Bladder cancer is the seventh most common cancer in men, although less common in women. Although bladder cancer increases with age, it usually occurs after the ages of 60-70, but it should be known that this disease can be seen at any age. There is also a risk of recurrence of bladder cancer, which is more common in men than in women. Therefore, patients should be followed closely.
What is Bladder Cancer?
The bladder, the main task of which is to store urine, is an organ that can stretch as it fills with empty urine. While bladder cancer usually starts from the urothelial cells of the mucosa lining the inner surface of the bladder, bladder tumors can be malignant or benign. However, benign bladder tumors that are not cancerous can also be seen.
What are the Symptoms of Bladder Cancer?
Bladder cancer symptoms are as follows:
Blood in the urine (hematuria): In bladder cancer, painless bleeding is usually seen in the urine, there may be visible bleeding in the urine, as well as bleeding that can be seen under a microscope. Bleeding may be in the form of blood clots, not all of the urine. Blood in the urine can be caused by many reasons other than a tumor. It should be kept in mind that different diseases such as kidney stones or infections can cause blood to appear in the urine.
- painful urination
- to urinate frequently
- Feeling of urgency to urinate
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Discomforts such as difficulty urinating and even inability to urinate due to the clot can be seen as a symptom of bladder cancer.
In some cases, when the first signs of bladder cancer appear, the cancer can spread to another part of the body by metastasizing. The symptoms seen in patients with metastasis may differ according to the region where the cancer has spread. in progressive bladder tumors:
- Back pain
- pain in lower abdomen
- Symptoms such as loss of appetite and weight loss may occur.
What are the Causes of Bladder Cancer?
Although the exact cause of bladder cancer is unknown, there are risk factors.
Smoking: Smoking and tobacco use are the most common risk factors for bladder cancer. The probability of developing bladder cancer is 4-7 times higher in those who use cigarettes and tobacco products compared to non-smokers, and the risk increases in passive smoking.
Age: Bladder cancer is more common after a certain age. The majority of people diagnosed with bladder cancer are over the age of 50.
Gender: Men are 3-4 times more likely to develop bladder cancer than women.
Chemicals: Chemicals used in the textile, rubber, leather, paint, chemical, battery industry or printing industry increase the risk of bladder cancer.
- being white
- Chronic bladder infections
- Not drinking enough fluids and urinating too much
- Consuming a lot of high-fat or additive foods
- Having a family history of bladder cance
The risk of developing bladder cancer is higher in people who have received chemotherapy with cyclophosphamide and in patients who have had radiotherapy to adjacent areas of the bladder for other reasons.
How is Bladder Cancer Diagnosed?
Bladder cancer is detected by symptoms or as a result of suspicion during routine controls. First of all, an experienced urologist should be examined.
Urology Doctor Examination
The urologist first evaluates risk factors for bladder cancer, such as genetics, smoking or exposure to radiation. On physical examination, the urologist:
- The doctor performs a systemic checkup and determines if there is a sign of cancer.
- The doctor checks for swelling in the abdomen and liver.
- Checks for enlarged lymph nodes in the groin, abdomen, and neck.
In case of suspected bladder cancer, additional tests may be requested to clarify the diagnosis.
Urine Tests in Bladder Cancer
Urinalysis: A simple laboratory test, used to check for blood and other substances in a urine sample.
Urine cytology: The presence of cancer cells is checked by examining the urine sample under a microscope.
Urine culture: In the examinations of the urine sample kept in the laboratory, what kind of microbes are examined. It is important in determining whether there is a bladder infection.
Urine tumor marker tests: A sensitive and specific marker has not been found yet. These tests look for substances released into the blood by bladder cancer cells.
Imaging Methods and Diagnosis of Bladder Cancer
Ultrasonography (USG): Ultrasound, which does not require the application of contrast material, easily detects bladder tumors larger than 5 mm, and can also help learn whether the kidneys or ureters are blocked. Ultrasound can also be used to detect the size of bladder cancer and whether it has spread to nearby organs or tissues.
Computed Tomography (CT urogram): It can provide information about the size, shape and location of all tumors in the urinary tract, including the bladder. It can also help show enlarged lymph nodes, which may contain cancer, as well as other organs in the abdomen and pelvis. Sometimes a contrast agent is given to the patient, either orally or intravenously, to provide a more detailed image. Those who are allergic to iodine and other substances should tell their doctor beforehand.
