Bladder cancer is the growth of abnormal tissue (tumor) in the bladder. Bladder cancer develops slowly and is more common in older people (60 years and older). Cigarettes and tobacco products contain many harmful substances and are responsible for almost half of bladder cancer cases.
Another known source of risk is occupational exposure to chemicals used in paint, metal and oil production. Having a higher risk does not necessarily mean that someone will get cancer. Sometimes bladder cancer occurs without any known cause.
Stages of the Disease
Tumors that grow into the space inside the bladder and have not advanced into deep tissues are called non-muscle invasive (Ta-T1 tumors) (See Figure). These tumors are superficial and represent the early stage. 75% of patients are diagnosed at this stage. In most cases, these tumors are non-aggressive and rarely spread to other organs, so they are not usually fatal, but they can reoccur (= recurrence) or develop aggressive features (= progression).
As the cancer grows into the bladder muscle and spreads to surrounding muscles, it becomes muscle-invasive bladder cancer. This type of cancer is more likely to spread to other parts of the body (metastatic disease) and is more difficult to treat. In some cases it can be fatal.
If bladder cancer spreads to other parts of the body, such as lymph nodes or other organs, it is called either locally advanced or metastatic bladder cancer. A cure is unlikely at this stage and treatment is limited to controlling the spread of the disease and reducing symptoms.
Signs and Symptoms
• Blood in the urine (hematuria) is the most common symptom. (It is important that it is painless, clot-free and intermittent.)
• Urinary tract symptoms such as painful urination or more frequent urination (Infection and stone disease must be excluded.)
• Pelvic pain in more advanced stages of bladder cancer, Some symptoms such as side pain, weight loss, or a feeling of a mass in the lower abdomen may be observed.
Tests that your doctor will request from you:
• Urine Analysis
• Urine Cytology (Necessity will be determined by your doctor). is determined.)
• Transabdominal Ultrasound (Can image masses larger than 5-10 mm in a full bladder. It cannot detect very small or superficial tumors (CIS). Ultrasound cannot replace CT urography or cystoscopy.)
• Computerized Urography with Tomography (It gives information about possible tumors in the kidney or ureters, and furthermore in the lymph nodes and abdominal organs. The scan takes about 10 minutes and uses x-rays. This imaging technique is the most accurate way to diagnose cancers in the urinary system.)
• Magnetic Resonance Imaging (MRI scans also show detailed images of soft tissues in the body. They use radio waves and powerful magnets instead of x-rays. MRI images are especially useful in showing whether cancer has spread to nearby tissues or lymph nodes outside the bladder.)
• Cystoscopy (The main test used to diagnose bladder cancer. It allows your doctor to look inside your bladder and urethra using a thin, lighted tube called a cystoscope.)
TREATMENT
ENG -MT (Endoscopic bladder tumor removal)
TURMT is the surgical removal (resection) of bladder tumors. This procedure is both diagnostic and therapeutic. It is applied endoscopically. The surgeon removes the tumor and any additional tissue that needs to be examined under a microscope (histological evaluation). TURMT is also therapeutic because complete removal of all visible tumors is a treatment for this cancer. Complete and accurate TURMT is important for good disease progression. In some cases, repeat surgery is required after 4-6 weeks.
Single dose, immediate instillation into the bladder after TURMT
If a superficial tumor can be completely and safely removed by TURMT and there is no sign of deep invasive growth, immediate instillation (instillation) can be performed after the procedure. It destroys tumor cells floating in the fluid after TURMT and kills residual tumor cells at the site of removal and from small tumors that were overlooked. This reduces the risk of recurrence of the disease. Single instillation is recommended if you have more than one tumor, if removal is required deep within the bladder wall, if the bladder may be perforated, or If postoperative bleeding is very severe, it is not performed.
Additional bladder instillation after TURMT
Additional intravesical chemotherapy depends on disease progression after surgery. If you are at low risk for recurrence and progression of the disease, a single dose instillation will be sufficient to reduce the risk of recurrence of the disease and this is the standard form of treatment. If you have a medium-risk tumor, a single dose instillation may not be sufficient and additional chemotherapy instillations may be required. The ideal number and frequency of chemotherapy instillations has not been defined.
Radical Cystectomy:
The main treatment for muscle-invasive (spread) bladder cancer is surgical removal of the urinary bladder. (See figure)
There are several reasons why your doctor may recommend removal of the entire bladder:
• Presence of a muscle-invasive tumor
• Multiple cancerous areas (multifocal), aggressively growing (high Presence of a tumor that is superficial or superficial but relapses after chemotherapy or immunotherapy
• Failure or recurrence or occurrence of serious side effects after a bladder-sparing approach (chemoradiation) having symptoms such as
Bladder removal involves removing the bladder, the ends of the ureters, and the pelvic lymph nodes. Depending on factors such as tumor location and type of urinary diversion, some of the adjacent sex-specific organs (prostate and seminal vesicles in men, the entire urethra, adjacent vagina and uterus in women) are removed. Men should be aware that prostate cancer is sometimes found in the removed prostate, but it usually does not affect long-term survival or treatment.
Bladder-Sparing Approaches
The bladder-sparing approach is still used in a small number of cases around the world. But it deserves consideration. Bladder preservation may be achieved at the expense of multiple therapies and their side effects. Transurethral resection of bladder tumor (TURMT) and radiation are used to treat or control the tumor locally. Chemotherapy kills cancer cells that may have already spread in the body (system It is used to treat microdisease. The aim is to preserve quality of life by preserving the bladder and its function without compromising cancer treatment.
Studies in selected patient groups have shown good results for bladder-sparing approaches; After failure of bladder-sparing therapy, approximately one-third of patients still undergo cystectomy.
Chemoradiation
Radiotherapy combined with sensitizing chemotherapy is a reasonable alternative for patients who are not candidates for cystectomy or who refuse surgery. To evaluate this approach, general condition (life expectancy), kidney function, previous radiation, previous abdominal operations, and other cancer history need to be taken into account. It is recommended to consult a radiation oncologist before deciding on this treatment.
Radiotherapy
Radiation therapy is an option for bladder preservation in patients who are not candidates for surgery or do not want surgery. The results of radiotherapy alone are worse than complete removal of the bladder, but if combined with chemotherapy (chemoradiotherapy), acceptable results can be achieved. Side effects; They include mild to severe irritation of the bladder and digestive tract, as well as urinary incontinence, increased risk of infection and fistulas (abnormal passages between organs).
Prevention of Bladder Cancer
Having a higher risk does not necessarily mean that a person will get cancer. Sometimes bladder cancer develops without a known cause. It is important to maintain a healthy lifestyle. If you smoke, try to quit. Follow workplace safety rules and avoid exposure to harmful chemicals. Some evidence suggests that drinking lots of fluids, especially water, may reduce the risk of bladder cancer. Eating a balanced diet with plenty of fruits and vegetables has health benefits and may protect against cancer.
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