RESUMO
PURPOSE: To update current recommendations on prevention, screening, diagnosis, and evaluation of bladder cancer (BC) based on a thorough assessment of the most recent literature on these topics. METHODS: A non-systematic review was performed, including articles until June 2017. A variety of original articles, reviews, and editorials were selected according to their epidemiologic, demographic, and clinical relevance. Assessment of the level of evidence and grade of recommendations was performed according to the International Consultation on Urological Diseases grading system. RESULTS: BC is the ninth most common cancer worldwide with 430,000 new cases in 2012. Currently, approximately 165,000 people die from the disease annually. Absolute incidence and prevalence of BC are expected to rise significantly during the next decades because of population ageing. Tobacco smoking is still the main risk factor, accounting for about 50% of cases. Smoking cessation is, therefore, the most relevant recommendation in terms of prevention, as the risk of developing BC drops almost 40% within 5 years of cessation. BC screening is not recommended for the general population. BC diagnosis remains mainly based on cystoscopy, but development of new endoscopic and imaging technologies may rapidly change the diagnosis algorithm. The same applies for local, regional, and distant staging modalities. CONCLUSIONS: A thorough understanding of epidemiology, risk factors, early detection strategies, diagnosis, and evaluation is essential for correct, evidence-based management of BC patients. Recent developments in endoscopic techniques and imaging raise the hope for providing better risk-adopted approaches and thereby improving clinical outcomes.
Assuntos
Carcinoma de Células de Transição/epidemiologia , Cistoscopia , Dinâmica Populacional , Abandono do Hábito de Fumar , Fumar Tabaco/epidemiologia , Neoplasias da Bexiga Urinária/epidemiologia , Algoritmos , Carcinoma de Células de Transição/diagnóstico , Carcinoma de Células de Transição/patologia , Carcinoma de Células de Transição/prevenção & controle , Detecção Precoce de Câncer , Humanos , Incidência , Imageamento por Ressonância Magnética , Imagem de Banda Estreita , Estadiamento de Neoplasias , Guias de Prática Clínica como Assunto , Prevalência , Fatores de Risco , Sociedades Médicas , Tomografia Computadorizada por Raios X , Neoplasias da Bexiga Urinária/diagnóstico , Neoplasias da Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/prevenção & controle , UrologiaRESUMO
Bladder cancer is the most frequent cancer of the urinary system. Fibroblast growth factor receptors (FGFR) belong to the tyrosine kinase family and have important roles in cell differentiation and proliferation and embryogenesis. FGFR3 is located on chromosome 4p16.3, and missense mutations of FGFR3 are associated with autosomal dominant human skeletal disorders and have some oncogenic effects. We examined the incidence of FGFR3 thanatophoric dysplasia mutations located in exon 7, A248C and S249C, and in exon 10, G372C and T375C, and their correlation with clinical-pathological parameters in bladder carcinoma patients. Fifty-six paraffin-embedded specimens of transitional cell carcinoma of the urinary bladder were included in this study. Analysis of FGFR3 thanatophoric dysplasia mutations located in exon 7, A248C and S249C, and in exon 10, G372C and T375C, was performed by PCR-restriction fragment length polymorphism (RFLP) analysis and DNA sequencing. FGFR3 thanatophoric dysplasia mutations located in exon 7, A248C and S249C, and in exon 10, G372C and T375C, were detected in 33 of the 56 patients (heterozygous mutant). Among the 56 transitional cell carcinomas, missense point mutations were detected in seven of them at codon A248C, 28 of them at codon S249C, and three of them at codon T375C, similar to data from previous reports. When the results of the FGFR3 thanatophoric dysplasia mutations located in exon 7, A248C and S249C and in exon 10, G372C and T375C, were analyzed one by one or as a group, despite the findings of previous research reports, our data suggest that these mutations are detected homogenously regardless of the tumor classification and tumor grade.
