Bladder cancer is one of the most common cancers. It is more common in men than in women. Although it is generally advanced age disease, it can also be seen at a young age.
Cancer often develops from cells inside the bladder. (The bladder is a hollow organ that stores urine in the lower abdomen) Although it usually appears in the bladder, the same type of cancer can be seen in other parts of the urinary tract.
7 of every 10 cancers are caught in an early curable stage. However, there is a possibility of cancer recurrence (reappearance) at an early stage. For this reason, patients treated with bladder cancer should be taken at regular intervals in terms of recurrence and progression.
Results
Bladder cancer signs and symptoms
• If there is blood in urine, urine may be bright red or cola. Sometimes the color of urine may be normal, bleeding can be detected in the urinalysis.
• Painful urination
• Pain in the lower abdomen
Also in patients with bladder cancer;
• Back pain
• There may be complaints such as frequent urination. However, these complaints often develop due to other diseases.
Causes of Bladder Cancer
Bladder cancer develops when the cells in the bladder begin to grow uncontrollably. Instead of regular growth and division in these cells, mutations that cause cells to grow uncontrolled or die. These abnormal cells cause cancer.
Among the causes of bladder cancer;
• Smoking and tobacco use
• Professional exposure to chemical agents
• Receiving radiotherapy (radiation therapy) in the past years
• Continuous irritation of the cells lining the bladder
• Parasitic infections (outside of Turkey)
The factors that cause bladder cancer have not been determined exactly, cancer can be seen in patients without any risk factors.
What are the types of bladder cancer?
Different cells in your bladder can become cancerous. The type of cell where cancer develops determines the type of bladder cancer. The type of cancer allows us to make the best choice for the treatment of the disease.
Types of Bladder Cancer:
Urothelial Cancer
Urethral cancer, previously called change cell cancer, develops from the cells that cover the bladder. Urethelial cells expand when the bladder is full and shrink when the bladder is empty. Cancer can also occur in those areas because the same cells produce the urethra and cover the urethra. It is the most common type of bladder cancer in our country.
Flat Cell Cancer
Squamous cell cancer develops due to persistent irritation of the bladder due to prolonged use of urinary catheters or infection. Turkey is seen rarely. It is found in different parts of the world that some parasitic infections (schistomyosis) cause inflammation in the bladder.
ADENOCANCER
It develops from cells that make glands that secrete mucus in the bladder. Adenocarcinoma is also rare in our country.
Some cancers can consist of more than one cell.
What are the Risk Factors in Bladder Cancer?
Factors that increase the risk of bladder cancer include:
• Cigaret
Smoking cigars or cigars increase the risk of bladder cancer by causing the accumulation of harmful chemicals in the urine. When you smoke, your body processes chemicals in the smoke, causing it to accumulate in the urine. These harmful chemicals damage the cells that make up the bladder, increasing the risk of cancer.
• Advancing Age
Your bladder cancer risk increases with age. Bladder cancer can occur at any age, but is rarely detected before age 40.
• Being a Man
Bladder cancer in men occurs more than women.
• Exposure to Various Chemicals
The kidneys have a key role in filtering harmful chemicals from the bloodstream. Chemicals are filtered and sent to the bladder. For this reason, some chemicals are known to increase the risk of bladder cancer. Arsenic and other chemicals used in paint, rubber, leather and textile industries have a role in cancer development.
• Previously Cancer Treatment
Cyclophosphamide, an anti-cancer drug, increases the risk of bladder cancer. The risk of developing bladder cancer also increases in patients who have received radiotherapy targeting the pelvic region with the diagnosis of cancer.
• Chronic Bladder Inflammation
Chronic or recurrent bladder inflammations (cystitis) due to long-term urinary catheter use increase the risk of flat cell cancer in the bladder.
Cancer History in Family or Self
If you have cancer in your bladder, it is likely to recur. If your first degree relatives have bladder cancer, there is a risk in you.
What Can We Do to Prevent Bladder Cancer?
There is no method to prevent bladder cancer development, but there are things that can be done to reduce the risk.
Do not smoke!
When smoking is not allowed, the chemicals that cause cancer in cigarettes will not accumulate in your bladder. Don't start if you don't smoke. Get medical support to quit smoking. Medicines, support groups and other methods help you quit smoking.
