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Bladder Cancer: An Overview of Information
Last reviewed: 23.04.2024
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Cancer of the bladder is most often a transitional cell. Symptoms include hematuria; later, urine retention may be accompanied by pain. The diagnosis is confirmed by visualization methods or by cystoscopy and biopsy. Isolate surgical treatment, destruction of the tumor tissue, intravesical instillation or chemotherapy.
Other histological types of bladder cancer with epithelial (adenocarcinoma, squamous cell carcinoma of the bladder, mixed tumors, carcinosarcoma, melanoma) and non-epithelial (pheochromocytoma, lymphoma, choriocarcinoma, mesenchymal tumors) are much less common.
The bladder can also be affected by the direct growth of malignant neoplasms from neighboring organs (prostate, cervix, rectum) or distant metastasis (melanoma, lymphoma, malignant tumors of the stomach, breast, kidneys, lungs).
ICD-10 codes
- C67. Malignant neoplasm;
- D30. Benign neoplasms of urinary organs.
What causes bladder cancer?
In the US, more than 60,000 new cases of bladder cancer and approximately 12,700 deaths are recorded each year. Bladder cancer is the fourth most common in men and less common in women; the ratio of men to women is 3: 1. Bladder cancer is more often diagnosed in white than among African Americans, and the incidence of it increases with age. In more than 40% of patients, the tumor recurs in the same or another department, especially if the tumor is large, poorly differentiated or multiple. With progression, expression of the p53 gene in tumor cells can be associated.
Smoking is the most common risk factor, it causes more than 50% of new cases. The risk also increases with excessive use of phenacetin (abuse of analgesics), prolonged use of cyclophosphamide, chronic irritation (in particular with schistosomiasis, concrements), contact with hydrocarbons, tryptophan metabolites or industrial chemicals, especially aromatic amines (aniline paints, for example naphthylamine, used in industrial color) and chemicals used in the rubber, electrical, cable, dyeing and textile industries.
More than 90% of bladder cancer is transitional cell. The majority is papillary bladder cancer, which tends to exophytic growth and a highly differentiated structure. Infiltrating tumors are more insidious, they tend to early invasion and metastasis. The squamous cell variant is less common, usually found in patients with parasitic invasion or chronic mucosal irritation. Adenocarcinoma can occur as a primary tumor, but it can also be a metastasis of malignant colon formations, which must be excluded. Bladder cancer tends to metastasize to the lymph nodes, lungs, liver and bones. In the bladder, the cancer in situ is highly differentiated, but non-invasive, usually multifocal and tends to recur.
Symptoms of bladder cancer
Most patients have unexplained hematuria (macro or microscopic). Some patients have anemia. Hematuria is revealed during examination. Irritative symptoms of bladder cancer - urination disorders (dysuria, burning, frequency) and pyuria are also common during treatment. Pelvic pain occurs in the prevalent version, when palpable volume formation in the cavity of the small pelvis.
Diagnosis of bladder cancer
Bladder cancer is suspected clinically. Excretory urography and cystoscopy with biopsy from pathological areas are usually performed immediately, because these tests are necessary, even if the urinal cytology that can detect malignant cells is negative. The role of urinary antigens and genetic markers has not been fully established.
For apparently superficial tumors (70-80% of all tumors), biopsy cystoscopy is sufficient to determine the stage. For other tumors, computed tomography (CT) of the pelvic organs and abdominal cavity and chest x-ray are used to determine the incidence of the tumor and detect metastases.
Bimanual examination using anesthesia and magnetic resonance imaging (MRI) can be useful. A standard TNM staging system is used.
Symptoms and Diagnosis of Bladder Cancer
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Treatment of bladder cancer
Early superficial bladder cancer, including initial muscle invasion, can be completely removed by transurethral resection or tissue destruction (fulguration). Repeated instillations in the bladder of chemotherapeutic drugs, such as doxorubicin, mitomycin or thiotepa (rarely used), can reduce the risk of recurrence. The instillation of the BCG vaccine (Bacillus Calmette Gurin) after transurethral resection is generally more effective than instillations of chemotherapeutic drugs for cancer in situ and other highly differentiated, surface, transitional cell variants. Even when the tumor can not be completely removed, some patients can get the effect of instillation. Intravesical therapy of BCG with interferon can be effective in some patients who have relapses after BCG therapy alone.
Tumors that penetrate deep into or out of the walls usually require radical cystectomy (removal of the organ and adjacent structures) with concomitant withdrawal of urine; resection is possible in less than 5% of patients. Increasingly, cystectomy is performed after initial chemotherapy in patients with locally advanced disease.
Urinary diversion has traditionally included withdrawing an isolated ileum loop to the anterior abdominal wall and collecting urine in the external urine collection. Alternatives, such as an orthotopic new bladder or skin diversion, are very common and acceptable to many - if not most - patients. In both cases, the inner reservoir is built from the gut. When forming an orthotopic new bladder, the reservoir is connected to the urethra. Patients release the reservoir, relaxing the muscles of the pelvic floor and increasing the abdominal pressure so that the urine passes through the urethra almost naturally. Most patients provide urine control during the day, but some incontinence can be at night. With the drainage of urine into the subcutaneous reservoir ("dry" stoma), patients release it by self-catheterization during the day as needed.
If surgical treatment is contraindicated or the patient objects, radiotherapy alone or in combination with chemotherapy can provide a 5-year survival rate of about 20-40%. Radiation therapy can cause radiation cystitis or proctitis or stenosis of the cervix. Patients should be examined every 36 months for progression or relapse.
Detection of metastases requires the appointment of chemotherapy, which is often effective, but rarely radical, unless the metastases are limited to the lymph nodes.
Treatment of recurrent bladder cancer depends on the clinical stage, place of relapse and previous treatment. Recurrence after transurethral resection of superficial or surface invasive tumors is treated by repeated resection or tissue destruction. Combined chemotherapy can prolong the life of patients with metastases.
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What is the prognosis of bladder cancer?
Superficial bladder cancer in comparison with the invasive rarely leads to death. For patients with deep invasion of the muscle layer, 5-year survival is approximately 50%, but adjuvant chemotherapy can improve these results. In general, the prognosis for patients with progressive or recurrent invasive bladder cancer is poor. The prognosis for patients with squamous cell carcinoma of the bladder is also unfavorable, as it is usually highly invasive and is only detected in the advanced stage.