Bladder cancer among women, at the 92 Congress of the SIU

In Venice, from the 12 to the 15 October, the 92 ° Congress of the SIU (Italian Society of Urology) 5.600 new bladder tumors among women: smokers at risk The tobacco 'lights up' and quintuples the probability of illness

In Italy, 57 thousand women suffer from bladder cancer of which 3.300 in Campania alone according to AIRTUM data (Italian Association of Cancer Registry). In 2018, about 5.600 expected new 'lit' diagnoses and increased by the number of women addicted to smoking, recognized as one of the main risk factors for bladder cancer, along with environmental pollutants and toxic synthetic substances. Difficult early diagnosis due to alarm bells such as haemorrhagic cystitis and / or urge urgency, often underestimated. On the contrary, discovering the disease in its initial phase makes the difference on the prognosis and the possibilities of conservative treatments. New hopes also come from research for some selected metastatic forms. Smoking cessation is the best prevention, while smoking cessation 'turns off' disease risks after 15 years

 The cigarette also smokes the intimate health of women and "ignites" the risk of certain cancers, in particular of the bladder and upper urothelial tract. There are 57 women in Italy affected by the disease (vs 21.200 men) according to AIRTUM data, (Italian Cancer Registry Association) 3300 of which in Campania alone, for a total of 269.000 cases, but only for 2018 new diagnoses are expected among women around 5.600. With growing estimates, directly proportional to the increased number of smokers, exposed to an 4-5 disease risk times higher than non-smoking women. It is not just the numbers that are worrying, but also the difficulty of early diagnosing bladder cancer, often 'deceived' by subtle symptoms: haemorrhagic cystitis (which, on the other hand, should never be trivialized by the patient or by the doctor) and the increase in urinary frequency due to urgency. Arriving first means, instead, more quality of life for the woman and options of conservative care in case of superficial tumors, or an endoscopic surgery possibly followed by chemo or immunotherapy, against demolition therapies with the removal of the organ and lymph nodes affected by disease, combined with chemotherapy and / or radiotherapy in case of muscle-invasive bladder tumors. New and promising opportunities for treatment are also emerging for some forms of metastatic disease, which can be effectively treated with immunotherapy. As with pulmonary and other respiratory tracts, abstention or cessation of smoking is the first protective and preventive action even for bladder tumors, although among women (ex) smokers the chances of disease development do not "go out" before 15 years: a very long period that explains the harmful power of tobacco, not only on the bladder but on the general health of the organism.

 "Cigarette smoke, substances derived from dyes and paints, environmental pollution - he says Walter Artibani, Professor of Urology and General Secretary of the Italian Society of Urology (SIU) - are among the main and known risk factors for bladder cancer. Pathology that, according to AIRTUM data (Italian Cancer Registry Association) involves Italian 260.000: 212.000 men, in which it represents the fourth tumor by diffusion with about 21.500 new cases expected for 2018, and 57.000 women among which the incidence is significantly lower with 'only' 5.600 new diagnoses for the same year. Smoking, among the various risk factors, remains however the priority so as to be able to induce an increase in the probability of developing disease, in women smokers, of 4-5 times higher than those who are not. Onset that is stimulated by the contact between the nicotine catabolites with the epithelium lining the urinary tract, the urothelium ”.

Although the incidence of bladder cancer is more limited in women, the diagnosis remains more difficult and complex. "Often the 'discovery' is late - explains the professor - due to confounding factors, firstly the underestimation both of the patient and of the doctor of hemorrhagic cystitis, which instead, as well as any other episode of macroscopic hematuria, also episodic, they should never be trivialized. On the contrary, they are worthy of in-depth diagnosis with abdominopelvic ultrasound, urinary cytology and cystoscopy as appropriate. That is to say investigations that allow to exclude the presence of a bladder tumor and / or to arrive at an early diagnosis which is linked to a better prognosis and greater therapeutic possibilities, even conservative ones. In addition to hemorrhagic cystitis, persistent urgency disorders that increase the 'compelling' need to urinate often should not be underestimated '.

Smoking is not only responsible for the onset of bladder cancer, it also puts at risk the entire urogenital system, in particular the upper urinary tract urinary tract. "Urothelial tumors - he adds Artibani - they can also affect the upper urinary tract, therefore the renal pelvis, calices and ureter. These are not hereditary tumors, however there is a known familiarity that links the presence in more members of the same family affected by colorectal carcinoma with the higher probability of developing urothelial tumors of the upper urinary tract, according to what is clinically called 'Lynch syndrome '. Therefore in the case of haematuria and / or hemorrhagic cystitis in women already treated for colorectal cancer, the diagnostic evaluation must necessarily be timely and thorough ”.

There are different types of bladder tumors and the sooner the possibility of treatment is better recognized. "There are two broad categories of bladder tumors - explains the general secretary of SIU - the superficial ones that do not infiltrate the bladder wall deeply, and the infiltrating ones that deeply involve the wall, including the muscle tissue. Depending on the type of disease, the treatment will also be different: the superficial forms are rather 'boring', because they tend to recur, requiring, therefore, multiple evaluations and treatments over the years, but not dangerous because, if well treated, they rarely progress . As a rule, for the treatment of superficial forms, non-invasive methods are used with endoscopic resections followed, if necessary, by bladder instillations with mitomycin-based chemotherapy or immunotherapy. While rather aggressive invasive muscle infiltrating forms require timely, invasive and integrated treatments. The standard therapy involves the removal of the bladder and lymph nodes and therefore a urinary or external derivation (the so-called ostomy with small bag) or through the reconstruction of a neovescica. Whenever possible, cisplatin-based preoperative neoadjuvant systemic chemotherapy or trimodal therapy consisting of maximal endoscopic resection associated with systemic chemotherapy and radiotherapy is indicated and advantageous. This last solution, of which there are various evidences of effectiveness, must be evaluated by a multidisciplinary team formed by a urologist, oncologist and radiotherapist. Finally, new hopes for treatment have recently opened for metastatic bladder tumors in which modern immunotherapy, in selected cases, seems to give unexpected results. "

Prevention is possible and makes use of the abstention from smoking, or rather the abolition of the (main) risk factor. "Whoever quits smoking - he concludes Artibani - eliminates the risk or returns to having the same chances of developing a bladder tumor of a non-smoker within 15 years. This brief 'recovery' time says a lot about the damage caused by the cigarette. There is no doubt that smoking is decreasing, especially in males, while a greater trend than in the past among women is appreciable, especially young women, recalling the need for strong and targeted awareness campaigns against cigarette smoking ”.

 

Bladder cancer among women, at the 92 Congress of the SIU