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Bladder cancer is a malignant tumor with pronounced geographical zonality of morbidity. This tumor accounts for about 4-5% of all neoplasms.
Bladder cancer is more often registered in men: it accounts for almost ¾ of all cases of the disease. The vast majority of all patients with this diagnosis are elderly people.
Regions with repeatedly increased morbidity are Egypt, the countries of North Africa and the Middle East. The high incidence of bladder cancer in these tropical countries is associated with schistosomiasis - helminthic invasion, which significantly increases the risk of malignant degeneration of the bladder epithelium. A high incidence of bladder cancer is also recorded in the Balkan states located in the Danube Basin. Here, endemic Balkan nephropathy is widespread - it is a disease of unknown etiology that affects the urinary system and is a precancerous pathological process.
As it's for the most malignant neoplasms, the exact cause of bladder cancer has not been established, but the risk factors for this disease are known:
aniline, naphthylamine. The incidence of persons working with naphthylamine can reach 100%.
9 out of 10 patients with bladder cancer are perennial smokers.
is another firm risk factor. It is established that malignant tumors of the bladder in women whose husbands regularly smoke, occur 2-3 times more often than in the wives of non-smoking men.
the epithelium of the wall of the bladder is changed and the number of dangerous mutations increase.
The bladder is regularly traumatized by calcination and stones accretion, the regeneration processes are in an enhanced mode, which can affect the growth of abnormal cells.
is tropical parasitosis. Schistosomes penetrate the body through the skin and enter the internal organs, including the bladder. Prolonged irritation of the bladder wall can lead to malignant degeneration of epithelial cells.
they are caused by the human papilloma virus, which is involved in the occurrence of malignant tumors of various locations (E.g., cervical cancer).
E.g., a high dose of radiation obtained from radiotherapy for uterine cancer.
is one of the intensively studied factors of the majority of oncological diseases.
Genetic predisposition to bladder cancer is not a determining factor of the development of disease, but a special background, in the presence of which the disease develops especially often. It can be manifested by increased sensitivity to chemical reagents, a tendency to intensified regeneration, a special structure of the bladder, in which urine stagnation occurs and the duration of its action on the epithelium increases.
According to scientists, the peculiarity of the hepatic transformation of xenobiotics - harmful substances that cause irritation, toxic effects and dangerous mutations, also plays a role in the origin of the disease. Presumably the genetically determined decrease in the efficiency of xenobiotic transformation is one of the significant risk factors of bladder cancer, since the concentration of these substances in the urine rises - their negative impact to the inner shell of the bladder also increases.
The tumor does not manifest itself at the initial stages: the first signs usually appear later, when the process touches deep tissue.
A malignant tumor of the bladder is characterized by a triad of symptoms:
In the typical course of disease, the first thing to appear is blood in urine. A provoking factor may be physical stress, alcohol intake, an infectious disease. Urine becomes red, or veins or blood clots appear in the normally colored urine. Persistent profuse hematuria can lead to appreciable blood loss with the development of anemia, which is manifested by weakness, fatigue, dizziness.
Any of mentioned above symptoms, even of episodic nature, requires immediate medical consultation to determine the cause of hematuria. More over, a small amount of blood in urine is not visible to the naked eye, so for early diagnosis of tumors it is necessary to periodically take urine for a general analysis.
A characteristic dysuric disorder is a "symptom of slamming": due to the accumulation of blood clots in the bladder during urination, the urine stream suddenly breaks off and resumes after a change of body position. Other dysuric symptoms are strong uresiesthesia, sensation of pain over the pubis with a filled bladder. In some cases, there is a so-called tamponade of the bladder: it overflows with blood clots and blocks the exit of urine. Such a condition requires urgent medical attention. Dysuric disorders in the form of frequent and painful urination occur in 1/3 of patients.
The expressed pains are usually characteristic for late stages and testify about disintegration of a tumor, formation of ulcers and sites of necrosis. The pain is localized in the lower abdomen, in lumbus, perineum, on the back side of the thighs. Advanced bladder cancer in women can produce symptoms of uterine involvement, which is associated with the growth of the tumor into neighboring organs and tissues. Progression of the disease worsens the overall well-being of patients: weight decreases, digestion, hematopoiesis and other body systems are disrupted.