Intravenous pyelogram (IVP): This method, which was used in the past to detect abnormalities in the bladder and urinary system, has left its place to new and better informative techniques.
Retrograde pyelogram: The application is similar to the intravenous pyelogram procedure, the contrast material used is injected directly into the urinary system using cystoscopy, not intravenously. A retrograde pyelogram is used to determine what is causing the obstruction in normal urine flow. It can also help diagnose cancer in the lining of the ureter or kidney.
MRI (Magnetic Resonance): It can be used to measure the depth and size of the bladder tumor and to view the lymph nodes where the cancer has spread. however, the patient should be given contrast material to get a detailed picture of the tumor and its effects.
PET CT Scan: A small amount of radioactive material is injected into the patient’s body, and since this radioactive material is absorbed by cancerous cells that tend to use energy, where the cancer has spread in the body is displayed. PET CT is not considered standard imaging for bladder cancer. It can be used in the evaluation of metastatic bladder cancer.
Chest X-ray: It can be used to detect whether bladder cancer has spread to the lungs. If a chest CT scan has been done, a chest X-ray is not required.
Cystoscopy
Cystoscopy is the gold standard procedure in the diagnosis of bladder cancer. The urethra and the inside of the bladder are examined with a thin flexible endoscope with a light and camera at the tip. Cystoscopy detects the size, location and growth patterns of abnormalities in the bladder. It is possible to perform biopsy and urine samples during cystoscopy.
Biopsy – Transurethral resection of bladder tumor (TUR-CT)
The urology doctor takes a piece of tissue that he sees as abnormal during cystoscopy and sends it to the laboratory for examination. With this procedure, also known as transurethral resection of bladder tumor (TUR-CT), a sample of the bladder tumor and bladder muscle close to the tumor can be removed. He or she can evaluate the bladder to see if any mass is felt during the biopsy. TUR-CT can also be used in the treatment of non-muscle invasive bladder tumors.
Treatment of Bladder Cancer
Bladder cancer treatment options depend on several factors, such as the patient’s general health status, the type of cancer, the extent of the cancer, and the stage of the cancer.
Surgical Treatment of Bladder Cancer
The type of surgical treatment in bladder cancer may vary depending on the type of bladder tumor and the stage of the cancer.
TUR surgery (Transurethral resection): TUR operation of bladder tumor is generally performed to remove non-muscle invasive tumors that are located in the mucosa of the bladder but do not extend into the muscle layer of the bladder wall. TUR can also be used in the diagnosis and staging of bladder cancer.
TUR surgery can be performed under general anesthesia as well as under regional anesthesia. The TUR operation is performed by entering the natural hole at the tip of the urinary tract without making any incisions in the body.
During the TUR operation, the urologist reaches the bladder with the endoscope, which has a small U-shaped wire at the end, and cuts the cancerous tissue from the body with electric current. In very small tumors, after the piece is taken, the area of cancerous cells is burned and the treatment is removed.
After the TUR operation, the urologist may recommend chemotherapy, which is administered once a week to destroy the remaining cancer cells and prevent recurrence, or once a week for 6-8 weeks.
Partial or segmental cystectomy: It is the surgical removal of the tumor and part of the bladder. The role of partial cystectomy in the treatment of bladder cancer is extremely limited, but it is performed in the treatment of some cancers with special histology.
Radical Cystectomy: It is a surgery in which the tumor and the entire bladder and nearby tissues and organs are removed. In the radical cystectomy operation, the prostate and seminal vesicles are removed in men as well as the bladder. In some patients, the entire urinary tract is removed. In women, the uterus, fallopian tubes, ovaries and all or part of the uterus are removed, but in recent years, the bladder has been removed within safe limits, leaving the gynecological organs in place.
Removal of lymph in the pelvis, called a pelvic lymph node dissection, is also part of the operation in both men and women. Pelvic lymph node dissection is the most accurate way to detect cancer that has spread to the lymph.
In radical cystectomy operation, which can be performed laparoscopically or robotically, it is possible to complete the surgical procedure with smaller incisions instead of the larger incisions in open surgeries.
