Bladder cancer

Most bladder tumours are urothelial carcinomas: they arise in the urothelium, the layer of cells lining the inside of the bladder. They can be non-muscle-invasive (limited to the superficial layers) or muscle-invasive, when they grow into the bladder wall and require more intensive treatment.

Tobacco is the main risk factor, followed by occupational exposure to certain chemicals (textile, paint and leather industries) and older age.

The most common sign is blood in the urine (haematuria), often without pain. Other symptoms include needing to urinate more often, urgency or a burning sensation when urinating, which can be mistaken for a urinary infection.

Any bleeding in the urine — even if it happens once and stops on its own — requires a urological assessment.

The basic work-up includes cystoscopy, urine cytology and imaging of the whole urinary tract (CT urogram). Diagnosis is confirmed by transurethral resection of the tumour (TURBT), which also establishes whether it is muscle-invasive.

For invasive tumours, the study is completed with a thoraco-abdominal CT scan and, when needed, additional staging tests to plan the most appropriate treatment for each patient.

Non-muscle-invasive tumours are treated with endoscopic resection and intravesical instillations (including BCG or intravesical immunotherapy) and require close follow-up because of their tendency to recur.

In muscle-invasive cancer, the standard treatment is radical cystectomy with lymph node dissection and urinary diversion, often preceded by chemo-immunotherapy. Dr. Carrión is part of the team that pioneered radical cystectomy with intracorporeal bladder reconstruction (neobladder) using Da Vinci robotic surgery in Catalonia, and he takes an active part in immunotherapy programmes and clinical trials in urothelial carcinoma.