Pay Attention to Chemicals!
If you work with chemicals, you need to avoid being exposed to chemicals.
Take security measures.
Eat Vegetables and Fruits!
Prefer diet rich in vegetables and fruits. Antioxidants in fruits and vegetables can help reduce your risk of cancer.
How is Bladder Cancer Diagnosed?
Tests and procedures to diagnose bladder cancer include:
cystoscopy
Cystoscopy is done with the help of a thin camera (cystoscope) that is smaller than your urine hole. Your doctor will evaluate the urinary tract, prostate duct and bladder in terms of the disease.
Biopsy
During cystoscopy, your doctor can take a tissue sample to examine from the bladder. In this procedure performed under anesthesia, if all the suspicious tissue is removed, this is called transurethral resection of the bladder tumor.
Urine Cytology
Urinary cytology is the examination of urine under a microscope for cancer cells. It can be performed in patients with suspected tumor but no tumor can be seen visually.
Imaging Tests
Imaging tests such as ultrasound, computed tomography (CT), magnetic resonance imaging (MR) can be performed to examine the urinary tract.
How do we detect the spread of bladder cancer?
After the diagnosis of bladder cancer, your doctor determines whether the cancer has spread to lymph nodes or other parts of the body by additional imaging methods. These:
• IT
• MRI
• Bone scintigraphy
• Lung X-ray
The stage of the disease is determined by the information obtained from these examinations. The phases range from 0 to 4. Stage 1 indicates that the disease holds the superficial layer of the bladder and does not progress to the muscle layer. Stage 4, the most advanced stage, indicates that the disease has spread to the lymph nodes or distant organs. Depending on the stage of the disease, your doctor will recommend you the most appropriate treatment options.
Bladder Cancer Degrees (GRADE)
Bladder cancer is graded according to microscopic images of cancer cells. This rating is known as tumor grade. Bladder cancer is also classified as low or high grade.
Low Grade Bladder Tumor
In this type of tumor, the appearance of cancer cells is similar to normal cells. The low grade tumor usually grows slower and spreads less into the muscle layer of the bladder than the high grade tumor.
High Grade Bladder Tumor
The appearance of cancer cells in these tumors is abnormal and unlike normal cells. The high grade tumor is more aggressive than the low grade tumor and spreads rapidly to the muscle layer of the bladder and other tissues and organs.
What is the Treatment of Bladder Cancer?
Treatment options for bladder cancer vary according to the type, grade and stage of the cancer.
• Surgical, cancerous tissue is removed,
• Chemotherapy inside the bladder is given for the treatment of superficial bladder cancer, which has a higher risk of progression or recurrence,
• Reconstruction is performed to ensure urine flow if the bladder has to be removed due to cancer,
• Chemotherapy is applied in patients who cannot be operated or to increase the chance of treatment of the patient who will undergo surgery for bladder removal.
• Radiation therapy is performed to destroy cancer cells in patients who cannot undergo surgery or are undesirable.
• Immunotherapy triggers the body's defense system to fight cancer cells inside the bladder or in the body.
• Several of these treatment options can be applied together.
How is Bladder Cancer Surgery Performed?
Transurethral Resection of Bladder Cancer (TURMT)
It is a surgical procedure to remove the tumor in superficial bladder tumors that do not involve muscle tissue. During the procedure, the bladder is entered with the help of camera cystoscope and the tumor cells are cut out using electricity or other energy sources. TURMT procedure is performed by giving general or regional anesthesia. Since the procedure is done through the urinary canal, no incision is made in your body. As part of the TURMT procedure, a single dose of chemotherapy can be given after the procedure to kill tumor cells that remain inside the bladder and prevent tumor recurrence.
cystectomy
Cystectomy is surgery to completely remove the bladder. In radical cystectomy, all bladder, some of the ureters and surrounding lymph tissues are removed. In men, prostate and semen sacs are also removed in radical cystectomy. In women, the uterus, ovaries and upper part of the vagina are removed. Radical cystectomy is performed under the abdomen with a single incision. There is a risk of bleeding during the procedure. It is one of the most experienced surgeries in urology. Removal of the prostate, semen sacs may cause hardening difficulties. If cancer is suitable in men, the nerves required for erection can be preserved. In women, the removal of the uterus and eggs causes infertility and early menopause.
