Bladder cancer – a malignant tumor that develops from the epithelium of the urinary bladder. The prevalence of all cancer is 2-4% and tends to 70% of tumors of the genitourinary system. This oncopathology has a clear gender focus, hitting the men 4 times more often than women and, accordingly, bladder cancer is the 5th most frequent occurrence of all forms of cancer in males and 11th in females.
In 90% of cases of malignant transformation of cells of the bladder it develops a tumor called transitional cell (urothelial) carcinoma. The remaining 10% are adenocarcinoma, squamous and glandular squamous cell carcinoma.
Major risk factors for bladder cancer
Risk factors – it is something that can improve the chances of getting cancer. Some of these people can affect their own, adjusting their behavior to a more gentle to the body. Knowing this is important because a question of life and death, as though it may sound pathetic. Remember them:
- Smoking. This is the most significant risk factor for developing cancer of the bladder. Smokers suffer from this disease in three (!) Times more likely to smoking. It is associated with smoking oncologists half
of all detected cases of bladder cancer;
- Industrial hazards, including aromatic amines (benzidine and beta-naphthylamine), some organic chemicals used in the manufacture of rubber and dyes in the leather, textile production;
- Infections of the urinary tract and kidneys, bladder stones, and other causes of his chronic irritation. Schistosomiasis (bilharzia), an infection caused by the parasite Schistosoma hematobium, penetrating into the bladder can also cause cancer;
- Family history (in the presence of old people suffering from this type of cancer). It is believed that the presence of certain genes (GST or NAT) may contribute to the transfer of the bladder cancer is inherited;
- Inadequate fluid intake. Most of the chemical contaminants excreted in the urine, if the drink little, their concentration in the body is high, which can cause cancer.
Symptoms of bladder cancer
Bladder cancer (scheme) In most cases, the first alarm bell is hematuria that is blood in the urine secreted. Depending on the amount of blood urine may change color from pale yellow-red or pink to dark red. In some cases, the color of urine remains constant, but the blood is determined by urinalysis. Cases of blood in the urine may be sporadic, once a week or even a month. If a person has developed cancer of the bladder, the blood must appear again. In the early stages of cancer pain is practically no, and hematuria is the main marker of the disease. But when he saw the blood, should not be in his urine immediately go to extremes: it is much more often the case with benign tumors or stones in the kidneys or bladder. But the trip to the doctor in this case is clearly needed.
Signs of bladder cancer, which naturally include urinary disorders:
- increasing the frequency of urgency;
- dysuria (pain sensation or burning sensation when urinating);
- urgent need to urinate even when the bladder is empty.
In more advanced stages of bladder cancer may cause additional symptoms, such as pain in the lower back or the inability to urinate.
Diagnosis of bladder cancer
As the theater begins with a hanger, and the diagnosis of bladder cancer – a physical medical examination and the study of history. After these procedures, coherent and thoughtful physician decides whether to send the patient for further examination, which may include:
- Cystoscopy. Urologist enters the urethra cystoscope – a thin tube with a lens or mikrovideokameroy at the end and moves it toward the bladder. Then, a cystoscope is supplied sterile saline solution to stretch the bladder and to the doctor the opportunity to scrutinize its inner surface;
- Laboratory tests (microscopic examination of urine, urine culture, blood tests for tumor markers of BTA and NMP22, as well as on immune cells);
- Biopsy. Samples are taken to carry it out more often during cystoscopy;
- Excretory urography. This X-ray study of the urinary tract, conducted after the administration of a specific dye. Further it appears from the bloodstream by the kidneys and into the bladder. The dye outlines the boundaries of the bladder and can detect a tumor;
- Retrograde pyelogram. catheter is inserted for this research into the bladder through the urethra, in which the dye is applied directly to the bladder;
- The computer and magnetic resonance imaging;
- Ultrasound of the bladder;
- Bone scintigraphy.
Stages of cancer of the bladder Staging bladder cancer is the summation of all the characteristics and features of its distribution in the body. This process helps doctors choose the right tactics treatment and predict its outcome. Distinguish the following stages of this cancer:
- 0 stage – a tumor growing toward the center of the bladder, without affecting the connective and muscular tissue; Stage I – Tumor invades connective tissue beneath the epithelium of the bladder, but has not yet reached the muscular wall and regional lymph nodes;
- Stage II – The tumor penetrates the thin muscle layer of the bladder wall, but still does not permeate through it and does not reach the fatty tissue surrounding the bladder;
- Stage III – tumor reaches fat and can spread in the tissue of the prostate, uterus or vagina, but not in the pelvic wall or abdominal cavity;
- Stage IV can take place in one of the following scenarios:
- tumor sprouted through the bladder wall and spread to the pelvic wall and the abdominal cavity;
- tumor struck regional lymph nodes, but not to distant organs;
- in tumor infiltrated lymph nodes and bone, liver or lungs.
The survival rate for bladder cancer
Survival rates are used by doctors to determine the likely outcome of the disease. Some patients want to know these numbers, while others avoid this data: as they say, in much wisdom is much grief. Nevertheless, we will give you a 5-year survival rates for bladder cancer, given by the American Cancer Society:
Stage 0 – 98%;
Stage I – 88%;
Stage II – 63%;
Stage III – 46%;
Step IV – 15%.
