What you need to know about bladder cancer

Bladder cancer - symptoms and treatment

More than 90 percent of bladder cancer begins in the cells that form the inner lining of the bladder wall. Bladder cancer can be treated with surgery, chemotherapy, intravesical chemotherapy, immunotherapy, or radiotherapy.

Each year in the United States, bladder cancer affects about 56,000 men and 17,500 women, and about 12,000 men and 4,700 women die from this disease.

Smoking is not the main culprit Lung Cancer Not only does it have a role in urinary system cancers, the most important of which is bladder cancer. Also, read with us to learn more.

What is bladder cancer?

The bladder, a hollow organ in the lower part of the abdomen, acts as a reservoir for urine until it exits the body through the urethra.

There are different types of bladder cancer. Each type of cancer is named according to the type of cancer cells causing it. There is transitional cell carcinoma, squamous cell carcinoma or adenocarcinoma - according to the types of cells that line the lining cells where the cancer originates.

Most bladder cancers (more than 90 percent) begin in transitional cells that occupy the inner lining of the bladder wall. In some cases, cancers that arise from these cells lining the bladder can invade the deeper layers of the bladder (called the lamina propria), the thicker muscular layer of the bladder, or the bladder wall into the fatty tissue that surrounds the bladder.

Squamous cells are thin, flat cells that line the urethra and can form in the bladder after prolonged episodes of cystitis or irritation. Squamous cell carcinoma makes up about 5 percent of bladder cancers.

Adenoma is a very rare type of bladder cancer that begins in the glandular (exocrine) cells in the lining of the bladder. Only 1 percent to 2 percent of bladder cancers are adenocarcinomas.

Bladder cancer diagram
Bladder Cancer

What are causes and risk factors for bladder cancer?

Certain factors increase the risk of bladder cancer:

  • Cigarette smoking is the biggest risk factor. It doubles the risk. Smoking pipes, cigars, and exposure to second-hand smoke may also increase the risk of infection
  • Previous exposure to radiation is the next most common risk factor (for example, as treatment forcervical cancer or prostate cancer or rectal cancer)
  • Some chemotherapy drugs (such as cyclophosphamide) also increase the risk of bladder cancer
  • Environmental exposure increases the risk of bladder cancer. People who handle carcinogenic chemicals, such as aromatic amines (the chemicals used in dyes) are at risk. It also appears that extensive exposure to rubber, leather, some textiles, paint, and hairdressing supplies, usually associated with occupational exposure, increases the risk.
  • Infection with a parasite known as Schistosoma haematobium, which is more common in developing countries and the Middle East
  • It may be people who suffer from Urinary tract infections recurring bladder stones, or other Urinary Tract DiseasesThose who have a chronic need for a catheter in the bladder are more likely to develop squamous cell carcinoma.
  • Patients with previous bladder cancer have an increased risk of developing new or recurring bladder tumors.
  • Other risk factors include diets rich in fried meat and animal fats, and older adults. In addition, men are at three times higher risk than women.

What are the symptoms of bladder cancer?

In general, symptoms of bladder cancer are non-specific. Some symptoms of bladder cancer are also symptoms of other conditions, and they should prompt you to see your doctor.

The presence (appearance) of blood in the urine is the most important warning sign. Other symptoms include pain during urination, frequent urination, or difficulty urinating.

What are the stages of bladder cancer?

Bladder cancer can be either early-stage (confined to the bladder lining) or invasive (penetrates the bladder wall and may spread to nearby organs or lymph nodes).

The stages range from T1 (confined to the inner lining of the bladder) to T4 (the most invasive advanced stage). In the early stages (TA, T1, or CIS), the cancer is confined to the lining of the bladder or to the connective tissue just below the lining, but it has not invaded the main wall of the bladder (muscle).

Stages II through IV refer to invasive cancer:

In the second stage, the cancer has spread to the muscular wall of the bladder.

In stage III, the cancer has spread to fatty tissue outside the bladder muscle.

In stage IV, the cancer has spread from the bladder to lymph nodes, nearby organs or bones.

The more advanced and preferred staging system is known as TNM, which stands for tumor stage, lymph node involvement, and metastasis. In this system:

Gas bladder tumors can range from T2 (metastasize to the main muscle wall of the bladder below the lining) all the way to T4 (tumor spread outside the bladder to nearby organs or the lateral pelvic wall).

Lymph node involvement ranges from N0 (no lymph node involvement) to N3 (cancer in many lymph nodes, or in one or more large lymph nodes larger than 5 cm).