New Bladder Construction
A new way is made to excrete urine from the body after radical cystectomy (urine diversion). An option is to make a new bladder if the disease allows. A spherical reservoir is created using part of the intestine. From the new bladder
This cistern is connected to the normal urinary hole in the body. It mostly allows you to urinate normally. In a small number of patients, the new bladder cannot be emptied completely, it may be necessary to use a urinary catheter regularly to ensure urinary discharge of the bladder.
Ileal Conduit
In this type of diversion, a tube is formed from a part of the small intestine. Urinary tracts from the kidneys are connected to this tube, and the tip of the tube is outside the body. Urine discharges into a bag (urostomy bag) that sticks to the body.
Continuous Urinary Diversion
In this diversion, a small reservoir that keeps urine in the body is created from a part of the intestine. Urine is discharged using a catheter several times a day through a hole in the abdomen.
How Is Chemotherapy Performed In Bladder Cancer?
Chemotherapy uses medication to kill cancer cells. In bladder cancer treatment chemotherapy, two or more chemotherapy drugs are often used together. Medicines can be given into the bladder through the arm in the arm or with the help of a urinary catheter.
Chemotherapy is usually given to increase the chance of treatment before bladder removal surgery. It can be given to kill cancer cells that may remain after surgery. As an alternative to surgery, it can be used in some rare cases with radiation therapy.
In superficial bladder tumors, where cancer cells do not progress to the muscle, giving chemotherapy into the bladder is one of the primary treatment methods.
Is There a Place for Radiation Therapy in Bladder Tumor?
Radiation therapy uses high-energy rays to destroy cancer cells. In treatment, machines are used that turn around the body of the inpatient and send high energy waves to a certain point.
In selected cases, if surgery is not possible, chemotherapy and radiotherapy can be used as an alternative to surgery.
What is the Importance of Immunotherapy?
Immunotherapy, also known as biological therapy, uses the body's own defense system to fight cancer cells.
In bladder cancer, immunotherapy is done in the bladder with the aid of a catheter from the urinary canal. The immunotherapy drug used in bladder cancer is Bacillus Calmette-Guerin (BCG), a vaccine for protecting against tuberculosis.
Atezolizumab is a new immunotherapy drug that does not respond to chemotherapy, has developed locally or is used to treat metastatic bladder cancer. It is done intravenously, triggers the body's defense system cells to attack cancer cells.
What is Bladder Protection and For Whom?
In patients with muscle-spread bladder cancer, bladder can be left in place with a triple treatment approach in some patients. In this tripod treatment, closed surgery (TURMT), chemotherapy and radiation therapy are applied.
First, as much cancer tissue as possible is removed from the bladder by closed surgery (TURMT). A few weeks after surgery, chemotherapy is applied with radiation therapy.
After triple therapy, if the cancer cannot be cleared or relapsed, radical cystectomy can be performed.
What is Upper Urinary System Cancer?
The type of cancer (urethral cancer) that causes bladder cancer can also be seen in the upper urinary system:
In the ducts (ureter) that provide urine flow from kidneys to bladder,
In the kidney where urine accumulates (renal pelvis) before emptying into the ureter,
In other structures in the kidney where urine production begins.
As with bladder cancer, the treatment of upper system tumors varies with the type, grade and stage of the tumor, and the general health of the patient.
Upper urinary system tumors include radiotherapy and chemotherapy to prevent cancer recurrence after surgery to remove cancer and kill remaining tumor cells.
The only kidney that functions after surgery remains. In this case, the operation of the single kidney is followed by regular tests.
What Should Be Done After Bladder Cancer Treatment?
Bladder cancer can recur. Therefore, it is followed for years even after successful treatment. How often and with which methods follow-up varies according to the type of treatment performed with the type of cancer.
Your doctor will create the appropriate follow-up plan for you. After cancer treatment, follow-up is performed with cystoscopy, usually at three-month intervals in the first few years. If there is no cancer recurrence, the follow-up period decreases after the first few years and can decrease until the control once a year. Additional tests may be required other than cystoscopy follow-up. Patients with aggressive cancer can be followed more closely.
The follow-up of patients with cystectomy and bladder removal is performed at regular intervals with tests and imaging methods.
