Una volta avuta la diagnosi di tumore della vescica con il medico curante andrà valutata la terapia a seconda dei casi: una cura “migliore” che funzioni per tutti non esiste e molto dipende dalla risposta individuale dell’organismo, dal tipo e dallo stadio di avanzamento del cancro oltre che dalle generali condizioni di salute del paziente. La chirurgia è a tutti gli effetti il metodo più utilizzato, in modo defifitivo o in combinazione con altri trattamenti.
Le terapie, cosa occorre sapere
I principali tipi di trattamento per il cancro della vescica sono la chirurgia, la terapia intravescicale, la chemioterapia e la radioterapia. E’ possibile che più di un trattamento possa essere eseguito (spesso alla chirurgia se ne abbina uno o più di uno). La chirurgia può spesso rimuovere i tumori della vescica allo stadio iniziale, ma rimane il rischio di metastasi. La rimozione totale della vescica (cistectomia radicale) aiuta ad evitarle, ma può avere effetti collaterali, per cui si può optare per una rimozione parziale ed altre terapie adiuvanti. Vediamo nel dettaglio.
Chirurgia per il cancro della vescica
La chirurgia è parte del trattamento per la maggior parte dei tumori della vescica. Esistono diversi tipi di operazione la cui scelta dipenderà dal tumore e dalla sua fase di avanzamento. Questi sono:
Chirurgia transuretrale
Si utilizza in fasi iniziali e per forme non invasive: è la TURBT o resezione transuretrale ed è la prassi più frequentemente utilizzata. Si fa in anestesia generale o regionale (dove la parte inferiore del corpo è intorpidita). Per questa operazione, un tipo di cistoscopio rigido chiamato resettoscopio viene inserito nella vescica attraverso l’uretra. Il resettoscopio ha un cappio alla sua estremità per rimuovere eventuali tessuti anormali o tumori. Il tessuto rimosso viene inviato ad un laboratorio per essere guardato da un patologo (biopsia). I tessuti che non possono essere rimossi vengono “bruciati”, “folgorati” attraverso il citoscopio con altre metodiche, tra cui il laser. Gli effetti collaterali post operatori sono lievi (dolore e sanguinamento durante la minzione) e passegggeri. La degenza è in media di 24 ore e si può tornare alle normali attività nell’arco di un paio di settimane. Questa operazione può essere ripetuta in caso di recidiva, ma alla lunga può portare complicanze (fino all’incontinenza).
Cistectomia
Quando il cancro della vescica è invasivo e già abbastanza diffuso si esegue la cistectomia (asportazione della vescica) che può essere parziale o radicale a seconda dei casi. Il più delle volte si esegue la seconda; se il tumore è molto invasivo si asportano anche i linfonodi e gli organi vicino. La cistectomia richiede anestesia generale e necessita di un’ospedalizzazione di circa 7 giorni, oltre che la ricostruzione della vescica per immagazzinare le urine. Questa può comportare un sacchetto esterno, uno interno con catetere e valvola per lo svuotamento o la ricostruzione ex -novo della vescica (attraverso una parte di intestino) che permette all’urina di seguire il vecchio percorso, ma tutto dipende da quanto e come il tumore è diffuso. In ogni caso si tratta di operazioni molto invasive che possono comportare effetti collaterali importanti non solo sul modo di urinare: negli uomini ad esempio può subentrare un deficit d’erezione e sterilità, mentre nelle donne una difficoltà dell’eccitazione. Vanno tenuti in considerazione poi gli effetti psicologici ed i rischi infettivi della stomia.
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Fonte: Cancer.org
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