Bladder cancer is a malignant tumor that develops from the epithelium of the bladder. The prevalence among all cancer diseases is 2-4% and is committed to 70% among the tumours of urogenital system. This cancer has a clear gender focus, affecting men 4 times more often than women and, consequently, bladder cancer is the 5th place in frequency of occurrence among all cancers in men and 11th in women.
In 90% of cases of malignant transformation of bladder cells to develop a tumor called transitional cell (urothelial) carcinoma. The remaining 10% are adenocarcinoma, squamous and glandular squamous cell carcinoma.
The content of the article
The major risk factors of bladder cancer
A risk factor is something that can increase the chances of getting cancer. Some of these people may impact on their own, adjusting their behavior to a more gentle to the body. Knowing this is important because the question is about life and death, how would it not sound pathetic. Remember them:
- Smoking. This is the most significant risk factor of bladder cancer. Smokers suffer from this disease in 3 (!) times more often than non-smokers. It is with the Smoking the opinion of oncologists, half of all detected cases of bladder cancer;
- Industrial hazards, among which the aromatic amines (benzidine and beta-naphthylamine), some organic chemicals used in the production of rubbers and dyes, leather, textile production;
- Urinary tract infections and kidney, bladder stones and other causes of chronic irritation. Schistosomes (bilharzia), an infection caused by the parasite Schistosoma hematobium, penetrating into the bladder, can also cause cancer;
- Family history (presence in the family of persons suffering from cancer). It is believed that the presence of certain genes (GST and NAT) can contribute to the transfer of bladder cancer by inheritance;
- Insufficient fluid intake. Most of the chemical pollutants excreted in the urine, if a little to drink, their concentration in the body is high, that can cause cancer.
Symptoms of bladder cancer
Cancer of the bladder (the scheme) In most cases, the first alarm bell is hematuria, that is, the appearance of blood in the urine secreted. Depending on the amount of blood the color of urine may vary from pale yellow-red or pinkish to dark red. In some cases the color of the urine is unchanged, but the blood is determined in the analysis of urine. Cases of the appearance of blood in the urine can be sporadic, once a week or even a month. If you have developed bladder cancer, blood will appear again. In the early stages of cancer almost no pain, and hematuria is the main marker of this disease. But seeing in his urine blood, should not fall into extremes: much more often it happens in benign tumors or stones in the kidneys or bladder. But a trip to the doctor in this case clearly required.
Signs of bladder cancer, which of course, are disorders of urination:
- increased frequency of urination;
- dysuria (pain or burning with urination);
- urgent need to urinate even if the bladder is empty.
In the more advanced stages bladder cancer may cause additional symptoms, such as pain in the lower back or the inability to urinate.
Diagnosis of bladder cancer
Cystoscopy in diagnosis of bladder cancer in men As the theater begins with a hanger, and the diagnosis of bladder cancer — with a physical examination and medical history. Following these consistent and thoughtful procedures, the doctor decides whether to send a patient for further investigation, which may include:
- The cystoscopy. The urologist inserts into the urethra cystoscope — a thin tube with a lens or micrometeorology at the end and propels it toward the bladder. Then the cystoscope is supplied sterile saline solution to stretch the bladder and to provide the doctor the opportunity to examine carefully its internal surface;
- Laboratory tests (microscopic examination of urine, urine culture, blood tests for tumor markers NMP22 and BTA, as well as on immune cells);
- Biopsy. Samples of it are taken most often during cystoscopy;
- Excretory urography. This x-ray study of the urinary tract that occurs after the injection of a special dye. In the future, it is excreted from the bloodstream by the kidneys and into the bladder. The dye delineates the boundaries of the bladder and can detect a tumor;
- Retrograde pyelogram. For this study into the bladder through the urethra catheter, in which the dye is fed into the bladder directly;
- Computer and magnetic resonance tomography;
- Ultrasound of the bladder;
- Bone scintigraphy.
Stages of bladder cancer
Staging of bladder cancer is the summation of all the characteristics and signs of its spread in the body. This process helps doctors to choose the right tactics of treatment and predict the outcome. Distinguish the following stages of this cancer:
The stage of bladder cancer (scheme)
- Stage 0 — the tumor is growing toward the center of the bladder without affecting the connective and muscular tissue;
- Stage I — tumor invades connective tissue located under the epithelium of the bladder, but has not yet reaches the muscular wall and regional lymph nodes;
- Stage II — the tumor penetrates the thin muscular layer of the bladder wall, but has not yet permeated it through and through and does not reach the adipose tissue surrounding the bladder;
- Stage III — the tumor reaches the adipose tissue and may spread into the tissues of the prostate, uterus or vagina, but not pelvic wall or abdominal cavity;
- Stage IV can occur in one of the following scenarios:
- the tumor has invaded through the bladder wall and spread to the pelvic wall and the abdominal cavity;
- cancer has regional lymph nodes but not distant organs;
- the tumor has penetrated to remote lymph nodes and to bones, liver or lungs.