Op.Dr.Osman Nuri Akbulut
Urology Specialist
Medilife Bağcılar Hospital
Cancer often develops from cells inside the bladder. (The bladder is a hollow organ that stores urine in the lower abdomen) Although it usually appears in the bladder, the same type of cancer can be seen in other parts of the urinary tract.
7 of every 10 cancers are caught in an early curable stage. However, there is a possibility of cancer recurrence (reappearance) at an early stage. For this reason, patients treated with bladder cancer should be taken at regular intervals in terms of recurrence and progression.
Results
Bladder cancer signs and symptoms
• If there is blood in urine, urine may be bright red or cola. Sometimes the color of urine may be normal, bleeding can be detected in the urinalysis.
• Painful urination
• Pain in the lower abdomen
Also in patients with bladder cancer;
• Back pain
• There may be complaints such as frequent urination. However, these complaints often develop due to other diseases.
Causes of Bladder Cancer
Bladder cancer develops when the cells in the bladder begin to grow uncontrollably. Instead of regular growth and division in these cells, mutations that cause cells to grow uncontrolled or die. These abnormal cells cause cancer.
Among the causes of bladder cancer;
• Smoking and tobacco use
• Professional exposure to chemical agents
• Receiving radiotherapy (radiation therapy) in the past years
• Continuous irritation of the cells lining the bladder
• Parasitic infections (outside of Turkey)
The factors that cause bladder cancer have not been determined exactly, cancer can be seen in patients without any risk factors.
What are the types of bladder cancer?
Different cells in your bladder can become cancerous. The type of cell where cancer develops determines the type of bladder cancer. The type of cancer allows us to make the best choice for the treatment of the disease.
Types of Bladder Cancer:
Urothelial Cancer
Urethral cancer, previously called change cell cancer, develops from the cells that cover the bladder. Urethelial cells expand when the bladder is full and shrink when the bladder is empty. Cancer can also occur in those areas because the same cells produce the urethra and cover the urethra. It is the most common type of bladder cancer in our country.
Flat Cell Cancer
Squamous cell cancer develops due to persistent irritation of the bladder due to prolonged use of urinary catheters or infection. Turkey is seen rarely. It is found in different parts of the world that some parasitic infections (schistomyosis) cause inflammation in the bladder.
ADENOCANCER
It develops from cells that make glands that secrete mucus in the bladder. Adenocarcinoma is also rare in our country.
Some cancers can consist of more than one cell.
What are the Risk Factors in Bladder Cancer?
Factors that increase the risk of bladder cancer include:
• Cigaret
Smoking cigars or cigars increase the risk of bladder cancer by causing the accumulation of harmful chemicals in the urine. When you smoke, your body processes chemicals in the smoke, causing it to accumulate in the urine. These harmful chemicals damage the cells that make up the bladder, increasing the risk of cancer.
• Advancing Age
Your bladder cancer risk increases with age. Bladder cancer can occur at any age, but is rarely detected before age 40.
• Being a Man
Bladder cancer in men occurs more than women.
• Exposure to Various Chemicals
The kidneys have a key role in filtering harmful chemicals from the bloodstream. Chemicals are filtered and sent to the bladder. For this reason, some chemicals are known to increase the risk of bladder cancer. Arsenic and other chemicals used in paint, rubber, leather and textile industries have a role in cancer development.
• Previously Cancer Treatment
Cyclophosphamide, an anti-cancer drug, increases the risk of bladder cancer. The risk of developing bladder cancer also increases in patients who have received radiotherapy targeting the pelvic region with the diagnosis of cancer.
• Chronic Bladder Inflammation
Chronic or recurrent bladder inflammations (cystitis) due to long-term urinary catheter use increase the risk of flat cell cancer in the bladder.
Cancer History in Family or Self
If you have cancer in your bladder, it is likely to recur. If your first degree relatives have bladder cancer, there is a risk in you.
What Can We Do to Prevent Bladder Cancer?
There is no method to prevent bladder cancer development, but there are things that can be done to reduce the risk.
Do not smoke!
When smoking is not allowed, the chemicals that cause cancer in cigarettes will not accumulate in your bladder. Don't start if you don't smoke. Get medical support to quit smoking. Medicines, support groups and other methods help you quit smoking.
Pay Attention to Chemicals!