New bladder from the intestine (Neobladder reconstruction): Since the bladder of the patients who underwent radical cystectomy operation, a new way should be made for the urine to exit the body. There are different urinary diversion surgeries along with techniques where a new bladder is created from a part of the bowel. Which urine diversion method is suitable for the patient is determined by the urology doctor by evaluating the biological age of the patient, the current diseases, the stage of the disease, and the possibility of treatments such as chemotherapy and radiotherapy that may be needed later. The final decision is made by talking to the patient in detail.
Chemotherapy Treatment in Bladder Cancer
It is used to destroy bladder cancer cells that spread throughout the body. Living without a bladder can sometimes negatively affect the social life of the patient. For patients who are eligible to retain all or part of the bladder, it is possible to use chemotherapy and radiation therapy as an alternative to bladder removal.
Chemotherapy can be applied in two different ways in bladder cancer.
Systemic Chemotherapy: Systemic chemotherapy is also known as whole body or intravenous chemotherapy. The aim of the method applied by the Medical Oncologist is that the chemotherapy drugs given intravenously circulate through the body and destroy the cancerous cells. It is used in metastasized bladder cancers or in selected cases after radical cystectomy operations. Systemic chemotherapy can also be done to shrink the tumor before the operation.
Intravesical Chemotherapy: Intravesical or local chemotherapy is usually administered by a urologist. Intravesical chemotherapy in superficial bladder cancers as cancer cells do not reach deep muscle tissues. It is possible to use it as a complement to TUR treatment in these patients. In intravesical chemotherapy, drugs are delivered to the bladder through a catheter placed in the urethra.
Radiation Therapy in Bladder Cancer
It can be used in conjunction with chemotherapy to treat bladder cancer in patients who are not suitable for surgery or who do not want surgical treatment. It can be preferred to reduce the complaints caused by a tumor such as pain, bleeding or obstruction, or in the treatment of metastasized cancers.
Immunotherapy in Bladder Cancer
Immunotherapy, also defined as biological therapy, is the use of drugs to help the immune system recognize and destroy cancer cells. In the treatment of bladder cancer, immunotherapy is usually administered directly into the bladder. BCG vaccine is used as the standard immunotherapy drug for bladder cancer. BCG vaccine, which is administered with a catheter as a liquid into the bladder, activates the immune system cells in the bladder and provides treatment.
In recent years, studies on T cells, which are known to support the immune system and have a protective effect against infection and cancer, have yielded positive results.
Frequently asked Questions
Although it is usually seen after the age of 50, the diagnosis and treatment of bladder cancer or benign tumors of the bladder, which can occur at any age, are performed by urology doctors. It is important to choose a urology doctor who specializes in the treatment of bladder cancer and benign bladder tumors, as surgical techniques are also available.
Three criteria are considered to determine the stage of bladder cancer.
The depth of the cancerous tumor in the bladder wall and the grade of the tumor
Whether the bladder tumor has spread to regional lymph nodes
It is examined whether the bladder cancer has metastasized to other organs such as the lung or liver.
Information obtained from pathology and examinations is used to determine which parts of the bladder are cancerous, whether the cancer has spread from where it first started, and where the cancer has spread. Bladder cancer staging is done according to the international TNM system.
Survival or recovery from bladder cancer varies from person to person. Success depends on the type and stage of bladder cancer, the number and size of tumors, the characteristics of the cancer, its recurrence, the treatments chosen, and the patient’s response to treatment, so bladder cancer survival rates are actually individual. In the study of the American Cancer Society, considering all stages of bladder cancer, the 5-year survival rate for those with bladder cancer was 77 percent, the 10-year survival rate was 70 percent, and the 15-year survival rate was 65 percent.
Bladder cancer most commonly metastasizes to the lungs, liver, or bones.
There is no scientific data showing that diet, herbal products, vitamins and minerals prevent the development of bladder cancer or reduce the possibility of recurrence. Many studies have been done on this subject, in general, natural and healthy nutrition and active mobility are recommended.
Bladder tumor is a common disease over the age of 50. But in practice, it is observed that it is seen even in the 20s. In addition, the incidence of bladder tumors in men is approximately 4 times higher than in women, but it tends to have a worse prognosis when seen in women.
