Fabio is a man in his fifties who lives in Milan. The alarm rings like every morning. The smartphone reminds him that he has a meeting at 9. In the bathroom he notices something wrong. He gets dressed, has breakfast, goes out to go to the meeting. Then he has a moment of lucidity, while on the pedestrian crossing he waits for the green: the red man of the traffic light seems to speak to his unconscious and tell him stop, stop, do not go to the meeting, because this morning something more important happened and you owe yourself occupy immediately. Fabio picks up the phone, cancels the meeting and does what anyone who sees blood in their urine should do: go to the doctor.
Lo spot
Everything happens in just one minute in the spot we have just told the synopsis, wanted and promoted by the association PaLiNUro – Patients Free from UROtelial Neoplasms for the month of bladder cancer prevention (you can see it at this link). The director Fabrizio Mari signs it, while the Italian actor Mauro Negri plays Fabio. A video (made with the non-conditioning support of Astellas) that passes the important message: the prevention and timely diagnosis of this tumor can save lives, so it is essential to “stop at red”. “We want to make people aware, educate them and encourage their reaction and action: if you see red, go to the doctor”, stresses Edoardo Fiorini, President of the Association.
Unrecognized symptoms, especially in women
Bladder cancer, more properly called urothelial carcinoma, is the fifth most common cancer in Italy, the fourth in the male population. It affects after the age of 50, more among men but is also increasing among women, especially smokers, since cigarette smoking is the main risk factor. In addition to blood in the urine (hematuria), the other symptoms are: frequent urge and urge to urinate, burning, pelvic pain and back pain, often underestimated by patients – especially women, contrary to what happens in other diseases – and by themselves doctors. “In women – recalls Giaro Conti, national secretary of the Italian Society of Oncological Urology (SIUrO) – the symptoms are often confused with those of other female pathologies, such as cystitis, but if the blood loss persists after a first attempt at treatment, you don’t have to waste time and go to the urologist. Furthermore, the first level tests that can reveal the tumor are simple and inexpensive (urinary cytology and cystoscopy, ed.), There is no reason not to prescribe them and not to do them “.
The possibilities of cure
Discovering cancer at an early or late stage makes a huge difference not only in the risk of recurrence and mortality, but also in the quality of life. “We can imagine the bladder as a series of concentric balloons”, explains Patrizia Giannatempo, Director of SC Oncologia Medica, IRCCS Foundation National Cancer Institute of Milan: “The tumor originates in the innermost one and gradually it can reach the second, in which there is muscle tissue rich in blood vessels, which can facilitate their diffusion “.
What are the treatment options in this case? “A patient with muscle-invasive or metastatic urothelial carcinoma (about 20% of total cases, ed.) – explains the oncologist – receives chemotherapy, but for those who are not candidates for this treatment there are several options within clinical protocols, including immunotherapy. At the moment, FGFR3 inhibitors are also available, only within clinical protocols, drugs that bind to some receptors present on malignant cells and selectively kill them. Finally, we have a third category of new drugs, which are revolutionizing the therapeutic possibilities of patients with advanced urothelial carcinoma: monoclonal antibodies conjugated with an anticancer drug that binds to nectin, a specific receptor present on the surface of tumor cells “. The patient with non-muscle-invasive disease, on the other hand, can undergo a local treatment such as TURB (Transurethral Resection of the Bladder) and instillations of chemotherapy drugs in the bladder, in addition to local surgical treatments and combined ones of radiotherapy.
The psychological impact
Surgery is also more or less invasive depending on the stage of the disease, and this has an impact on the psychological aspect. Blood loss is a traumatic event in itself. But cystectomy surgery, which remains the treatment of choice, can be followed by urinary incontinence, sexual impotence that poses serious problems for the couple, and last but not least, the aesthetic component with a change in body image.