Bladder Cancer

The following factors may increase the risk of developing bladder cancer:

• Smoking (the most important; responsible for ~50% of cases).
• Occupational exposure to aromatic amines (paint, rubber, leather industry).
• Chronic inflammation of the bladder (e.g. schistosomiasis, chronic catheterization).
• Previous radiation or chemotherapy with cyclophosphamide.

People with bladder cancer may experience the following symptoms or signs.

• Painless macroscopic hematuria (the most characteristic symptom).
• Discomfort during urination, frequent urination, dysuria (in some patients).
• Advanced stages: pelvic pain, ureteral obstruction, metastatic symptoms.

The following list describes options for diagnosing bladder cancer. Not all of the tests listed below are used for every person. Your doctor will consider the following factors when choosing a diagnostic test:

• The type of cancer suspected
• Your symptoms
• Your age and general health status
• The results of previous medical examinations

The following tests can be used to diagnose bladder cancer:

• Cystoscopy with biopsy (gold standard).
• Urine cytology examination.
• Imaging (CT urography, MRI).
• Molecular/urological markers (e.g. NMP22, BTA, FISH tests).

For most types of cancer, a biopsy is the only sure way for a doctor to know if an area of ​​the body has cancer.

Biopsy is the removal of a small amount of tissue for histological examination under a microscope. Only a biopsy can make a clear final diagnosis. A pathologist is a doctor who specializes in interpreting histological examination to evaluate cells, tissues, and organs for the purpose of making a final diagnosis.
There are several types of biopsies, which are classified based on the technique and/or size of the needle used to collect the tissue sample.

In addition to diagnosis, biopsy can provide additional information such as:

The staging of the disease ..

• Non-invasive (Ta, T1, CIS) – cancer is limited to the epithelium/submucosa.
• Invasive (≥T2) – the cancer extends into the muscularis mucosa or outside the bladder.

The prognosis depends on the stage and degree of differentiation.

• High recurrence rates (especially in non-invasive cases).
• Early diagnosis and regular monitoring are critical.

Not all tumors have the same treatment targets. To find the most effective treatment, your doctor may perform tests to identify the genes, proteins, and other factors in your tumor. This helps doctors better match each patient with the most effective treatment whenever possible. In addition, research studies continue to discover more about specific molecular targets and new treatments that target them.

Treatment often depends on the stage (how advanced) the cancer is. For example:

• Non-invasive : transurethral resection (TURBT) ± intravesical immunotherapy (BCG) or chemotherapy.
• Invasive : radical cystectomy + lymphadenectomy, neoadjuvant/adjuvant chemotherapy (cisplatin-based).
• Metastatic : systemic chemotherapy, immunotherapy (anti–PD-1/PD-L1), targeted therapies (e.g. FGFR inhibitors, NTRK inhibitors).

Targeted therapy is a treatment that targets specific genes, proteins, or the environment of cancer tissues that contribute to the growth and survival of the cancer. This type of therapy prevents the growth and spread of cancer cells and limits damage to healthy cells.

Molecular testing for bladder cancer is particularly useful in the following areas:

Treatment personalization – Allows the identification of targetable gene alterations (e.g. FGFR, NTRK), so that the patient can receive personalized treatments with greater effectiveness and fewer side effects.

Prognosis and response prediction – Molecular markers such as mutations in TP53 or PD-L1 expression help to assess which patients will respond best to chemotherapy or immunotherapy.

Participation in clinical trials – Molecular testing opens the door to experimental but promising treatments for patients with advanced disease.

In short, molecular testing is the “key” to the application of personalized medicine in bladder cancer, improving both the outcome and the quality of life of patients.

The tests are performed on the surgical specimen (paraffin cubes) or the biopsy material (paraffin cube) from which your histological examination was performed or on the aspiration material (FNAB, EBUS) from which your cytological examination was performed. In our fully integrated Laboratory, the pathologist selects the most appropriate & representative paraffin cube, ensuring that the most appropriate sample will be used for the tests. Qualitative and quantitative parameters are checked.

In case your sample is not already at Microdiagnostics archive, please contact us immediately so that we can arrange for its safe and rapid transport to our laboratory. You will also need to quickly and easily complete the Consent Form.

Most of the time, the sample material we are called upon to handle is small because it has resulted from a minimally invasive method (needle biopsy, fluid aspiration, paraffin block with minimal material).

In our laboratory, Pathologists check in a timely manner whether the material to be examined is sufficient. If so, then a management algorithm is followed, with the aim of achieving the performance of multiple tests on the material (Immunohistochemistry, real-time PCR, NGS) in order to fully check the molecular profile of your tumor (proteins, genes, histological Grading).

In this case, and once sample enrichment manipulations have been exhausted, we contact your clinician to discuss alternative approaches in order to obtain the desired information to select the optimal treatment for you. Some examples:

• Performing an alternative test (e.g. Immunohistochemistry instead of PCR, or choosing Next Generation Sequencing (NGS))
• Performing Immunohistochemistry instead of FISH (Fluorescent In Situ Hybridization) and tubulin
• Possible blood sampling instead of tissue testing (liquid biopsy)
• Possible option to take a new biopsy or puncture

Our team will undertake the quick and safe transport of the sample to our laboratory, please inform us at tel. 2310 232 272.

By cash, bank card, bank deposit, or Online interbank deposit.

One of the primary concerns at Microdiagnostics is the protection of your personal data as well as the strict observance of the conditions of protection of your genetic material and medical results. In full compliance with the General Data Protection Regulation (GDPR), we ensure that any test performed is done with your knowledge and consent and we do not communicate results over the phone.