What is Bladder Cancer?
The bladder (urinary bladder), which has a flexible structure,is the part where urine accumulates. After
After the urine is stored in the bladder, it is expelled from the body through the urethra. In this emptying process, the muscles that allow the bladder to stretch according to the amount of urine are also involved.
Uncontrolled proliferation of cells in the bladder for various reasons is called bladder cancer. Cancerous cells generally consist of uroepithelial cells in the urinary bladder and may spread to muscles, lymph nodes, surrounding tissues and organs in the future. The tumor can also affect the urinary system, often with the bladder.
The tumor can be benign (benign) or malignant (malignant). According to the researches, 95% of the total cases consist of malignant tumors. However, this disease, which can be treated before reaching the metastasis stage, has a high probability of recurrence. Bladder cancer is also one of the most common types of cancer in the excretory system.
Important risk factors for bladder cancer include age, gender, and race. This type of cancer is more common in older people, especially in individuals over 50 years of age compared to younger individuals. It has also been found that bladder cancer is up to 4 or 5 times more common in men than in women. Bladder cancer is the 7th most common type of cancer in men. Mortality rates, however, are just the opposite; The death rate from bladder cancer in women is higher than in men. Studies have also shown that most individuals with bladder cancer are Caucasian.
What are the Symptoms of Bladder Cancer?
Symptoms of bladder cancer are as follows:
o Hematuria (Light red or brown blood in the urine)
o Sudden urge to urinate
o Difficulty urinating
o Inability to urinate
o Pain or feeling of pain during urination
o Urinating more often than usual
Blood in the urine is the most common and obvious symptom of bladder cancer. Other symptoms can also be seen due to infections and diseases such as bladder stones. However, if there is blood while urinating, bladder cancer is directly involved.
In some cases, there are no symptoms, even if the cancer progresses. Symptoms such as severe back, leg, pelvic and abdominal pain, loss of appetite and sudden weight loss may indicate that the cancer has metastasized. Depending on the metastasis, the areas of pain may vary from patient to patient.
What Causes Bladder Cancer?
Like most types of cancer, the exact cause of bladder cancer is not known, but it is known that some factors can cause cancer:
o Medicines used regularly for various diseases, especially chemotherapy drugs
o Genetic factors
o Bladder stones
o Low daily fluid consumption
o Intense exposure to chemicals
o Bladder infections
o Eating foods high in oil and additives
The use of cigarettes and tobacco products and exposure to chemicals are the two most common causes of bladder cancer. The incidence of bladder cancer, which can also be seen in passive smokers, is 5-6 times higher in smokers than in non-smokers.
Exposure to chemicals, which is another of the factors that highly increase the risk of bladder cancer, includes individuals working in certain lines of business as a risk factor. Employees in industries and factories such as paint and chemical industry, textile, leather, printing and battery may be exposed to these chemicals.
What are the Types of Bladder Cancer?
bladder cancer; It is classified separately according to the cells in which cancerous tumors are seen in the bladder, the thickness of the bladder wall, the grade of the tumors and the development of the cancerous cells.
According to the cells in which cancerous tumors are seen, the types of bladder cancer are as follows:
Urothelial carcinoma, one of the most common types of bladder cancer, arises in urothelial cells. Since these cells, which are located in the inner part of the bladder, are also found in the urinary tract, tumors can be located throughout this region.
A rare type of bladder cancer, adenocarcinoma accounts for approximately 1% of total cases.
Squamous Cell Carcinoma
In some cases, chronic irritation of the bladder occurs. Complications due to prolonged use of catheters or inflammations lead to the appearance of squamous cells. This type, like adenocarcinoma, is very rare.
According to the thickness of the bladder wall, cancer types are classified as follows:
Invasive bladder cancer is the definition used for cases where the bladder muscle layer is involved or the tumor protrudes beyond the bladder. This type of cancer has a higher risk of metastasis. Therefore, metastatic evaluation should be performed in this group.
Cancers that are limited to the inner part of the bladder and do not involve the muscle layer are considered as non-invasive cancer. Generally early stage cancers
According to the grade of cancerous tumors, bladder cancer is classified as follows:
Low Grade Tumor
These tumors, called low grade, have a similar structure and appearance to standard cells. Tumors with a low risk of spreading towards the bladder wall generally develop slowly.
High Grade Tumor
High-grade tumors, which have an aggressive structure, have an abnormal appearance different from standard cells. These tumors can spread rapidly to different parts of the bladder.
Bladder cancer is also divided according to the way tumors develop:
Flat carcinoma, also known as carcinoma in situ, is one of the invasive bladder cancers. Tumors that spread towards the bladder wall and do not spread to the interior are called flat carcinomas.
Papillary Urothelial Carcinoma
These tumors, which spread only in the inner region of the bladder, arise in urothelial cells. Although cancerous cells usually remain in the bladder, they can metastasize in some cases.
