Bladder Cancer: Symptoms, Diagnosis and Treatment

Bladder cancer is the second most common cancer among cancers that start from the kidneys and occur along the urinary tract. Approximately two-thirds of bladder cancers are non-fatal but tend to recur, while one-third are malignant formations that have the potential to spread (metastasize) to muscle tissue and then to the rest of the body.

The kidneys filter and clean up to 200 liters of blood on average in a day. After this process, the kidneys produce an average of 1.5 liters of urine per day in order to establish the intra-body fluid balance and to ensure the purification of the blood. It conveys the substances that need to be removed from the body to the bladder through the urinary tract in the urine formed.

Bladder Cancer

The main function of the bladder is to store urine. The functioning of the bladder takes place under the control of the central nervous system. When the urine stored in the bladder reaches a certain level, the urge to urinate occurs.

What is Bladder Cancer?

Bladder cancer is the second most common cancer among cancers that start from the kidneys and occur along the urinary tract. Approximately two-thirds of bladder cancers are non-fatal but tend to recur, while one-third are malignant formations that have the potential to spread (metastasize) to muscle tissue and then to the rest of the body.

Bladder cancer occurs more frequently in men than in women, and the disease usually occurs in adults. When the ranking of the most common cancers among genders in Turkey is analyzed, bladder cancer is seen in the 3rd frequency in men and 13th in women.

What Are Bladder Cancer Symptoms?

The most important symptom that prompts patients to apply to a physician after bladder cancer occurs is urination, which has a visibly red color change due to the presence of red blood cells in the urine, and is usually painless. This symptom is called macroscopic hematuria.

In addition to blood in the urine, many other symptoms may occur during the course of the disease.

  • Pain in the groin and upper groin area
  • Frequent urination
  • Urgent need to urinate
  • Presence of microscopically detectable blood in the urine (microscopic hematuria)
  • Presence of blood clot in the urine
  • Painful urination
  • Mass and feeling of fullness in the groin area
  • Back pain
  • Weakness
  • Weight loss

In case of spread of the disease to other tissues and organs (metastasis), it may cause various findings depending on the area where it spreads. E.g; Complaints such as coughing or producing bloody sputum may indicate that bladder cancer has spread to the lungs. The occurrence of bone pain in bladder cancer patients may be a sign of the spread of the disease to the skeletal system.

What are the Stages of Bladder Cancer?

A system called TNM classification is used in the staging of bladder cancers.

  • T is evaluated according to the findings of the presence and spread of bladder cancer. While T1 tumors are in the more superficial parts of the bladder, T2 tumors indicate the presence of spread to muscle structures, T3 tumors to the adipose tissue around the bladder, and T4 tumors to other organ structures.
  • N is classified according to whether the bladder cancer has spread to the lymph nodes. Involvement of a single lymph node smaller than 2 centimeters is classified as N1, while involvement of more than one lymph node between 2 and 5 centimeters is classified as N2, and involvement of any number of lymph nodes larger than 5 centimeters is classified as N3.
  • In M staging, the evaluation is made according to whether the cancer has spread to organs other than the bladder. It is evaluated as M1 if metastasis is detected and M0 if it is not detected.

Bladder Cancer

The clinical staging of bladder cancer, which is created using the TNM classification, is divided into 4 stages:

Stage 1 bladder cancer is superficial cancer of the bladder without lymph node involvement and spread to another organ.

Stage 2, as in stage 1, defines the clinical stage in which no spread to other tissues and organs is detected, but the cancer has progressed to deeper muscle structures.

Stage 3 is a more advanced clinical stage, usually accompanied by lymph node involvement, in which no spread to distant organs to the bladder is detected.

Stage 4 bladder cancer means that the disease has now spread to other distant tissues and organs.

How Does Bladder Cancer Occur?

The cells that make up the human body have a unique life cycle. Cells grow and develop in their life cycle and also age during this process. Aging cells sacrifice themselves when the time comes, leaving their place to new cells in a delicate balance.

This cycle is broken due to various factors and if a cell has a tendency to multiply and spread uncontrollably, it is defined as cancer. Cancers usually get their name according to the tissue and organ from which they originate.

What Causes Bladder Cancer?

There are many risk factors that can cause the formation of bladder cancer. The most frequently detected chemicals are chemicals, and various infections and drugs are also considered among risk factors.

  • Genetic mutations
  • Smoking
  • Various professions such as paint industry, dry cleaning, rubber and chemical industry
  • Schistosomiasis, a parasite that settles in the bladder
  • Irritation caused by bladder stones in the bladder for long periods
  • Some pain relievers and cancer drugs

Bladder Cancer Diagnosis

Urologists can benefit from various imaging methods, laboratory examinations, evaluation of cells excreted in the urine, and microscopic examination of biopsy material in the diagnosis of bladder cancer.

  • Biochemical laboratory tests

Tests such as urine tests, blood values, kidney and liver function tests can be evaluated in bladder cancer patients.

  • Urine cytology

It refers to the investigation of the presence of normal or cancerous cells of the bladder, which are excreted with urine, with a microscope.

  • Imaging tools

Ultrasonography, intravenous urography, computed tomography, magnetic resonance imaging and cystoscopy can be given as examples for imaging methods that can be used in the diagnosis of bladder cancer.

Computed tomography and magnetic resonance imaging are used to determine whether the disease has spread outside the bladder.

Bone scintigraphy can be used to evaluate the spread to the skeletal system in patients with bladder cancer who complain of bone pain.

Cystoscopy allows endoscopic evaluation of the bladder. The method called transurethral resection (TUR) can be applied during the cystoscopy examination, and a piece can be taken. The TUR procedure can be used for both diagnostic and therapeutic purposes.

Bladder Cancer

Bladder Cancer Treatment

Different methods are used in the treatment planning in bladder cancer, depending on whether the disease has spread to the muscle tissue. If there is no spread in the muscle tissue, after endoscopic removal of the lesion, intravesical BCG can be applied according to the risk status of the patient.

With the BCG procedure, close to 40% gain can be achieved in terms of re-emergence and progression of the disease. After this procedure, side effects such as muscle fatigue, weakness, nausea-vomiting, diarrhea, fever, and pain during urination may occur.

Depending on the stage and localization of the tumor, surgical procedures applied in bladder cancer can be performed by removing the bladder completely or removing a part of it. A surgical approach called radical cystectomy is usually used in bladder cancers that have spread to muscle tissue. In this method, in which the surrounding tissues and lymph nodes are removed in addition to the bladder, chemotherapy can be used as an additional treatment approach to surgery.

The treatment method that aims to destroy cancer cells by using high-energy rays is called radiation (ray) therapy. Radiotherapy applications come to the fore especially in patient groups who are not suitable for surgical interventions or where surgical interventions are not preferred.

Bladder-sparing treatment approaches are the process of preserving the bladder instead of removing it completely, with the use of chemotherapy and radiotherapy applications, following the reduction of the cancer structure as much as possible by transurethral resection (TUR). Such organ-preserving approaches may come to the fore in appropriate patient groups following the physician’s evaluation.

If bladder cancer has spread to other parts of the body, systemic chemotherapy and/or targeted immunotherapy come to the fore in the treatment that can be applied in response to this situation.

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