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Bladder Cancer

What is bladder cancer?

The bladder, which is the main task of the body to store urine, is an organ that can stretch as it is filled with urine. Bladder cancer usually starts from the urothelial cells of the mucosa that pave the inner surface of the bladder. Bladder tumours are mostly malignant, but can be benign, albeit rarely. Although the incidence of bladder cancer increases with age, it usually occurs after the age of 60-70. However, 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. For this reason, it is important to closely follow the patients.

What are the symptoms of bladder cancer?

Bladder cancer symptoms are as follows;

  • Blood in the urine (haematuria): In bladder cancer, painless bleeding is usually seen in the urine. There may be visible bleeding in the urine or bleeding that can be seen under the microscope. Bleeding may occur in the form of blood clots, not in all of the urine. The blood seen in the urine may be caused by many reasons other than the tumour. It should be kept in mind that different diseases such as kidney stones or infections may cause blood to be seen in the urine.
  • Painful urination
  • Frequent urination
  • Feeling stuck in the urine
  • Disorders such as difficulty in urinating due to clots or even inability to urinate may be a symptom of bladder cancer. In some cases, when the first symptoms of bladder cancer occur, the cancer may have already spread by metastasizing to another part of the body. Symptoms experienced in patients with metastasis may vary depending on the region where the cancer is spread. In advanced bladder tumours;
  • Back pain
  • Pain in the lower abdomen
  • Symptoms such as loss of appetite and weight loss can be experienced.

 

How is bladder cancer diagnosed?

Bladder cancer is determined by the symptoms experienced or by suspicion during routine checks. First of all, an experienced urologist should be examined.

Urology doctor examination

The urology doctor will primarily evaluate risk factors for bladder cancer, such as genetics, smoking, or radiation exposure. In the physical examination of the urology doctor;

  • Doctor does a systemic check and determines if there's a sign of cancer.
  • Checks the abdomen and liver for swelling.
  • Checks for enlarged lymph nodes in the groin, abdomen and neck.

Additional examinations may be requested to clarify the diagnosis in cases of abnormal and suspected bladder cancer.

 

Urine tests in bladder cancer

 

  • Urinalysis; It is a simple laboratory test. It is used to control blood and other substances in the urine sample.
  • Urine cytology: The presence of cancer cells is checked by examining the urine sample under a microscope.
  • Urine culture: In the examinations made in the urine sample kept in the laboratory, what types of microbes are examined. Bladder is important to determine whether there is an infection.
  • Urine tumour marker tests: A sensitive and unique marker has not yet been found. In these tests, substances released into the blood by bladder cancer cells are searched.

 

Diagnosis of bladder cancer by imaging methods

 

  • Ultrasonography (USG): Ultrasound that does not require contrast agent application easily detects bladder tumours larger than 5 mm, and can also help to find out if the kidneys or ureters are clogged. Ultrasound can also be used to determine the extent of bladder cancer, 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 tumours in the urinary tract, including the bladder. It can also help to show enlarged lymph nodes that may contain cancer, as well as other organs in the abdomen and pelvis. In order to obtain the image in more detail, a contrast agent is sometimes given to the patient orally or intravenously. Those who are allergic to iodine and other substances should tell this to their doctor beforehand.
  • Intravenous pyelogram (IVP): This method, which has been used in the past to determine abnormalities in the bladder and urinary system, has left its place to new and better information methods.
  • Retrograde pyelogram: It is an application similar to intravenous pyelogram procedure. The contrast agent used is injected directly into the urinary system using cystoscopy, not intravenously. The retrograde pyelogram procedure is used to find out what causes obstruction in normal urine flow. It can also help diagnose cancer on the inner surface of the ureter or kidney.
  • MRI (Magnetic Resonance): It can be used to measure the depth and size of the bladder tumour and to monitor the lymph spread of cancer. The patient should be given contrast agent to get a detailed view of the tumour and its effects.
  • Pet CT Scan: A small amount of radioactive material is injected into the patient's body. Since this radioactive material is absorbed by cancerous cells that tend to use energy, it is displayed where the cancer spreads in the body. Pet CT is not considered as standard imaging for bladder cancer. It may have a potential role in the evaluation of metastatic bladder cancer.
  • Chest X-ray: It can be used to determine whether bladder cancer has spread to the lungs. If a chest CT scan was performed, a chest X-ray is not required.

 

Cystoscopy

Cystoscopy is one of the gold standard procedures in the diagnosis of bladder cancer. The urethra and the inside of the bladder are examined with a thin flexible endoscope with light and camera at the end. In the cystoscopy procedure, the size, location and growth patterns of the abnormalities in the bladder can be determined. Biopsy and urine samples can also be performed during cystostopia.

Biopsy - Transurethral resection of bladder tumour (TUR-CT)

During cystoscopy, the urology doctor takes a piece of the abnormal tissues and sends it to the laboratory for examination. During this procedure, which is also called transurethral resection of the bladder tumour (TUR-CT), a sample of the bladder tumour and the bladder muscle close to the tumour can also be obtained. Can evaluate the bladder to see if any masses are felt during the biopsy process. TUR-CT can also be used in the treatment of non-muscle-invasive bladder tumours.

How is bladder cancer treated?

Bladder cancer treatment options depend on various factors such as the patient's general health status, the type of cancer, the degree of cancer, and the stage of cancer.