Every year, bladder cancer takes thousands of lives, tens of thousands of patients with the disease suffer severe, crippling operations.
Remember about the latent onset of the disease and importance of early detection of the tumor. Take the DNA test for a genetic predisposition to bladder cancer - protect yourself and your family.
Examination of patients with suspected bladder cancer includes:
The final diagnosis is based on histological examination. The material taken during biopsy is studied under a microscope to reveal the type of tumor, the level of its differentiation, and the degree of malignancy. To detect metastases, an additional examination may be required - FGDS, colonoscopy, MRI, CT, scintigraphy, angiography, etc.
The disease passes through 4 clinical stages:
A more complete classification of stages is indicated by three letters - T, N, M in combination with numbers starting from 0 to 4, which encode the expression of each feature.
For full characteristic of the tumor, the diagnosis is often indicated by its histological features, which are indicated by the letter G. The most favorable prognosis is the focus G1 — a highly differentiated tumor; histological type G3 is the most aggressive undifferentiated tumor; G2 — intermediate version.
The standard treatment is a radical removal of the tumor of the bladder.
The treatment method is selected individually, taking into account the type of tumor, the stage of the process, the overall patient's state of health.
The optimal way to treat bladder cancer of the first and partially second stage is transurethral resection of the bladder. The cystoscope is inserted through the urethra into the bladder, which is filled with clear liquid for better visibility. The surgeon examines the mucosa and excises the detected tumor with an electrocoagulator or laser. The removal is carried out in such a way as to capture the zone of healthy tissues. All material is sent for histological examination
TUR is an organ-preserving operation with a minimum period of rehabilitation. Timely intervention makes it possible to significantly increase the chances of a favorable outcome.
If growth of bladder cancer is occured, an enlarged operation - cystectomy, which consists of the complete removal of the organ, is prescribed. With a common bladder tumor in men, bladder, prostate, seminal vesicles and part of the urethra are removed together with the bladder in a single block, while in women - the uterus, the ovaries and often part of the vagina are removed. Defects are sutured. The rectum form is reformed as a reservoir, which will replace the bladder.
Cystectomy is a difficult operation with a long rehabilitation period. The operation, as a rule, is supplemented with radiotherapy aimed at the prevention of relapse and metastasis.
Radiation treatment (radiotherapy) can be used in isolation or in combination with a surgical operation. The mechanism of action is a blockade of division of tumor cells under the influence of ionizing radiation. For the treatment it can be used either remote radiotherapy, or brachytherapy - an effective technique of local irradiation, which is carried out in large modern cancer centers.
Immune treatment is indicated for stimulation of antitumor immunity in a number of cases. One of the ways of immunotherapy is the injection of BCG vaccine into the bladder. The exact mechanism of BCG action in bladder cancer is unknown. It is assumed that the effect is associated with the production of cytokines, interferon and other immune, biologically active substances. They activate cells of the immune system that recognize and destroy atypical cancer cells.
Chemotherapeutic drugs block the process of dividing the tumor cells. There are two possible variant of chemotherapy for bladder cancer: systemic and local. In the first case, drugs are injected into blood, in the second - directly into the bladder. Local chemotherapy has a number of advantages, most important of which is a lower frequency and severity of side effects associated with inhibition of division of healthy cells.
One of the methods of removing the surface tumor in bladder cancer is photodynamic therapy. Photosensitizers, which accumulate in the tumor tissue and increase its sensitivity to light, are injected into the body. The light source of a certain wave is conducted through the catheter to the site of exposure: as a result, atypical cells die, tumor vessels are destroyed and local antitumor immunity is strengthened.
Prevention of bladder cancer is aimed at eliminating of risk factors. For this it's recommended:
Unfortunately, the factor of burdened heredity can not be eliminated, but the established fact of genetic predisposition can give valuable information about the risk of the disease.
The DNA test is the only reliable study research of genetic predisposition to bladder cancer. Information that was obtained as a result of the test will form the basis of an individual plan for a regular medical examination aimed at actively detecting early signs of a tumor.
Keep your health: make prevention of bladder cancer as effective as possible.