M0 means that there is no metastasis outside the pelvis. M1 means that it has spread outside the pelvis.

Bladder cancer stages according to the extent of the tumor cells

What tests will I do if my doctor suspects bladder cancer or another urinary problem?

Your doctor will order a urinalysis to determine if a UTI could be the cause of your symptoms. A microscopic examination of your urine, called cytology, will look for cancer cells.

The cystoscopy test plays a key role in identifying and diagnosing bladder cancer. In this procedure, a lighted telescope (cystoscope) is inserted into the bladder from the urethra to see inside. When done under sedation, tissue samples (biopsy) are taken, which are then examined under a microscope for signs of cancer.

When this procedure is done in a doctor's office, a local anesthetic gel is placed in the urethra before the procedure to reduce discomfort.

If bladder cancer is diagnosed, the next step is to remove the tumor for detailed staging and diagnosis.

Transurethral resection (TURBT) is a leading urology procedure that is performed under general or spinal anesthesia in an operating room. A telescope is inserted into the bladder and the tumor is removed by scraping it from the bladder wall (part of the bladder wall is removed with it), using a special cystoscope (called a resectoscope). This procedure is diagnostic as well as therapeutic.

This can often be done as an outpatient procedure, in which patients are discharged from the hospital on the same day. After removal, the tumor is analyzed by a pathologist, who will determine the type of tumor, the degree of tumor (aggressiveness), and the depth of invasion. The purpose of the procedure is to remove the tumor and to obtain important staging information (such as tumor grade and depth of invasion).

For some patients with invasive cancer, a CT scan of the abdomen and pelvis may be the next step to determine if there has been any spread of the disease beyond the bladder.

An MRI, which uses magnets, radio waves and a computer to take detailed pictures, may also be done, and is useful in planning additional treatment.

A chest X-ray may also be done to find out if any cancer has spread to the lungs. Sometimes, bone imaging may be done to look for malignant spread (metastasis) of the cancer to the bones. Most of these tests are used selectively, that is, only in certain patients with related symptoms.

Once bladder cancer is diagnosed, the disease is staged using the tests listed above. The stage of the disease will determine the course of treatment.

Transurethral resection of bladder cancer (TURBT)
Transurethral resection (TURBT)

What are the treatment options for bladder cancer in Turkey?

There are four types of treatment for bladder cancer patients. These include:

  • surgery surgery
  • chemotherapy
  • Intravesical chemotherapy or immunotherapy for superficial cancer.
  • Radiation therapy.

Sometimes, combinations of these treatments will be used.

Surgical options for bladder cancer treatment in Turkey

Surgery is a common treatment option for bladder cancer. The type of surgery chosen depends on the stage of the cancer.

. is often used Transurethral cystectomy In the early stage of the disease (TA, T1 or CIS). It is performed under general anaesthesia or lumbar anaesthesia.

In this procedure, a special telescope called a resectoscope is inserted through the urethra into the bladder. The tumor is cut by it.

Partial cystectomy It is the removal of part of the bladder. Sometimes, it is used when a single tumor has invaded the bladder wall in only one area of the bladder. This type of surgery preserves most of the bladder. Chemotherapy or radiation therapy is often used together. Only a minority of patients are suitable for this bladder-conserving procedure.

Radical cystectomy It is the complete removal of the bladder. It is used to treat invasive and metastatic cancers outside the bladder (or multiple early-stage tumors over a large part of the bladder).

In Turkey, this surgery is often done using a robot that removes the bladder and any other surrounding organs. Such as the prostate and seminal vesicles in men, and the ovaries, uterus and part of the vagina in women.

Since the bladder is removed, a procedure called a urethral diversion must be performed so that urine can exit the body. A bag made of intestines can be made inside the body, or a leak-proof bag worn outside the body can be used to collect urine. The procedure usually requires a hospital stay of five to six days.

Chemotherapy for bladder cancer

Chemotherapy tends to use combinations of drugs whose main effect is to either kill or slow the growth and reproduction of rapidly multiplying cells. Cancer cells absorb chemotherapy drugs faster than normal cells (but all cells in the body are exposed to chemotherapy drugs). Chemotherapy drugs are given intravenously or may be delivered by injection (directly into the bladder through a catheter passed through the ureter), depending on the stage of the cancer.

Some common chemotherapy drugs used to treat bladder cancer include:

  • methotrexate
  • vinblastine
  • doxorubicin
  • cyclophosphamide
  • paclitaxel
  • carboplatin
  • cisplatin
  • ifosfamide
  • gemcitabine

Many of these drugs are used in combinations.

