Bladder cancer deaths exceed 19,000 in Brazil in 4 years, says Ministry of Health

The most common type of cancer in men, bladder cancer killed 800,000 people worldwide and more than 19,000 in Brazil from 2019 to 2022.

Data from the Ministry of Health Information System (SIH/SUS) indicate more than 110,000 cases of malignant bladder neoplasia since 2019. As with other types of cancer, smoking is the main risk factor for bladder neoplasia.

July is Bladder Cancer Awareness Month. The Brazilian Society of Urology (SBU) uses the date to warn about the importance of early detection of this type of tumor, when the chances of a cure are greater. On social media, posts, videos and live broadcasts with specialists inform the lay public.

Estimates from the National Cancer Institute (Inca) indicate that 11,370 new cases of bladder cancer are expected to be registered this year, 7,870 in men and 3,500 in women, corresponding to an estimated risk of 7.45 new cases per 100,000 men and 3.14 per 100,000 women.

According to INCA, this is the seventh most common cancer among men (except non-melanoma skin cancer), representing more than 3% of cancers in men.

“The main risk factor for bladder cancer is smoking, which is associated with more than 50% of cases. Therefore, by eliminating this habit, we can significantly reduce the chances of this tumor appearing,” warns the president of SBU, Luiz Otavio Torres.

“Another fundamental point in prevention is following healthy habits, such as maintaining a balanced diet, drinking adequate amounts of water and exercising,” he points out.

Driver Edgar Azevedo dos Santos, 51, discovered the disease after experiencing lower back pain in 2017. He underwent an ultrasound which revealed nodules.

He underwent surgery and chemotherapy sessions. “I never imagined I would have cancer. Since then I have been undergoing regular check-ups.”

“We have observed that many people are unaware of bladder cancer, how it manifests itself and what the main causes are. Most people already know that smoking can lead to lung cancer, for example, but many are unaware that it is also the main cause of bladder cancer,” says Karin Jaeger Anzolch, SBU’s Communications Director and coordinator of the organization’s awareness campaigns.

“In addition, although it often causes bleeding in the urine, it is usually intermittent and does not cause pain at first, which is why people often do not give it due importance and delay going to the doctor, which can worsen the condition,” he explains.

Although it is usually silent in the initial stage, bladder tumors can cause blood in the urine, increased urinary frequency, burning when urinating, urgency to urinate and a weak urinary stream.

“The presence of visible blood in the urine is the most common symptom of bladder cancer and is normally present in 80% of patients. Other commonly reported symptoms are increased urinary frequency, urinary urgency and pain when urinating, which may be related to the presence of carcinoma in situ,” says the coordinator of the Uro-Oncology Department at SBU, Mauricio Dener Cordeiro.

“Bladder cancer can also be asymptomatic and detected through imaging tests with ultrasound, tomography or nuclear magnetic resonance,” he explains.

Types of cancer

Bladder cancer can be classified according to the cell that has undergone alteration, the main ones being: transitional cell carcinoma (or urothelial), which represents the majority of cases and begins in the innermost layer of the bladder; squamous cell carcinoma (or epidermoid), which affects the thin, flat cells of the bladder and occurs after prolonged infection or inflammation; and adenocarcinoma, which is rarer and begins in the glandular (secretory) cells after prolonged infection or irritation.

Bladder cancer is considered superficial when it is limited to the lining tissue of the bladder and infiltrative when it penetrates the muscular wall, potentially affecting nearby organs or lymph nodes.

Risk factors

Smoking (also passive smoking) is the main risk factor for bladder cancer, but there are other threats such as: exposure to chemical substances; some medications and dietary supplements; gender and race (white men are more likely to develop the disease); advanced age; family history.

“In addition to smoking, contact with chemical substances such as those present in agricultural pesticides, dyes used in industry, diesel fumes or other substances can also predispose to this disease”, explains the supervisor of the Bladder Cancer Discipline at SBU, Fernando Korkes.

“Medications such as pioglitazone, used to control diabetes, have already been associated with the development of bladder cancer. However, the risk is relatively low, and the main point of attention should be for patients who have already had bladder cancer and are using this medication,” he says.

Diagnosis and treatment

Bladder cancer can be diagnosed using urine and imaging tests, such as ultrasound, computed tomography and cystoscopy (internal investigation of the bladder using a cystoscope, an instrument with a camera inserted through the urethra).

During cystoscopy, if the specialist identifies any changes, material may be removed for biopsy.

Treatment for bladder cancer varies depending on the stage of the disease and may consist of surgery, chemotherapy and radiotherapy.

The types of surgery consist of: transurethral resection – removal of the tumor via the urethra; partial cystectomy – removal of a part of the bladder; radical cystectomy – complete removal of the bladder, with the construction of a new organ to store urine.

In cases of initial lesions, after the tumor has been removed, the BCG vaccine or some chemotherapy drug may be administered into the bladder in order to prevent recurrence of the disease.

“Some of the innovations in this area include new medications such as immunotherapy, targeted therapies and therapies with antibodies conjugated to drugs that have already been used in practice and bring benefits to many patients. As for surgery, robotic platforms are very helpful in cases where it is necessary to remove the bladder and perform some type of reconstruction,” highlights Fernando Korkes.

Mortality

From 2019 to 2022, the Mortality Information System recorded 19,160 deaths due to malignant bladder neoplasm. Of these, 12,956 (67.6%) were male and 6,204 (32.3%) were female.

For the director of the SBU Higher School of Urology, Roni de Carvalho Fernandes, to screen for bladder cancer and develop effective public policies to reduce incidence and mortality, it is essential to consider several strategies, starting with awareness and education campaigns like the one promoted by the SBU.

It also highlights identifying high-risk groups, ensuring that everyone has access to health services that offer adequate diagnosis and treatment, with the creation of specialized centers to ensure high standards of care and better outcomes for patients.

“Implementing these measures requires collaboration between health professionals, governments, research institutions, non-governmental organizations and the community itself to effectively face this great challenge, which is to reduce mortality rates from bladder cancer,” says Fernandes.