Surgical treatment of bladder cancer

The type of surgical treatment in bladder cancer may vary depending on the type of bladder tumour and the stage of the cancer.

TUR surgery (Transurethral resection): Transurethral resection of the bladder tumour, that is, TOUR surgery, is generally used to remove tumours that are not invasive, that is, located in the mucosa of the bladder and do not extend to the muscle layer of the bladder wall. THE TUR can also be used in the diagnosis and staging of bladder cancer.

TUR surgery can be performed under general anaesthesia or under regional anaesthesia. TUR surgery is performed without any incision in the body, through the natural hole in the end of the urinary tract.

During the TUR surgery, the bladder is reached with an endoscope with a small "U" shaped wire at the end of the urology specialist. Cancerous tissue is removed from the body by cutting with electrical current. In very small tumours, the treatment is eliminated by burning the cancerous cells area after the piece is removed.

After the TUR surgery, the urologist can recommend chemotherapy applied once or once a week for 6-8 weeks with a catheter in the bladder to eliminate the remaining cancer cells and prevent them from recurring.

Partial or segmental cystectomy: It is the surgical removal of the tumour and part of the bladder. Partial cystectomy surgery has a very limited place in the treatment of bladder cancer, but it is applied in the treatment of some cancers with special histology.

Radical Cystectomy: It is a surgical method in which all tissues and organs near the bladder are removed together with the tumour. In radical cystectomy surgery, all urinary tract is removed in men, prostate and semen sacs as well as bladder, in necessary patients. In women, in the classical definition, the uterus, fallopian tubes, ovaries and all or part of the uterus are removed, but the removal of the bladder with safe limits by leaving the gynaecological organs in place has also been applied in recent years.

Removal of the lymph in the pelvis, called pelvic lymph node dissection, is also a part of the surgery in both men and women. Pelvic lymph node dissection is the most accurate way to identify cancer that has spread to the lymph.

In laparoscopic or robotic radical cystectomy surgery, the surgical procedure can be completed with smaller incisions instead of large incisions in open surgeries.

New bladder (Neobladder reconstruction) from the intestine: Since the bladder of patients who underwent radical cystectomy surgery is removed, a new way for the urine to exit the body should be performed. There are also different urinary deflection surgeries along with the methods that create a new bladder from a part of the intestine. The urology doctor decides which urine deflection method is appropriate for the patient by evaluating the biological age of the patient, the stage of the disease and the possibility of treatments such as chemotherapy and radiotherapy that may be required later. The final decision is made by discussing this decision in detail with the patient.

Chemotherapy treatment in bladder cancer

It is used to destroy the cancer cells of the bladder spread throughout the body. Living without bladder can sometimes negatively affect the patient's social life. Chemotherapy and radiation therapy for eligible patients to preserve all or part of the bladder can be used as an alternative to bladder removal.
In bladder cancer, chemotherapy can be applied in two different ways.

Systemic Chemotherapy: Systemic chemotherapy is also known as whole-body or intravenous chemotherapy. The method applied by the Medical Oncologist is also aimed to eliminate cancerous cells by circulating the whole body with chemotherapy drugs given intravenously. It is used after radical cystectomy surgeries in metastatic bladder cancers or selected cases. Systemic chemotherapy can also be applied to shrink the tumour before surgery.

Intravesical Chemotherapy: Intravesical or local chemotherapy is usually administered by a urologist. Since cancer cells do not reach deep muscle tissues in superficial bladder cancers, intravesical chemotherapy can be used as a complement to TOUR treatment in these patients. In intravesical chemotherapy, drugs are delivered to the bladder through a catheter placed in the urethra.

Radiation Treatment in Bladder Cancer It can be used in addition to the round or in combination with chemotherapy after the ROUND to treat bladder cancer in patients who are not suitable for surgery or do not want surgical treatment. It can be preferred to reduce the complaints caused by a tumour such as pain, bleeding or obstruction, or in the treatment of metastatic cancers.

Immunotherapy Treatment in Bladder Cancer

Immunotherapy, also called 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 applied directly into the bladder. BCG vaccine is used as standard immunotherapy drug for bladder cancer. The BCG vaccine, which is administered via catheter as liquid into the bladder, provides treatment by activating the immune system cells in the bladder.

In recent years, studies on T cells that support the immune system and are known to have a protective effect against infection and cancer give positive results.

What should be considered after Stomach cancer treatment?

The follow-up process is very important in patients with bladder cancer, as there is a risk of recurrence of bladder cancer after treatment. Follow-up is an important part of cancer treatment. Follow-up after bladder cancer treatment may vary depending on the stage, degree and type of treatment applied. Bladder cancer is also likely to recur for the first 2 years after treatment, then the follow-up is extended up to 10 years, although the possibility of recurrence decreases.

Although the follow-up process varies according to the patient, it is important to check every 3 months in the first year. During the follow-ups, while the liver and lymph nodes are controlled, the intra-bladder is observed by cystoscopy to determine whether there is any recurrence in the bladder. When deemed necessary by the treating physician, imaging methods such as CT, MRI, ultrasound, pet CT are also used.

Why should I be in the Memorial Health Group for the treatment of gastric cancer?

Treatment of bladder cancer requires high clinical experience. Radical cystectomy, which is applied especially in the treatment of advanced bladder cancer, can be applied robotically in very few clinics and Memorial Hospital in the world.

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