The survival rate for bladder cancer
Survival rates are used by doctors in order to determine the likely outcome of the disease. Some patients want to know these figures, however, avoid this information, as they say, in much wisdom is much grief. However, we will provide you the indicators of the 5-year survival rate for bladder cancer cited the American cancer society:
- stage 0 — 98%;
- stage I — 88%;
- stage II — 63%;
- stage III — 46%;
- stage IV — 15%.
Treatment of bladder cancer
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.
Surgical treatment In the early stages of bladder cancer the first choice is transurethral resection. In this type of surgery to cut the stomach, you don’t need a resectoscope inserted into the bladder through the urethra. At the end of this tool has a wire loop for the removal of the tumor. After the operation it is necessary to take preventive measures to ensure the complete destruction of the tumor. The remnants of the tumor can be destroyed by fulguration (non contact moxibustion spark AC) or high-energy laser.
Side effects of transurethral resection of prostate — a small amount of bleeding and pain when passing urine — usually mild and well tolerated. Unfortunately, even successfully carried out, the procedure cannot guarantee the absence of recurrence in other parts of the bladder. If it happened more than once, after several resections of the bladder is scarred and loses a significant portion of their volume. As a consequence, frequent urination and urinary incontinence.
When invasive cancer may require complete or partial removal of the bladder — cystectomy. If the tumor invaded the muscle layer, but it is small in size and concentrated in one place, then you can do a partial cystectomy. A breach in the bladder is sutured, and regional lymph nodes are removed and examined for the presence of metastases. The main advantage of this type of surgery is preservation of the bladder of the patient and no need for reconstructive surgery. But the bubble volume decreases, which leads to more frequent urination. But there’s nothing you can do about it. Another disadvantage is the possibility of cancer’s return, but in a different location, which usually does not happen when a radical cystectomy, which involves the complete removal of the bladder together with the prostate (in men) and ovaries, the fallopian tubes, uterus and part of vagina (in women). Operation depending on circumstances can be performed traditionally through large incisions of the abdominal wall, and laparoscopically, if it is the size of the tumor.
But how patient will defecate in the complete removal of the bladder? The accumulation and discharge of urine is intended to provide reconstructive surgery, which combines several ways. So, an artificial bladder can be created from a small section of the ileum, making the hole — urostomy — on the front of the abdominal wall. There are other ways, but we will tell about them another time, but for now move on to the next method of treatment of bladder cancer.
Intravesically the essence of therapy is to place the drug directly into the bladder through a catheter. This method is feasible only in the early stages of bladder cancer (stages 0 and I), because the drug is not beyond the bladder, and the tumor in advanced stages, as a rule, spread beyond. Distinguish intravesical immunotherapy and chemotherapy.
The most effective method intravesically immunotherapy is vaccination with the Bacillus of Calmette-Gerena or BCG. Yes, BCG is known primarily as a tuberculosis vaccine, but direct introduction 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 six weeks.
When intravesically chemotherapy drug is injected through the catheter into the bladder, where the bat begins to destroy actively growing cancer cells. Most often intravesically used chemotherapy drugs such as Mitomycin and Thiotepa. In the more advanced stages of cancer, when you need to influence not only locally but also systemically, chemotherapy drugs are administered orally or injecting.
Intravesically chemotherapy is a method of local impact on the tumor. But if the cancer has already metastasized to distant from the primary location of the tumor tissues and organs, necessary to act on the whole body. Yes, it is fraught with a “bouquet” of side effects, but in the case of III or IV stages of cancer to choose no longer necessary. Chemotherapy for bladder cancer is used in the following cases:
- before surgery to reduce tumor size to make it easier to remove (called neoadjuvant therapy);
- after the operation (or in some cases, after a course of radiation therapy) for “scrubbing” from the body residues of cancer cells (adjuvant therapy);
- in conjunction with radiation therapy to create synergies;
- at advanced stages of cancer to destroy metastases.
As a rule, for the treatment of bladder cancer as an option of radiation therapy uses external beam radiation therapy, in which irradiation of the tumor is performed by an external source.
Radiation therapy is similar to conventional x-ray examination, but the level of radiation here is much stronger. The procedure itself is painless and takes only a few minutes. Most often, the sessions of radiation therapy administered 5 times a week for several weeks.
Radiation therapy for bladder cancer using:
- as part of the treatment for early stage cancers after surgery;
- as a primary treatment for early stage cancers in patients who for some reasons can not be subjected to surgical intervention;
- as part of the induction treatment in advanced stages of cancer;
- as palliative treatment for advanced stages of cancer to ease the suffering of the patient.
Often radiotherapy is combined with chemotherapy, which increases the effect of both treatments.
In conclusion, some useful information. Many cancer survivors are interested in whether the change in lifestyle (healthy daily routine, healthy diet, moderate exercise, enough rest, avoiding harmful habits) to some degree to reduce the likelihood of recurrence. Unfortunately, it can only be assumed, because there is very little evidence supporting this assumption. This, of course, does not mean that it is necessary to let it go, just this aspect of cancer is still poorly understood. Most studies focused on primary prevention of cancer, not to prevent its recurrence.