Notícias

Câncer de Bexiga

O que é?

É o segundo tumor urológico mais frequente, sendo o 4º tumor maligno mais comum nos homens e o 9º nas mulheres. São tumores relacionados ao tabagismo e algumas profissões, sendo mais incidente em alguns países da Europa.


Tipos

SUPERFICIAL: atinge somente a mucosa e submucosa da bexiga e raramente provoca metástase.

INFILTRANTE: quando acomete as camadas mais profundas da parede da bexiga, como a muscular e a gordura perivesical e tem o risco aumentado de apresentar metástases.

METASTÁTICO: com metástase (disseminação para outros órgão) em linfonodos ou a distância.


Sintomas

A perda de sangue na urina (hematúria) micro ou macroscópica é o sintoma principal, mas outros sintomas irritativos do trato urinário baixo, como polaciúria, disúria e urgência em urinar também podem aparecer. Outros sintomas gerais nos casos avançados como anemia, emagrecimento, massas pélvicas também podem estar presentes.


Diagnóstico

IMAGEM: o ultrassom abdominal e pélvico apresenta alta sensibilidade em tumores maiores que 0,5 cm, sendo de utilidade pelo baixo custo e não ser invasivo, além de avaliar a bexiga e o trato urinário superior, onde podem se encontrar tumores em 10% dos casos de carcinomas indiferenciados. A tomografia e a ressonância podem ser usados, mas são mais úteis no estadiamento que no diagnóstico do tumor de bexiga.

CISTOSCOPIA: o exame endoscópico da bexiga é o método padrão de diagnóstico e acompanhamento, mas pode não detectar tumores pequenos em até 25% dos casos, principalmente o carcinoma in situ, que é uma lesão hiperemiada, plana, de alto grau de agressividade.

CITOLOGIA URINÁRIA: empregada no diagnóstico e acompanhamento destes tumores após a terapia inicial. Tem alta sensibilidade em tumores agressivos e baixa em tumores de baixo grau (35%), tendo alta especificidade (94%). Na citologia positiva é muito alta a existência de tumor urotelial, mesmo com cistoscopia normal.

RESSECÇÃO TRANSURETRAL DO TUMOR: o diagnóstico definitivo é realizado através da cirurgia endoscópica pela uretra (RTU), mostrando pelo anátomo-patológico se o tumor é superficial ou infiltrativo.


Tratamento

TUMORES SUPERFICIAIS: os tumores de bexiga são superficiais em 70-80% no diagnóstico e são tratados com ressecção endoscópica das lesões. Deve se fazer exame de toda a bexiga e uretra na procura de outros tumores. A ressecção das lesões deve ser total e incluir tecido muscular para avaliação de acometimento deste ou não. As áreas suspeitas são biopsiadas do mesmo modo e, em caso de tumores indiferenciados com acometimento da submucosa (estadiamento T1GIII), nova ressecção deve ser realizada com intervalo de 3-6 semanas da primeira cirurgia.

TERAPIA INTRAVESICAL: os tumores superficiais apresentam grande risco de recorrência e podem progredir para tumores invasivos. Após a cirurgia endoscópica, a instilação de medicamentos intravesicais é empregada no sentido de se evitar recidivas ou progressão tumoral. Alguns medicamentos são empregados, principalmente o BCG (imunoterapia) e alguns quimioterápicos. Existem regimes variados do emprego destes medicamentos e o BCG pode ser utilizado, mais comumente, numa dose semanal de 40-120 mg / aplicação por seis semanas, devendo ser repetido se houver recorrência ou nos casos de tumores mais agressivos.

TUMORES INVASIVOS: nos casos de carcinomas de células transicionais invasivos e os outros tipos histológicos, por serem doença potencialmente letal, um tratamento agressivo deve ser instituído. A retirada da bexiga (cistectomia radical) juntamente com a próstata e vesículas seminais no homem e útero, ovários e parede vaginal anterior na mulher, acompanhados da retirada de linfonodos pélvicos, é o tratamento padrão, proporcionando sobrevida de até 85% em 5-10 anos se não houver metástases e de 35% se os linfonodos estiverem acometidos. A reconstrução urinária é realizada no mesmo momento da cirurgia radical e pode ser feita a neobexiga ortotópica (para a uretra), heterotópica (para a pele) ou conduto ileal de Bricker(também para a pele), dependendo do estado geral do paciente e acometimento ou não da uretra. Nos tumores metastáticos a quimioterapia pode ser usada, existindo alguns esquemas variados de tratamento, mas com baixa resposta terapêutica.

 

Fonte: Portal da Urologia

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