Assuntos
Carcinoma de Células de Transição/genética , Receptor Tipo 3 de Fator de Crescimento de Fibroblastos/genética , Neoplasias da Bexiga Urinária/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células de Transição/epidemiologia , Carcinoma de Células de Transição/patologia , Códon , Éxons , Feminino , Estudos de Associação Genética , Genótipo , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Mutação , Estadiamento de Neoplasias , Displasia Tanatofórica/genética , Neoplasias da Bexiga Urinária/epidemiologia , Neoplasias da Bexiga Urinária/patologiaRESUMO
Epidemiological and laboratory research has shown that dietary components are associated with the risk of developing urinary tract tumors (UTT). The purpose of this case-control study, carried out between 2004 and 2008 in Córdoba, a Mediterranean city in Argentina, was to describe the role of dietary patterns and to investigate any association with the risk of developing UTT. One hundred and sixty-eight patients with histologically confirmed transitional UTT and 334 controls with acute, nonneoplastic, and nonurinary tract diseases from the same hospitals were studied. All patients were interviewed about their food habits and their exposure to a number of known or suspected risk factors for UTT. Multiple correspondence analysis was used to explore dietary patterns and data analyses were carried out by calculating odds ratios and their 95% confidence intervals by using multiple logistic regression. Two main dietary patterns identified were a 'prudent' pattern that was linked to controls and a 'western' pattern that was associated with cases. A frequent intake of vegetable oils, lean meats, grains, and fruits, the moderate use of alcohol (mainly red wine) together with potato and sweet consumption, and the habit of taking at least four meals per day, were associated with a reduced risk for UTT. In contrast, frequent consumption of infusions (mainly maté), potatoes, alcohol, sweets, and processed meat resulted in a high risk for UTT. The dietary patterns of our population have a role in the development of UTT, thus implying that appropriate nutritional education may decrease this risk.
Assuntos
Carcinoma de Células de Transição/epidemiologia , Dieta/estatística & dados numéricos , Comportamento Alimentar , Neoplasias Urológicas/epidemiologia , Idoso , Argentina/epidemiologia , Carcinoma de Células de Transição/etiologia , Carcinoma de Células de Transição/prevenção & controle , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Neoplasias Urológicas/etiologia , Neoplasias Urológicas/prevenção & controleRESUMO
El cáncer de vía urinaria alta (pelvis renal y/o uréter) es una neoplasia rara. Generalmente es del tipo células de transición. El objetivo de este trabajo es conocer los aspectos epidemiológicos, clínicos y de manejo de los pacientes institucionales con esta patología que han consultado en el Hospital Nacional Guillermo Almenara Irigoyenen Lima - Perú. Se revisaron retrospectivamente los ingresos al Servicio de Urología entre los años 1999 al 2005. Se recuperaron 26 ingresos con este diagnóstico. Se analizan sexo, edad, antecedentes clínicos, síntomas, exámenes de laboratorio, tipo histológico, tratamientos, complicaciones y seguimiento. Las edades fluctuaron entre los 47 y 82 años (promedio de 64,8 años). El 53,8 por ciento fueron mujeres. El tabaquismo lamentablemente no se consigna en los ingresos. La hematuria fue el principal síntoma. El 100 por ciento presentaba hematuria en el examen de orina. El 19,2 por ciento estaban con metástasis al momento del diagnóstico. Casi todos los pacientes tuvieron manejo quirúrgico clásico de forma convencional o laparoscópica. El 100 por ciento tenían carcinoma de células transicionales. Las complicaciones perioperatorias fueron mínimas. No se registra mortalidad operatoria. Esta patología es un cáncer poco frecuente, que debe sospecharse ante toda hematuria, que es el principal motivo de consulta. Idealmente el diagnóstico debe ser precoz. Su manejo debe ser esencialmente quirúrgico.
Introduction: Upper urinary tract tumors are infrequent. However when present, they are usually related to transitional cell carcinoma. The purpose of this study was to analyze epidemiologic, clinic and therapeutic aspects of this disease in the Hospital Nacional Guillermo Almenara Irigoyen in Lima - Perú. Material and Methods: A Retrospective review of all our admissions between 1999 and 2005 was performed. A total of 26 patients were admitted with this diagnosis. Gender, age, clinical findings, pathology, treatment and follow-up are analyzed.Results: Mean age was 64,8 years (47-82 years), 53,8 percent were women. Tobacco consumption did not appear in the admission data. The chief complaint was hematuria and 100 percent had microscopic hematuria in the lab tests. Almost all the patients underwent surgery (mainly nephroureterectomy with partial cistectomy). All cases had transitional cell cancer. There were minimal complications and no surgical mortality. Conclusions: Carcinoma of the upper urinary tract is infrequent, must be suspected in the event of hematuria. Ideally diagnosis should be preoperative with histological confirmation. Most of the cases are transitional cell cancer, and management must be essentially surgical.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Carcinoma de Células de Transição/epidemiologia , Neoplasias Renais/epidemiologia , Neoplasias Ureterais/epidemiologia , Carcinoma de Células de Transição/cirurgia , Carcinoma de Células de Transição/patologia , Complicações Pós-Operatórias , Estadiamento de Neoplasias , Estudos Retrospectivos , Seguimentos , Neoplasias Renais/cirurgia , Neoplasias Renais/patologia , Neoplasias Ureterais/cirurgia , Neoplasias Ureterais/patologia , Peru/epidemiologia , Prognóstico , RecidivaRESUMO