Bladder Cancer Stages
Bladder cancer, within the framework of TNM classification; The tumor is divided into stages according to the degree and extent of spread, whether it has reached the lymph nodes in the inner region and metastasis status.
In Stage 0, also called superficial bladder cancer, cancerous cells are only seen in the bladder. However, this phase also has an aggressive form.
In stage I, cancerous tumors have not spread to lymph nodes, muscles, or any other organ other than the bladder. At this stage, tumors are seen in the inner layers of the bladder but in the deep parts. Like Stage 0, this stage is called superficial, as the cells spreading in the bladder can be destroyed by cystoscopy.
Although the tumors do not metastasize to any organ, they have spread to the bladder muscle and wall.
At this stage, where the spread to the tissues around the bladder is observed, the tumor has not yet made its way to the organs.
At this stage, tumors have spread to the pelvis and abdomen, as well as to the bladder. There is also metastasis to distant organs and tissues such as the liver and lungs.
What are Bladder Cancer Diagnostic Methods?
Urologists use methods such as biochemical laboratory tests, imaging methods, cystoscopy and biopsy for diagnosis. The place of physical examination in bladder cancer is limited, usually advanced bladder cancers can be detected by physical examination.
If the disease is suspected, first of all, laboratory and radiological tests are requested by doctors. These tests include urinalysis, various blood tests, and ultrasonography. If a bladder tumor is suspected in a patient with urinary bleeding, if no bladder tumor is detected in ultrasonography, computed tomography or MR urography can be performed. Another test that can be done is urine cytology. In urine cytology, it is looked for the presence of cancerous cells under the microscope. Even if all these tests are normal, the most important test to be done in a patient with suspected bladder cancer is cystoscopy. Cystoscopy is the procedure of seeing the inside of the bladder by entering the urethra with a camera. Cystoscopy, which is generally performed under local anesthesia, is also applied for biopsy by taking tissue samples.
Tissue sampling during cystoscopy is called transurethral resection (TUR). In addition to diagnosis, TUR, which is discovered at an early stage and used as a treatment method in non-invasive cancer types, allows taking samples from both the tumor in the bladder and the muscle tissue.
Diagnosing bladder cancer at an early stage greatly increases the likelihood of success in treatment.
How is Bladder Cancer Treated?
The treatment of bladder cancer is planned with different methods according to the type of cancer, its stage, metastasis status and the general health status of the patients. However, surgical methods are generally used in the treatment of the disease.
Transurethral Resection (TUR)
Transurethral resection (TUR) is a method of reaching the bladder from the urinary canal with the aid of a cystoscope. With this method, which is used both for diagnosis and for treatment in early stage cancer, it is aimed to destroy cancerous cells by giving an electric current.
After TUR operations, there is a risk of cancerous cells remaining in the bladder. Therefore, urologists may schedule chemotherapy to destroy these cells. Chemotherapy is usually administered directly into the bladder using a catheter. After an average of 8 weeks of chemotherapy, successful results are obtained in non-invasive cancers.
The cystectomy method, which is divided into radical and partial (segmental), is based on the removal of all or part of the bladder directly. Segmental cystectomy may be considered in patients with adeno cancer if only a limited portion of the tumor has invaded the bladder. It is not a suitable surgery for other bladder cancers. In this method, only the tumor parts of the bladder are removed and the patients continue to evacuate in their natural course.
In radical cystectomy, both the entire bladder and part of the ureter are removed. In some cases, the entire urinary tract can also be removed. Sections such as uterus and ovaries in women and prostate and seminal vesicles in men are taken.
There are some risks, especially in radical cystectomy operations. Such as infection, bleeding, erection problems in men, damage to surrounding tissues and organs, blood clots.
After radical cystectomy, urine flow in patients is again provided by surgical methods. The artificial bladder, which is usually obtained from the intestines, is connected to the urinary tract and the patients are allowed to urinate in their normal course.
Radiotherapy and Chemotherapy
It is a treatment method applied in patients with muscle involvement without distant metastasis and who do not want the bladder to be removed or cannot undergo surgery. It should not be forgotten that the success of surgery (cystectomy) in invasive bladder cancers is better than radiotherapy and chemotherapy.
Radiotherapy treatment in bladder cancer can be applied internally (internally) and externally (externally). In external applications, patients are exposed to standing beam, while internal applications require hospitalization. The rays, which are usually given with the help of implants from the urinary tract, are also applied by opening an incision in the abdomen in some cases.
Chemotherapy, like radiotherapy, is used to shrink or completely destroy cancerous cells. The difference between the two methods is that chemotherapy is a drug treatment. Depending on the condition of the patients, one or more drugs are used during chemotherapy.
Chemotherapy can also be applied before the operation, especially in some cases where radical cystectomy is deemed appropriate. In this way, it is aimed to shrink the tumor.
Immunological treatment is carried out with the use of drugs in order to ensure that the body's immune system is effective on cancerous cells. The drug, which is applied directly into the bladder with the help of a catheter, allows the cells in this area to fight cancerous cells.