routine urinalysis detects microhaematuria (blood visible only under the microscope) and helps rule out active infections. Urine cytology<\/b> analyses cells in the urine to identify tumour cells that have shed from the bladder wall.<\/li>\n
- Bladder and renal ultrasound:<\/b> A non-invasive imaging test that allows visualisation of the urinary tract anatomy, mapping of the kidneys, and detection of any masses or polyps inside the bladder.<\/li>\n<\/ol>\n
Confirmatory and Staging Tests<\/h3>\n
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- Cystoscopy:<\/b> This is the definitive diagnostic test. It involves inserting a thin, flexible tube with an optical camera at the tip (cystoscope) through the urethra. It allows the urologist to directly visualise the entire inside of the bladder in real time, identify the location, size, and appearance of any lesion, and, if necessary, take small biopsies.<\/li>\n
- CT Urography (CT scan of the urinary tract):<\/b> Indicated to assess the upper urinary tract (kidneys and ureters) and check whether the tumour has infiltrated neighbouring tissues or whether there are affected lymph nodes.<\/li>\n
- Bladder MRI: <\/b>a more sensitive test for assessing the <\/li>\n<\/ul>\n
\t\t\tTreatments and Surgery for Bladder Cancer\t\t<\/p>\n
The treatment strategy depends entirely on the degree of tumour invasion into the bladder wall, determined after the tests and the initial surgical procedure.<\/p>\n
1. Transurethral Resection of the Bladder (TURBT)<\/h3>\n
TURBT is both the first step of treatment<\/b> and an essential diagnostic tool.<\/p>\n
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- The procedure:<\/b> A minimally invasive endoscopic surgery performed in the operating theatre under anaesthesia. The urologist inserts a surgical instrument through the urethra into the bladder to scrape (resect) and completely remove all visible tumour tissue.<\/li>\n
- Post-operative period:<\/b> The removed tissue is sent for pathological analysis to determine the aggressiveness and depth of the tumour. The patient usually remains in hospital with a urinary catheter for 1 to 3 days to allow bladder irrigation and healing.<\/li>\n
- Intravesical instillations (adjuvant treatment):<\/b> If the tumour is non\u2013muscle-invasive but has a risk of recurrence, TURBT is complemented with local treatments applied directly inside the bladder through a temporary catheter. Intravesical chemotherapy<\/b> (such as Mitomycin C) or BCG immunotherapy<\/b> (Bacillus Calmette-Gu\u00e9rin) may be used to stimulate the local immune system to destroy any remaining cancer cells.<\/li>\n<\/ul>\n
2. Radical Cystectomy (Bladder Removal)<\/h3>\n
In cases where the tumour has already invaded the muscle layer (muscle-invasive cancer) or when high-risk superficial tumours do not respond to intravesical treatments, the recommended surgery is complete removal of the bladder.<\/p>\n
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- Surgery:<\/b> In men, this involves removal of the bladder, prostate, and seminal vesicles. In women, it usually involves removal of the bladder, uterus, ovaries, and part of the vaginal wall. A lymphadenectomy (removal of pelvic lymph nodes) is also performed. This procedure can be carried out via the classic open approach or using minimally invasive techniques (laparoscopy or robotic surgery).<\/li>\n
- Urinary diversion:<\/b> Once the organ that stores urine is removed, the surgeon must create a new way for the body to eliminate urine produced by the kidneys. The two main options are:\n
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- Urostomy (incontinent diversion or ileal conduit):<\/b> A small segment of intestine is used to connect the ureters to the skin of the abdomen, where an external adhesive pouch is attached to continuously collect urine.<\/li>\n
- Ileal neobladder (continent diversion):<\/b> A complex reconstruction in which a new urine reservoir is fashioned from a segment of the patient\u2019s own intestine and connected directly to the urethra. This allows the patient to continue urinating independently and naturally, without the need for external pouches.<\/li>\n<\/ol>\n<\/li>\n<\/ul>\n
3. Multimodal Approaches (Bladder Preservation)<\/h3>\n
For patients who refuse removal surgery or who are not clinically fit to tolerate such a demanding procedure, a bladder-preservation<\/b> strategy may be chosen, based on combining the most complete possible TURBT with concurrent radiotherapy and chemotherapy (trimodal therapy). Although it offers the advantage of preserving the organ, it requires extremely rigorous follow-up to detect early recurrences.<\/p>\n
4. Treatment of Advanced or Metastatic Disease<\/h3>\n
In cases where the disease has spread beyond the pelvic region, treatment is based on systemic therapies that act throughout the body:<\/p>\n
- Ileal neobladder (continent diversion):<\/b> A complex reconstruction in which a new urine reservoir is fashioned from a segment of the patient\u2019s own intestine and connected directly to the urethra. This allows the patient to continue urinating independently and naturally, without the need for external pouches.<\/li>\n<\/ol>\n<\/li>\n<\/ul>\n
- Urinary diversion:<\/b> Once the organ that stores urine is removed, the surgeon must create a new way for the body to eliminate urine produced by the kidneys. The two main options are:\n
- Post-operative period:<\/b> The removed tissue is sent for pathological analysis to determine the aggressiveness and depth of the tumour. The patient usually remains in hospital with a urinary catheter for 1 to 3 days to allow bladder irrigation and healing.<\/li>\n
- CT Urography (CT scan of the urinary tract):<\/b> Indicated to assess the upper urinary tract (kidneys and ureters) and check whether the tumour has infiltrated neighbouring tissues or whether there are affected lymph nodes.<\/li>\n
- Bladder and renal ultrasound:<\/b> A non-invasive imaging test that allows visualisation of the urinary tract anatomy, mapping of the kidneys, and detection of any masses or polyps inside the bladder.<\/li>\n<\/ol>\n
- Urgent need to urinate (urinary urgency<\/i>);<\/li>\n
- Occupational \/ Industrial Exposure:<\/b> Workers in industries that use dyes, paints, rubber, leather, plastics, and certain chemical solvents (aromatic amines) have an increased risk.<\/li>\n
- Muscle-invasive bladder cancer:<\/b> The tumour has progressed and invaded the deep muscle layer of the bladder wall. This is a more serious situation, with an increased risk of spread (metastases) to lymph nodes or other organs, requiring more aggressive treatments.<\/li>\n<\/ul>\n