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The symptoms of this cancer are hard to miss. Despite this, patients do not start treatment until six months after the first symptoms appear. Why?
The most common symptom of bladder cancer is hematuria. Unfortunately, many patients do not go to the doctor right away. Some suspect that the red color of the urine is a symptom of cystitis, while others believe that it is the result of eating a dish of beetroot. – The average time from the onset of hematuria to the diagnosis of a bladder tumor is several months. Meanwhile, in the case of this cancer, this time is invaluable, because the results of treatment depend on the stage of the disease at the time of diagnosis – says Prof. Andrzej Borówka, head of the Urology Clinic of the CMKP located at the European Health Center in Otwock.
Bladder cancer causes and symptoms
Bladder cancer accounts for more than 7 percent in our country. all malignant neoplasms in men. In terms of the frequency of occurrence, it is second only to cancer of the lung, skin, colon and prostate in men. It happens four times less often in women. – The main risk factor for bladder cancer is smoking. The likelihood of its occurrence is the greater, the greater the number of cigarettes smoked a day and the longer they follow this habit, and the cessation of smoking by patients with this cancer contributes to the improvement of the prognosis – says Prof. Bilberry. The risk of developing bladder cancer also increases with age.
Usually, the first symptom of the disease is painless hematuria. It can be macroscopic – red in the urine, or microscopic – the presence of red blood cells is found in the urine sediment test. This symptom should always be consulted with a doctor. On the basis of a reliable interview, the latter may suspect that it is not a cystitis. Then he will perform an ultrasound. Final diagnosis is made on the basis of a transurethral endoscopy of the bladder, called a cystoscopy. Performing the examination with the use of a flexible cystoscope is painless. A complementary test is the cytological evaluation of urine sediment consisting in microscopic search for neoplastic cells in it, says Prof. Bilberry.
Removal of the bladder tumor – transurethral electrosection
If a tumor is found on ultrasound, it is removed by transurethral electrosection. An endoscope is used for this. A cutting device is inserted through the urethra, connected to a current source, with which the tumor is excised. The optical set allows the surgeon to view the course of the operation directly on the monitor screen. The removed tumor and tissues from its vicinity are sent for histopathological examination. On its basis, the malignancy of the neoplasm and the depth of its invasion of the bladder wall are assessed.
In some patients, the tumor recurs after transurethral electroresection. – In order to reduce the risk of recurrence, an intravesical infusion of a cytotoxic drug is used, and patients with unfavorable oncological characteristics of the superficial tumor undergo adjuvant treatment involving the administration of a series of BCG vaccine infusions or a cytotoxic drug to the bladder – says Prof. Bilberry. Cancer recurrences that have infiltrated the bladder membranes carry a risk of increasing the malignancy of the tumor and the depth of infiltration.
Radical treatment
– Infiltration beyond the mucosa, indicating significant local advancement of the cancer, is an indication for aggressive surgical treatment consisting in radical excision of the bladder together with the pelvic lymph nodes – says Prof. Bilberry. In some patients, in the case of a single, primary, relatively small and not very malignant tumor – combination therapy may be used to preserve the bladder. It consists in complete transurethral excision of the tumor and the use of multi-drug systemic chemotherapy and radiotherapy. This type of treatment can be carried out only under the conditions of close cooperation of various specialists – urologist, oncologist, chemotherapist, i.e. in centers with the above-mentioned methods of treatment. – The necessary condition is that the patient understands the essence of the treatment and accepts its rigors and the need for careful observation after treatment – explains prof. Bilberry.
Removal of the bladder
Unfortunately, in some patients, removal of the bladder is a necessary procedure. It is associated with the need to reconstruct the urinary tract. The most common form is a urinary fistula with an external reservoir attached to the abdomen. In some patients, the bladder may be replaced with a structure made of the intestine and ensuring urinary continence. The intestinal pouch usually fuses with the urethra, which makes it possible to pass urine naturally. The urologist during the operation makes the final decision on how to divert the urine. – Intestinal bladder is an attractive method of urine drainage for patients, but compared to external fistula it is burdened with a higher risk of complications. It is used only in patients in good general condition. Studies in patients undergoing bladder resection have shown that the quality of life of those who have had their urine drained through an external fistula is similar to that of patients with an intestinal bladder.
Chemotherapy before surgery
Some patients receive chemotherapy immediately before surgery. Its purpose is to destroy micrometastases that may be present in lymph nodes outside the area covered by the surgery. Such a procedure contributes to the improvement of the survival of patients by up to about 10%. It happens that in patients who received anticipatory chemotherapy, the histopathological examination of the removed bladder does not show cancer. – It is a favorable factor in the prognosis. It does not mean, however, that the bladder was removed unnecessarily – explains prof. Bilberry. She emphasizes that the removal of the bladder should take place as soon as possible from the determination of the indications for this operation. – It has been shown that the results obtained in patients operated on within three months of determining the need for bladder excision are clearly better than in patients operated on for a longer period of time – he adds.