OBJECTIVE: To determine the major dietary patterns associated with bladder cancer risk, we conducted a principal components analysis (PCA) in a case-control study from Uruguay. METHODS: A total of 255 newly diagnosed and microscopically confirmed cases of transitional cell carcinoma of the bladder and 501 hospitalized controls were included in the study. Both series were drawn from the four major public hospitals in Montevideo, Uruguay. Cases and controls were frequency matched on age and sex. Controls were submitted to factor (principal components) analysis. RESULTS: We retained three factors that explained 25.1% of the total variance (including error variance). The first factor was labeled as the sweet beverages pattern. This factor was characterized by high loadings of coffee, tea, and added sugar and was strongly associated with risk of bladder cancer (OR 3.27, 95% CI 1.96-5.45). The second factor was labeled as the Western pattern and displayed high loadings of red meat, fried eggs, potatoes, and red wine. This pattern was directly associated with risk of bladder cancer (OR 2.35, 95% CI 1.42-3.89). Finally, the third factor was labeled as the prudent pattern and showed high loadings of fresh vegetables, cooked vegetables, and fruits. This pattern was not associated with risk of bladder cancer. CONCLUSIONS: According to our study, non-alcoholic beverages were the strongest risk factor for bladder cancer, whereas the Western pattern was also associated with a significant increase in risk of bladder cancer.
Assuntos
Carcinoma de Células de Transição/epidemiologia , Dieta/estatística & dados numéricos , Neoplasias da Bexiga Urinária/epidemiologia , Distribuição por Idade , Bebidas , Carcinoma de Células de Transição/diagnóstico , Carcinoma de Células de Transição/patologia , Estudos de Casos e Controles , Café , Intervalos de Confiança , Educação , Análise Fatorial , Saúde da Família , Feminino , Humanos , Ilex paraguariensis , Entrevistas como Assunto , Masculino , Razão de Chances , Análise de Componente Principal , Fatores de Risco , População Rural/estatística & dados numéricos , Fatores Socioeconômicos , Inquéritos e Questionários , Chá , População Urbana/estatística & dados numéricos , Neoplasias da Bexiga Urinária/diagnóstico , Neoplasias da Bexiga Urinária/patologia , Uruguai/epidemiologiaRESUMO
OBJECTIVE: To determine the role of the habitual use of the most common artificial sweeteners (AS) in the development of urinary tract tumors (UTT) in Argentina. METHODS: Case-control study of 197 patients with histologically confirmed UTT of transitional varieties, and 397 controls with acute, non-neoplastic, and non-urinary tract diseases, admitted to the same hospitals in Córdoba (Argentina) between 1999 and 2006. All subjects were interviewed about their use of AS and their exposure to other known or suspected risk factors for UTT. RESULTS: Fifty-one UTT patients (26%) and 87 controls (22%) used AS. The risk of UTT was significantly increased in long-term (> or =10 years) AS users compared with none-AS users. The OR (95% CI) for long-term consumers was 2.18 (1.22-3.89) and for short-term users was 1.10 (0.61-2.00) after adjustment for age, gender, BMI, social status. and years of tobacco use. CONCLUSION: Regular use of AS for 10 years or more was positively associated with UTT.
Assuntos
Carcinoma de Células de Transição/induzido quimicamente , Edulcorantes/efeitos adversos , Neoplasias Urológicas/induzido quimicamente , Idoso , Argentina/epidemiologia , Aspartame/efeitos adversos , Carcinoma de Células de Transição/epidemiologia , Estudos de Casos e Controles , Ciclamatos/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Sacarina/efeitos adversos , Tiazinas/efeitos adversos , Neoplasias Urológicas/epidemiologiaRESUMO
BACKGROUND: Bladder cancer is the fourth most frequent malignancy among Uruguayan men. A previous study from Uruguay suggested a high risk of bladder cancer associated with maté drinking. We conducted an additional case-control study in order to further explore the role of non-alcoholic beverages in bladder carcinogenesis. METHODS: In the time period 1996-2000, 255 incident cases with transitional cell carcinoma of the bladder and 501 patients treated in the same hospitals and in the same time period were frequency matched on age, sex, and residence. Both cases and controls were face-to-face interviewed on occupation, tobacco smoking, alcohol drinking and intake of maté, coffee, tea, and soft drinks. Statistical analysis was carried out by unconditional multiple logistic regression. RESULTS: Ever maté drinking was positively associated with bladder cancer (odds ratio [OR] 2.2, 95% confidence interval [CI] 1.2-3.9) and the risk increased for increasing duration and amount of maté drinking. Both coffee and tea were strongly associated with bladder cancer risk (OR for coffee drinking 1.6, 95% CI 1.2-2.3; OR for tea drinking 2.3, 95% CI 1.5-3.4). These results were confirmed in a separate analysis of never-smokers. CONCLUSION: Our results suggest that drinking of maté, coffee and tea may be risk factors for bladder carcinoma in Uruguay.