Side effects can occur with chemotherapy, and their severity depends on the type of medication used and the patient's ability to tolerate the medications. Common side effects of chemotherapy include:

  • Vomiting and nausea
  • Anorexia
  • Hair loss
  • Fatigue due to anemia
  • exposure to infection
  • mouth ulcers

Chemotherapy can be used alone, but it's often used in combination with surgery or radiation therapy.

Intravesical treatment for bladder cancer

Bladder cancer can be treated with immunotherapy or intravesical chemotherapy (through a tube inserted into the urethra and bladder).

Immunotherapy refers to using the body's immune system to attack cancer cells.

A vaccine called Bacillus Calmette-Guérin (BCG) is a tuberculosis vaccine commonly used for this purpose in the intravesical treatment of Ta, T1 stages, or in situ (limited to the inner lining) of bladder cancer.

In this procedure, a solution containing BCG is kept in the bladder for a few hours before it is drained.

Intravesical BCG is usually given once a week for six weeks, but sometimes long-term maintenance therapy is needed. Bladder irritation, pain or burning during urination, low-grade fever, and chills are possible side effects of BCG inside the bladder.

Intravesical chemotherapy with mitomycin C is another treatment option.

Because chemotherapy is given directly into the bladder, other cells in the body are not exposed to chemotherapy, reducing the chances of side effects. It is also often given as a single dose after the tumor has been removed by cystoscopy.

Catheters inside the urethra, which allow drugs to be inserted directly into the bladder
Intravesical treatment via intraurethral catheterization

Radiation therapy for bladder cancer

Radiation therapy destroys the DNA of cancer cells by exposing them to high-energy X-rays or other types of radiation. It may be an alternative to surgery or used in combination with surgery or chemotherapy. Radiation therapy can be given externally or internally.

In external beam radiation therapy, the radiation source is a machine outside the body that directs a focused beam at the tumor. With the use of today's modern imaging techniques, directed radiation emitted from several angles reduces exposure to the surrounding tissues and organs, thus limiting damage to these tissues.

External radiation may cause fatigue and skin irritation.

Internal radiation therapy is not often used to treat bladder cancer. In this type of treatment, radioactive pellets are inserted into the bladder through the urethra or an incision in the lower abdomen. Internal radiation requires a hospital stay during treatment, which can take several days, after which the granules are removed.

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Common Questions

According for studies Recent Bladder cancer ranks tenth among the most common types of cancer, and its incidence rates are increasing dramatically in Europe and other developed countries, while deaths are declining worldwide thanks to improved prevention, early diagnosis and treatment. Bladder cancer is approximately four times more common in men than in women, and the average age at diagnosis is 73 years. The median 5-year survival with bladder cancer is approximately 77% and depends largely on the stage at diagnosis. Metastatic disease, which accounts for only 5% of cases, has a 5-year survival of less than 5%.

Studies have indicated that tobacco smoking is the greatest risk factor for metastatic bladder cancer, which constitutes 90% of all cases. Smoking causes 50-65% of all cases of bladder cancer and increases the risk of developing the disease by 3 times. Meanwhile, squamous cell carcinoma of the bladder, which accounts for 5% of cases, is particularly common in Africa and the Middle East and is largely associated with primary schistosomiasis infection. The second largest risk factor after smoking is environmental and occupational exposure to carcinogenic chemicals. An estimated 81% of bladder cancer cases can be attributed to preventable risk factors. Prevention strategies, including smoking cessation, workplace safety practices, diet, weight loss, and schistosomiasis prevention can reduce bladder cancer infections year-round.

The stages range from T1 (confined to the inner lining of the bladder) to T4 (the most invasive advanced stage). In the early stages (TA, T1, or CIS), the cancer is confined to the lining of the bladder or to the connective tissue just below the lining, but it has not invaded the main wall of the bladder (muscle).

Stages II through IV refer to invasive cancer:

  • In the second stage, the cancer has spread to the muscular wall of the bladder
  • In the third stage, the cancer has spread to the fatty tissue outside the bladder muscle
  • In stage IV, the cancer has spread from the bladder to lymph nodes, nearby organs, or bones

 

Bladder cancer can recur because small areas of cancer cells may remain undetected in the body. Over time, the number of these cells may increase until they show up in test results or cause signs or symptoms to develop again. Depending on your medical history, your doctor may tell you the possibility of your bladder cancer recurring. Tell your doctor about any new symptoms, such as pain during urination, blood in the urine, frequent urination, an immediate need to urinate, and any other symptoms. These symptoms may be signs of the cancer coming back or signs of another medical condition.

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