The bladder is a hollow organ made up of muscles, where the urine filtered from the kidney is stored and excreted. Bladder cancer most commonly arises from the cells lining the inner surface of the bladder (transitional epithelium).
How Many Different Types of Bladder Cancer Are There?
Three different types of cancer can develop from the bladder.
- Alternative epithelial cell carcinoma: Cancer originates from cells called epithelial cells that line the inner surface of the bladder. It is the most common type of bladder cancer.
- Squamous cell carcinoma (Squamous cell carcinoma): Cancer arises from squamous epithelial cells after the bladder is exposed to infection and irritation for a long time.
- Adenocarcinoma: This type of cancer arises from secretory cells in the bladder. These secreting cells are called glandular cells.
What are Benign (Benign) Tumors of the Bladder?
There are many benign tumors that can occur in the bladder :
Papilloma of the Bladder
Papilomas, known as warts, are common skin tissue growths of viral origin. Generally considered harmless, bladder papilloma arises from uroepithelial cells lining the urinary tract. Bladder papilloma, called inverted (inverted) papilloma, has a smooth surface and tends to grow into the bladder wall. There may be a predisposition to this tumor in women compared to men. Leiomyomas are tumors that generally arise from smooth muscle cells. Over time, they grow and cause obstruction in some parts of the bladder, and as a result of this obstruction, a number of symptoms called obstructive symptoms such as increased frequency of urination may occur.
Bladder Fibroma
Bladder fibromas are tumors arising from the connective tissue in the bladder wall.
Hemangioma of the Bladder
The occurrence of hemangioma in the bladder is not a common condition. Hemangiomas are enlargements of blood vessels and are lesions that are usually present from birth. Depending on this tumoral formation, it can be seen as having intense blood in the urine, which is expressed as gross hematuria. Symptoms may occur.
Neurofibroma of the Bladder
Neurofibromas are rare and benign tumoral formations. These tumors usually arise from nerve cell sheaths.
Lipoma of Bladder
Lipoma refers to tumors occurring in adipose tissue. Lipomas, which usually occur due to excessive proliferation of fat cells, do not cause symptoms unless they press on any organ or structure.
What is the Incidence of Bladder Cancer?
Bladder cancer can occur at any age, including childhood. . However, its incidence generally increases in middle and advanced age.
Bladder cancer is seen 3 times more frequently in men than in women. It is the fourth most common cancer in men after prostate, lung and colon cancers. It accounts for approximately 7% of cancer cases in men. It is the ninth most common cancer in women and constitutes 2.5% of all cancer cases.
What are the Risk Factors for Bladder Cancer?
It has been reported that many tumor suppressor genes play a role in the formation of bladder cancer. Today, the most important tumor suppressor genes shown to be associated with bladder cancer formation are TP53 and cell cycle inhibitors RB, P21, P27 and P16.
Exposure to environmental carcinogens is very important in the development of bladder cancer. Bladder cancer is more common in chimney sweeps, plastic and rubber industry workers. In addition, bladder cancer is 4 times more common in smokers than non-smokers.
How does bladder cancer manifest?
The most common finding is painless bleeding in the urine. Painless and intermittent bleeding in the urine occurs in approximately 85% of patients. Complaints such as frequent urination, burning while urinating, and difficult urination may also be the first symptoms of bladder tumor. With bleeding, clots may come from the urine. In addition to these, pain in the lower abdomen or waist region may accompany these complaints.
How to Diagnose Bladder Cancer?
Urine tests have an important place in the diagnosis. The presence of blood cells (erythrocyte) in the urine in the complete urinalysis should reveal the suspicion of tumor.
Urine Cytology; It is a method of examining the urine by a pathologist and detecting cancer cells.
Today, it is used in diagnosis. There are some urine tests available. Of these, BTA stat and NMP22 are tests that are also used in our country. However, their sensitivity is low for small tumors. Others are ImmunoCyst and UroVision DNA FISH tests. ImmunoCyst probably has the highest sensitivity for small and low-grade cancers, while UroVision DNA FISH has the highest specificity.
Cystoscopy; It is the easiest and safest method for definitive diagnosis when a bladder tumor is suspected. By entering the urinary tract (urethra) with an optical instrument, the inside of the urinary bladder can be seen with 8-10 times magnified images. Flexible cystoscopy is a simple but very valuable diagnostic method that can be performed even under local anesthesia.
Imaging methods are also used for diagnosis. The simplest imaging method in the diagnosis of bladder tumor is abdominal ultrasonography (Abdominal Ultrasonography). The tumor reaching a certain size can be visualized by ultrasonography. Other methods are Computed tomography (CT/CT), Magnetic Resonance (MRI) and Intravenous Urography (IVP). In addition, Positron Emission Tomography (PET) is very useful in showing the extent of the spread of this disease.
How is Bladder Cancer Treatment Organized?
When a bladder tumor is suspected, it is entered through the urinary tract under general/lumbar anesthesia. the tumor should be resected (Transurethral Resection: TUR). Tumor tissues resected with the help of electrocautery should be sent for pathological examination. In some cases, biopsy should be taken from the normal areas of the urinary bladder.
TUR can provide a permanent improvement in superficial tumors (Ta, T1). However, in the presence of more than one tumor or when the tumor diameter is larger than 4 cm, the risk of recurrence is higher, and in these patients, the bladder should be washed with a drug solution such as Mitomycin or Immune BCG once a week for 6-8 weeks.
If the tumor has infected the muscle layers (T2, T3) Complete removal of the bladder (Radical Cystectomy) followed by bowel bladder is the most ideal treatment method, especially in young and well-rounded patients. This postoperative orthotopic bladder (intestinal bladder connected to the urinary tract) is the best method in terms of patient comfort in suitable patients.
Ileal loop (the method in which the bladder is carried in the abdomen) should be performed in patients who are not suitable for this. These surgeries are nowadays laparoscopic or even robotic. Systemic chemotherapy and/or radiotherapy should be applied to patients who are not suitable for radical cystectomy or who have metastasis, that is, spread to other organs.
There is always a risk of recurrence in a patient with bladder tumor... Therefore, patients should be periodically periodically should be followed. Accordingly, regular urine tests and control cystoscopy should be performed. In patients diagnosed with superficial tumors, a situation may occur in which the bladder must be completely removed, albeit a little, during their future life. This risk is less in low-grade tumors and higher in high-grade tumors.
Especially in high-grade tumors, there is a small possibility of tumor formation in the upper urinary system, namely the renal pelvis and the ureters, where urine is collected and transmitted. For this reason, kidneys should also be examined every 2 years.
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