Assuntos
Bebidas , Carcinoma de Células de Transição/epidemiologia , Ilex paraguariensis , Neoplasias da Bexiga Urinária/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Café , Fatores de Confusão Epidemiológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Fatores de Risco , Fumar/efeitos adversos , UruguaiRESUMO
Objetivo: Investigar alguns dados epidemiológicos do câncer vesical bem como fatores de risco. Métodos: Foram selecionados 125 pacientes atendidos no período 1980-2002, com idade média de 63,6 +/- 11,3 anos, sendo 97 (77,6 por cento) homens e 28 (22,4 por cento) mulheres. As proporções de tumor G1, G2 e G3 foram: 48 por cento, 35,2 por cento e 16,8 por cento, As proporções dos estádios da lesão primária foram: pTa-5 - 85 (68 por cento) e pT2-4 - 40 (32 por cento). Entre os pacientes com tumores superficiais houve recidiva eem 41 (48,2 por cento). Resultados: O grau da lesão primária mostrou relação com o estádio T (p<0,0001) e sobrevida (p<0,0001), mas não com a taxa de recidiva vesical dos tumores superficiais (p=0,72). O estádio T também mostrou forte correlação com a sobrevida (p<0,001). Conclusões: O CCT é mais comum em homens que mulheres e acomete pacientes com idade média de 63,9 anos. O grau e o estádio T mostram forte correlação com a progressão da doença e a sobrevida.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Carcinoma de Células de Transição/epidemiologia , Neoplasias da Bexiga Urinária , Idoso de 80 Anos ou mais , Recidiva , Estudos Retrospectivos , Fatores de RiscoRESUMO
El cáncer de vía urinaria alta (pelvis renal y/o uréter) es una neoplasia rara. Generalmente es del tipo células de transición. En la región norte de Chile, la incidencia de cáncer urotelial (vesical) es mayor en el resto del país. Concordantemente, la incidencia de cáncer de vía urinaria alta (CVUA) pareciera ser mayor. El objetivo de este trabajo es conocer los aspectos epidemiológicos, clínicos y de manejo de los pacientes institucionales con CVUA que han consultado en el Hospital Clínico Regional de Antofagasta (HCRA). Se revisaron retrospectivamente los ingresos al Servicio de Urología del HCRA entre el 1/1/1991 y el 31/12/2000. Se recuperaron 47 ingresos con este diagnóstico, descartándose 16 con datos incompletos. Se analizan sexo, edad, antecedentes clínicos, tabaquismo, síntomas, tiempo evolución, examen físico, exámenes de laboratorio e imagenológicos, tipo histológico, tratamientos, complicaciones y seguimiento. Se evaluaron 31 casos. Las edades fluctuaron entre los 33 y 89 años (promedio de 62,1 años). El 67,7 por ciento fueron hombres. El 80,6 por ciento eran de Antofagasta. El tabaquismo lamentablemente no se consigna en los ingresos. La hematuria fue el principal síntoma (61,2 por ciento). El 74,1 por ciento presentaba hematuria en el examen de orina. Pielografía de eliminación, ecografía renal, cistoscopia y TAC abdomino-pélvico se realizaron en más del 75 por ciento de los pacientes. La ureteroscopia se realiza escasamente (29,0 por ciento). Sólo 25,8 por ciento tenían confirmación previa al tratamiento. El 19,3 por ciento estaban con metástasis al momento del diagnóstico. El 67,7 por ciento fue sometido a cirugía (principalmente nefroureterectomía con cistectomía parcial). El 95 por ciento tenían carcinoma de células transicionales. Las complicaciones perioperatorias fueron mínimas. No se registra mortalidad operatoria. El seguimiento promedio es de 18,6 meses. El CVUA es un cáncer poco frecuente, que debe sospecharse ante toda hematuria, que es el principal motivo de consulta. Idealmente el diagnóstico debe ser precoz y preoperatorio, con confirmación histológica (ureteroscopia con biopsia). La mayoría son histológicamente carcinoma de células transicionales. Su manejo debe ser esencialmente quirúrgico