The five senses in bladder cancer diagnostics

Bladder carcinoma (BC) is the second most common malignancy of the urinary tract in males after prostate cancer. Diagnosis is usually subsequent to patients' report of blood in the urine (macrohematuria) frequently without pain. Yet, macrohematuria may be also associated to other bladder conditions such as stones, infections, or benign tumors, and its presence may be intermittent or not assessable without a specific test (urinalysis), thus bleeding is sometimes diagnosed serendipitously during routine checkups. Bleeding in BC is caused by the presence of fragile tissue, but this is related neither to the stage nor to the extension of the neoplastic lesion. Other non-exclusive symptoms involve irritative bladder behaviors, such as changes in urination frequency, dysuria and urgency; in case of large cancers, lower back pain or inability to urinate may be present. Also in these situations, the abovementioned symptoms may be associated to other clinical conditions not related to BC. Thus, it is extremely important to verify its presence and to perform an accurate differential diagnosis. Hearing the patient, and accurately report all symptoms and possible risk factors during anamnesis (smoking, professional exposure to chemicals, persistent phlogosis) is thus crucial to address him/her to a specialist for more specific analyses. A reliable assessment of BC presence and stage may be obtained mainly by a visual, direct analysis of the bladder followed by subsequent evaluation of a specialist urologist, using cystoscopy, tomography, ultrasonography and urinary cytology. These techniques will be analyzed here and newest frontiers in their development will be explained. We will show an overview of the most used biological markers of BC traceable inside urine and used for both diagnosis and stadiation purposes, allowing to taste urine content and helping in both diagnosis and possible cure. We will illustrate the mechanism of action of a palpation device, that allows differentiating normal and cancer samples by touching a bioptic specimen. We will also describe a recently developed technique able to smell volatile molecules from the urine of patients and to help in diagnosis. Finally, we will describe recent advances in BC diagnostics obtained by electrical impedance spectroscopy.