Treatment of cancer of the bladder
In the fight against bladder cancer oncologists can use surgery, intravesical therapy, chemotherapy and radiation therapy. Let’s talk about each of these methods in more detail.
In the early stages of bladder cancer by the method of first choice is transurethral resection. Under this type of surgery is not required to cut the belly: resectoscope is introduced into the bladder through the urethra. At the end of this tool has a wire loop to remove the tumor. After surgery, you need to take preventive measures to ensure the complete destruction of the tumor. The remains of the tumor can be destroyed by fulguration (burning non-contact AC spark), or high- energy laser.
Side effects of transurethral resection – slight bleeding and pain during urination – usually mild and well tolerated. Unfortunately, even the successfully conducted procedure can not guarantee the absence of recurrence in other parts of the urinary bladder. If this happened, more than once, then after a few resections bubble covered with scars and lose much of their volume. As a result – frequent urination and urinary incontinence.
If invasive cancer may require the complete or partial removal of the bladder – cystectomy. If the tumor was struck by the muscular layer, but it is small and concentrated in one place, you can do a partial cystectomy. “Gaps” in the bladder sutured, and the regional lymph nodes are removed and examined for the presence of metastases. The main advantage of this type of surgery – to save the patient’s bladder, and no need for reconstructive surgery. But the volume of the bubble decreases, which leads to more frequent urination. But there’s nothing you can do about it. Another shortcoming – the possibility of cancer returning, but in a different place, which is not usually the case with radical cystectomy, which provides for the complete removal of the bladder along with the prostate (in men) and the ovaries, fallopian tubes, uterus and the vagina (in women). The operation in case may be carried out as usual, through a large abdominal incision, laparoscopic and if allowed tumor sizes.
But how can the patient be with their physical needs with complete removal of the bladder? Accumulation and discharge of urine is intended to provide reconstructive surgery, which brings together a number of ways. Thus, an artificial bladder can be created from a small section of the ileum, making outlet – urostomy – on the front of the abdominal wall. There are other ways, but we will tell about them another time, but for now go to the next method of treatment of bladder cancer.
The essence of intravesical therapy is drug room directly into the bladder through a catheter. This method is justified only in the early stages of bladder cancer (stage 0 and I), as effect of the drug does not go beyond the bladder, and in advanced stages of tumor has usually spread beyond. There are intravesical immunotherapy and chemotherapy.
The most effective method of intravesical immunotherapy is vaccination bacillus Kalmetta-Guerin or BCG. Yes BCG is known primarily as a TB vaccine, but direct administration into the bladder it mobilizes cells of the immune system to destroy cancer cells. Treatment usually begins a few weeks after transurethral resection and lasts about one and a half months.
When intravesical chemotherapy drug is injected through the catheter into the bladder, where the bat starts to destroy actively growing cancer cells. Most often in the framework of intravesical chemotherapy using drugs such as thiotepa and mitomycin. In more advanced stages of cancer, when it is necessary to work not only locally but also systemically, chemotherapy drugs are administered orally or by injection.
Intravesical Chemotherapy – a method of a local effect on the tumor. But if the cancer has given metastasis to distant location from the primary tumor tissues and organs, it is necessary to work on the whole body. Yes, it is fraught with “bouquet” of side effects, but in the case of III or IV stages of cancer do not have to choose. Chemotherapy for bladder cancer is used in the following cases:
- before surgery to reduce the tumor size for ease of removing it (the so-called neoadjuvant therapy);
- after operation (or in some cases – after radiotherapy) for the “scrubbing” of organism remnants of cancer cells (adjuvant therapy);
- together with radiotherapy to generate synergies;
- running on stages of cancer to destroy metastases.
Generally, for the treatment of bladder cancer radiotherapy alternatively using outdoor teletherapy at which irradiation of the tumor is performed through an external source.
Radiation therapy is similar to conventional X-ray examination, but the level of radiation is much stronger. The procedure itself is painless and takes only a few minutes. In most cases radiotherapy sessions administered five times a week for several weeks.
Radiation therapy for bladder cancer used:
- as part of treatment of cancer in the early stages after surgery;
- as the primary treatment for early stages of cancer in patients who, for whatever reason, can not be subjected to surgery;
- as part of induction therapy in advanced stages of cancer;
- as palliative therapy to advanced cancer stages to ease the patient’s suffering.
Often radiation therapy combined with chemotherapy – it improves the effect of both treatments.
Finally – some useful information. Many patients who have had cancer are interested in whether a change of lifestyle (regular daily routine, a healthy diet, moderate exercise, sufficient rest, avoiding harmful habits) to some extent reduce the chance of relapse. Infortunately, this can only assume, since there is very little evidence to support this assumption. This, of course, does not mean that it is necessary in advance to let it go, just this aspect of cancer is still poorly understood. Most studies have focused on the primary prevention of cancer, rather than to prevent its recurrence.
Read about: Colorectal Cancer
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