If you work with chemicals, you need to avoid being exposed to chemicals.
Take security measures.
Eat Vegetables and Fruits!
Prefer diet rich in vegetables and fruits. Antioxidants in fruits and vegetables can help reduce your risk of cancer.
How is Bladder Cancer Diagnosed?
Tests and procedures to diagnose bladder cancer include:
cystoscopy
Cystoscopy is done with the help of a thin camera (cystoscope) that is smaller than your urine hole. Your doctor will evaluate the urinary tract, prostate duct and bladder in terms of the disease.
Biopsy
During cystoscopy, your doctor can take a tissue sample to examine from the bladder. In this procedure performed under anesthesia, if all the suspicious tissue is removed, this is called transurethral resection of the bladder tumor.
Urine Cytology
Urinary cytology is the examination of urine under a microscope for cancer cells. It can be performed in patients with suspected tumor but no tumor can be seen visually.
Imaging Tests
Imaging tests such as ultrasound, computed tomography (CT), magnetic resonance imaging (MR) can be performed to examine the urinary tract.
How do we detect the spread of bladder cancer?
After the diagnosis of bladder cancer, your doctor determines whether the cancer has spread to lymph nodes or other parts of the body by additional imaging methods. These:
• IT
• MRI
• Bone scintigraphy
• Lung X-ray
The stage of the disease is determined by the information obtained from these examinations. The phases range from 0 to 4. Stage 1 indicates that the disease holds the superficial layer of the bladder and does not progress to the muscle layer. Stage 4, the most advanced stage, indicates that the disease has spread to the lymph nodes or distant organs. Depending on the stage of the disease, your doctor will recommend you the most appropriate treatment options.
Bladder Cancer Degrees (GRADE)
Bladder cancer is graded according to microscopic images of cancer cells. This rating is known as tumor grade. Bladder cancer is also classified as low or high grade.
Low Grade Bladder Tumor
In this type of tumor, the appearance of cancer cells is similar to normal cells. The low grade tumor usually grows slower and spreads less into the muscle layer of the bladder than the high grade tumor.
High Grade Bladder Tumor
The appearance of cancer cells in these tumors is abnormal and unlike normal cells. The high grade tumor is more aggressive than the low grade tumor and spreads rapidly to the muscle layer of the bladder and other tissues and organs.
What is the Treatment of Bladder Cancer?
Treatment options for bladder cancer vary according to the type, grade and stage of the cancer.
• Surgical, cancerous tissue is removed,
• Chemotherapy inside the bladder is given for the treatment of superficial bladder cancer, which has a higher risk of progression or recurrence,
• Reconstruction is performed to ensure urine flow if the bladder has to be removed due to cancer,
• Chemotherapy is applied in patients who cannot be operated or to increase the chance of treatment of the patient who will undergo surgery for bladder removal.
• Radiation therapy is performed to destroy cancer cells in patients who cannot undergo surgery or are undesirable.
• Immunotherapy triggers the body's defense system to fight cancer cells inside the bladder or in the body.
• Several of these treatment options can be applied together.
How is Bladder Cancer Surgery Performed?
Transurethral Resection of Bladder Cancer (TURMT)
It is a surgical procedure to remove the tumor in superficial bladder tumors that do not involve muscle tissue. During the procedure, the bladder is entered with the help of camera cystoscope and the tumor cells are cut out using electricity or other energy sources. TURMT procedure is performed by giving general or regional anesthesia. Since the procedure is done through the urinary canal, no incision is made in your body. As part of the TURMT procedure, a single dose of chemotherapy can be given after the procedure to kill tumor cells that remain inside the bladder and prevent tumor recurrence.
cystectomy
Cystectomy is surgery to completely remove the bladder. In radical cystectomy, all bladder, some of the ureters and surrounding lymph tissues are removed. In men, prostate and semen sacs are also removed in radical cystectomy. In women, the uterus, ovaries and upper part of the vagina are removed. Radical cystectomy is performed under the abdomen with a single incision. There is a risk of bleeding during the procedure. It is one of the most experienced surgeries in urology. Removal of the prostate, semen sacs may cause hardening difficulties. If cancer is suitable in men, the nerves required for erection can be preserved. In women, the removal of the uterus and eggs causes infertility and early menopause.
