Dr. Palou is a renowned urologist recognized worldwide by the scientific community. He is currently Head of the Oncological Urology Unit at the Fundació Puigvert. He is a specialist in Bladder Cancer, Cystectomy, Prostatectomy among other treatments.
What is bladder cancer?
We have to imagine the bladder as a balloon and this balloon has different layers, the inner layer of several cells is what we call urothelium and it is what protects us from all the toxic substances that are generated by the kidneys and go to the bladder so that they do not re-enter the organism. These layers of cells, for different reasons, can be altered, start to grow anarchically, disorganized, and this is what we call a tumor. It can be low grade, high grade or even affect the muscular layer which is in charge of contracting, of making us urinate, or even the fat, or even go outside to what we call metastasis. But in conclusion it is this tumor that develops from these cells from the inside and as it is called urothelium we call it urothelial carcinoma.
Are there factors that can influence its appearance?
Tobacco is our main ally in the bladder tumor, and you may wonder why, why smoking affects the bladder, because when we smoke we ingest substances that go into the blood, from the blood they are filtered by the kidney and accumulate in the urine that ends up in the bladder. The bladder is a reservoir where the urine is for many hours and these toxic products are the ones that develop the tumor, therefore the more years smoked the more likely it is that a bladder tumor will appear. We also know that if we stop smoking the risk of tumor development decreases, in the first years about 40% but still the effect lasts for many years, so quitting smoking is a very important message in this regard.
What are the warning symptoms?
The most frequent symptom is hematuria. Hematuria means blood in the urine. The patient may notice one day that blood comes out, another day that it does not, and this sometimes causes some patients not to go to the doctor. But whenever blood is urinated, it must be studied. If it is a young person, a woman in her 20s, and also with the urge to urinate, it may be a simple urinary tract infection. But if it is a man, over 50 years of age, there is an increased risk that the underlying cause of this blood in the urine is a bladder tumor, so we must study it. Other times it may be the urge to urinate, the urge to urinate often, because this tumor is covering all the layers and as it affects the entire bladder it reduces the capacity and gives more urge to urinate. When a patient presents these symptoms we must rule out the presence of a tumor in the bladder.
How should bladder cancer be treated?
The treatment of a bladder tumor depends on the grade and stage. Grade is how bad the tumor is and the stage to which it has reached. If the tumor is only superficial, not muscle-invasive, with a transurethral resection, through the urine duct we remove the tumor and then we administer intravesical products that act as a peeling so that it does not reproduce any more. If the tumor affects the muscular layer we are talking about multiple treatments, we combine chemo or radio and surgery, the standard is chemo and surgery, which in this case will be robotic surgery that reduces bleeding, is less aggressive, smaller incisions and if possible we offer a new bladder with bowel and preserving the nerves that give the patient erection. In this way we improve quality of life and body image.