The bladder is our organ that stores the urine produced by the kidneys by filtering about 200 liters of blood per day and expels it by contraction. Bladder cancer, on the other hand, is a tumor formed by the uncontrolled proliferation of cells lining the inner part of our organ. It is the 10th most common in the world, and the 7th among men. It is 4 times more common in men than women. 90% develops from the epithelium that covers the inner surface of the bladder. 75% of bladder cancer is diagnosed as superficial (not reaching the muscle tissue).
Smoking is the biggest risk factor
Smoking is known as the most important risk factor, which is associated with approximately 50% of the cases. The risk may increase with the duration and intensity of smoking. The risk is higher in men and over the age of 40. Some occupations and chemical fields increase the risk. These chemicals are more common in some industries such as paint, petrochemical industry and rubber. Having a family history is also a risk factor. There are publications showing that the Mediterranean diet reduces the risk.
What are the symptoms?
The most common symptom is painless bleeding in the urine. Bleeding is mostly visible, sometimes detected in urinalysis. Apart from bleeding, there may also be complaints such as the feeling of urinating, the desire to go to the toilet frequently, burning and pain while urinating. However, since these complaints can also be seen in other diseases such as urinary tract infection and overactive bladder, a urology specialist should be consulted to investigate these complaints.
How does the diagnosis process progress?
When making a diagnosis, the patient’s complaints and risk factors are questioned. After the physical examination, one of the methods of ultrasound, computed tomography (CT) or MR imaging is selected. Definitive diagnosis is made by taking a sample from the tumor and sending it to pathology by entering the urinary canal with the endoscopic (closed) method under anesthesia.
The stage and degree of bladder cancer is very important!
Staging is done according to the tests, physical examination and pathology results of the biopsy. In particular, the depth of the disease in the pathology report in the bladder is important for the treatment and course of the disease. The spread of the disease to the surrounding tissues and lymph nodes by imaging methods is also taken into account in staging.
How is the treatment carried out?
The type of treatment is determined according to the stage of the disease. In bladder cancer, two groups are formed according to whether the disease progresses to the muscle tissue or not. In patients who have not progressed to the muscle tissue, the cancerous tissue is completely removed by TUR operation (closed method) and the follow-up protocol is determined according to the degree of the disease. In these patients, additional treatments are sometimes applied with different drugs applied into the bladder. Then, cystoscopy controls are made at regular intervals of the patients. Thanks to regular control, in case of recurrence of the tumor, there is a chance of treatment without delay.
More radical treatments come to the fore in patients whose cancer has progressed to the muscle tissue, or in patients whose disease has progressed during follow-up, while it has not progressed to muscle tissue before. If there is no spread to other organs or lymph nodes by imaging methods, an operation to completely remove the bladder, called radical cystectomy, is performed. Radical cystectomy is a procedure that involves removal of the prostate, seminal vesicles, and lymph nodes in men. In women, it involves the removal of the uterus, ovaries, and part of the vagina. There are different methods for the patient to urinate out. Options such as making a new bladder from the intestines or removing the urinary canals from the skin and conveying them to the bag are used. In the metastasized disease, chemotherapy and radiotherapy treatments are used.