New Bladder Construction
A new way is made to excrete urine from the body after radical cystectomy (urine diversion). An option is to make a new bladder if the disease allows. A spherical reservoir is created using part of the intestine. From the new bladder
This cistern is connected to the normal urinary hole in the body. It mostly allows you to urinate normally. In a small number of patients, the new bladder cannot be emptied completely, it may be necessary to use a urinary catheter regularly to ensure urinary discharge of the bladder.
Ileal Conduit
In this type of diversion, a tube is formed from a part of the small intestine. Urinary tracts from the kidneys are connected to this tube, and the tip of the tube is outside the body. Urine discharges into a bag (urostomy bag) that sticks to the body.
Continuous Urinary Diversion
In this diversion, a small reservoir that keeps urine in the body is created from a part of the intestine. Urine is discharged using a catheter several times a day through a hole in the abdomen.
How Is Chemotherapy Performed In Bladder Cancer?
Chemotherapy uses medication to kill cancer cells. In bladder cancer treatment chemotherapy, two or more chemotherapy drugs are often used together. Medicines can be given into the bladder through the arm in the arm or with the help of a urinary catheter.
Chemotherapy is usually given to increase the chance of treatment before bladder removal surgery. It can be given to kill cancer cells that may remain after surgery. As an alternative to surgery, it can be used in some rare cases with radiation therapy.
In superficial bladder tumors, where cancer cells do not progress to the muscle, giving chemotherapy into the bladder is one of the primary treatment methods.
Is There a Place for Radiation Therapy in Bladder Tumor?
Radiation therapy uses high-energy rays to destroy cancer cells. In treatment, machines are used that turn around the body of the inpatient and send high energy waves to a certain point.
In selected cases, if surgery is not possible, chemotherapy and radiotherapy can be used as an alternative to surgery.
What is the Importance of Immunotherapy?
Immunotherapy, also known as biological therapy, uses the body's own defense system to fight cancer cells.
In bladder cancer, immunotherapy is done in the bladder with the aid of a catheter from the urinary canal. The immunotherapy drug used in bladder cancer is Bacillus Calmette-Guerin (BCG), a vaccine for protecting against tuberculosis.
Atezolizumab is a new immunotherapy drug that does not respond to chemotherapy, has developed locally or is used to treat metastatic bladder cancer. It is done intravenously, triggers the body's defense system cells to attack cancer cells.
What is Bladder Protection and For Whom?
In patients with muscle-spread bladder cancer, bladder can be left in place with a triple treatment approach in some patients. In this tripod treatment, closed surgery (TURMT), chemotherapy and radiation therapy are applied.
First, as much cancer tissue as possible is removed from the bladder by closed surgery (TURMT). A few weeks after surgery, chemotherapy is applied with radiation therapy.
After triple therapy, if the cancer cannot be cleared or relapsed, radical cystectomy can be performed.
What is Upper Urinary System Cancer?
The type of cancer (urethral cancer) that causes bladder cancer can also be seen in the upper urinary system:
In the ducts (ureter) that provide urine flow from kidneys to bladder,
In the kidney where urine accumulates (renal pelvis) before emptying into the ureter,
In other structures in the kidney where urine production begins.
As with bladder cancer, the treatment of upper system tumors varies with the type, grade and stage of the tumor, and the general health of the patient.
Upper urinary system tumors include radiotherapy and chemotherapy to prevent cancer recurrence after surgery to remove cancer and kill remaining tumor cells.
The only kidney that functions after surgery remains. In this case, the operation of the single kidney is followed by regular tests.
What Should Be Done After Bladder Cancer Treatment?
Bladder cancer can recur. Therefore, it is followed for years even after successful treatment. How often and with which methods follow-up varies according to the type of treatment performed with the type of cancer.
Your doctor will create the appropriate follow-up plan for you. After cancer treatment, follow-up is performed with cystoscopy, usually at three-month intervals in the first few years. If there is no cancer recurrence, the follow-up period decreases after the first few years and can decrease until the control once a year. Additional tests may be required other than cystoscopy follow-up. Patients with aggressive cancer can be followed more closely.
The follow-up of patients with cystectomy and bladder removal is performed at regular intervals with tests and imaging methods.
Op.Dr.Osman Nuri Akbulut
Urology Specialist
Medilife Bağcılar Hospital