What is Bladder Cancer?
The bladder is an organ that stores urine filtered through the kidneys. Urine is then expelled from the body by the contraction of the bladder. The internal tissue of the bladder is unique. Bladder cancers occur in this layer, which is specific to the bladder. 90% of bladder cancers occur only in the lining of the bladder. Cancer cells multiply uncontrollably in these tissues inside the bladder and cause bladder cancer.
The most characteristic symptom of bladder cancer, especially in people over the age of 65, is painless blood in the urine. Bladder cancer is 4 times more likely to occur in men than in women. In addition, the symptoms are the same in both men and women.
Bladder Cancer Symptoms
Symptoms of bladder cancer include the following:
- Burning and pain during urination,
- Difficulty urinating,
- Intermittent or slow urination,
- Frequent urination,
- Decreased amount of urine,
- Weight loss or weakness,
- Difficulties with bladder or bowel control,
- In advanced stages of bladder cancer, pain in the buttocks and back, stiffness and pain in the calves.
Symptoms of Bladder Cancer Spreading to Bones
Cancer cells in the bladder can dislodge over time and pass into the circulatory system. Through the circulatory system, these cancer cells can also attach to the bones. In this case, bladder cancer has metastasized to the bones. These cancer cells that attach to the bones can remain silent for a long time. If bladder cancer spreads to the bones, the symptoms are as follows.
- Bone pain is the first symptom of bone metastases. Although bone pain is rarely seen at first, severe pain is seen in the later stages, especially at night.
- Bone fractures are another symptom. Because cancer causes bones to weaken, they can break easily.
- Lethargy
- Paralysis
- Difficulty urinating, especially if it occurs above the bones of the spine. Because the cancer starts to put pressure on the nerves in the spine.
- Loss of appetite,
- Nausea
- Excessive thirst,
- Confusion,
- Symptoms such as fatigue are due to high levels of calcium in the blood.
Causes of Bladder Cancer
There are some factors that increase the risk of bladder cancer. Age ranks first among these factors. Bladder cancers are more common in men over the age of 50.
Another factor that increases the risk of bladder cancer is smoking. The risk of bladder cancer is 6 times higher in smokers.
Some occupations also lead to an increased risk of bladder cancer. Exposure to organic or chemical dyes, especially in working environments, also increases the risk of bladder cancer.
Chronic bladder inflammation seen in some people is also among the factors that increase the risk of bladder cancer. Especially people with spinal cord diseases or those who are constantly using catheters often suffer from bladder inflammation.
Finally, chemotherapy is among the risk factors for bladder cancer. Chemotherapy used to treat other types of cancer causes changes in the bladder cells of some patients.
How is Bladder Cancer Diagnosed?
When consulting a physician with bladder cancer, physicians first take the history of the patients. Afterwards, preliminary findings are obtained by physical examination. Further tests are required for a definitive diagnosis.
Cystoscopy
Cystoscopy is an imaging method that is entered through the urinary tract of patients with a lighted and thin instrument. During this imaging procedure, a biopsy sample is also taken if necessary.
Imaging Methods
Different imaging tests are used to confirm the diagnosis and to visualize whether the cancer has spread to other organs. With these tests, the abdominal region of the patients is examined. The ureter and kidneys are also examined.
Stages of Bladder Cancer
As with every type of cancer, there are stages in bladder cancer. A more accurate treatment is planned by determining which stage the patients are at. In addition, correctly identified stages increase the likelihood of treatment success.
Phase 0
One of the biggest features that distinguishes bladder cancer from other types of cancer is 0. is the presence of a phase. In bladder cancer at this stage, cancer cells have spread to distant lymph nodes or organs. There are also two different subtypes of this population.
The first of these types is the 0a phase. At this stage, there are several papillae in the bladder. However, since these papillae are still in the epithelial layer, they have not invaded deeper.
Another subtype of the 0 phase is 0is. Instead of growing vertically, the papillae in this marbling show spreading growth. This type of cancer in patients is also called carcinoma in situ. In addition, these types of cancer are extremely aggressive.
Phase 1
At this stage, when no spread to distant organs or lymph nodes has occurred, the cancer tissues have spread to a lower layer of the epithelial lining. At this stage, when there is no transition to the muscle layer, cancerous tissues are seen both in the epithelial layer and in the subepithelial layer.
Phase 2
In the second stage of bladder cancer, the cancer has not yet metastasized to distant organs or lymph nodes, but the cancerous tissues have progressed to the muscle layer.
Phase 3
The third stage of bladder cancer is also divided into two subgroups. The first of these types is 3A. In patients at this stage, the cancer reaches the fat tissue under the muscle tissue. In addition, cancer is beginning to appear in the surrounding organs. Cancer, especially in the prostate and vagina, starts to appear. In addition, metastasis occurred in at least 1 regional lymph node. However, metastasis to distant organs or lymph has not yet occurred.
Patients in stage 3B have metastases in the upper pelvic and pelvic lymph nodes. There is still no metastasis to distant organs.
Phase 4
Bladder cancer 4. phase is also divided into two subgroups. In patients in stage 4A, cancerous tissues have metastasized to distant lymph. However, there are no metastases in distant organs yet. Metastasis in the iliac vessels may also be seen at this stage.
Another subgroup of stage 4 is 4B. In this stage, it spreads to organs such as bone, liver and lung in patients.
Bladder Cancer Treatment Methods
There are several different treatment methods for bladder cancer, which is extremely common among cancer types. The treatment to be applied should be decided by urologists and patients together according to the characteristics of the cancer and the patients.
Transurethral Resection (TUR)
Bladder cancer surgery, the most well-known bladder cancer treatment method, removes the bladder of patients. These surgeries, one of the most successful bladder cancer treatments, are performed with two different methods. The first of these methods is TUR.
This method, which is preferred especially in early stage bladder cancers, is performed with a medical device with a camera and a scraping blade at the end. With this medical device, the cancerous area is completely removed. This method is also frequently preferred in bladder cancers that have progressed to muscle tissues.
Cystectomy
One of the surgical methods used in the treatment of bladder cancer is radical cystectomy surgery. This method is preferred if there will be no damage to the bladder tissues during the removal of cancerous tissue.
In male patients undergoing cystectomy, the seminal vesicles and prostate are also removed. For this reason, male patients may experience erectile dysfunction. However, doctors can separate the nerves that are necessary for an erection. In this way, male patients are prevented from having erection problems in the future.
Cystectomies in women require the removal of the ovaries, uterus and part of the vagina. Removal of the ovaries in women can cause both early menopause and infertility.
In addition, cystectomy surgeries carry the risk of bleeding and infection. If these surgeries are performed with the da Vinci robotic surgery robot, then the operation is called robotic radical cystectomy surgery.
Radiotherapy and Chemotherapy
In bladder cancer patients, if surgery is not an option, then radiotherapy is applied to patients.
Chemotherapy, another method used in the treatment of bladder cancer, is applied with two different methods. The first of these methods is a type known as intravesical chemotherapy. In this type of chemotherapy, only the bladder is treated. This type of targeted treatment is especially used in aggressive cancers with a high risk of progression.
Another type of chemotherapy is systemic chemotherapy. In this method, chemotherapy is applied to the whole body of the patient.
Immunotherapy
In immunotherapy used in bladder cancer, patients' immune systems are an active part of the treatment. Patients' immune systems are activated with the drugs used and the immune system is enabled to fight cancer.
