Contents
What is bladder cancer?
bladder cancer in men and women it is a kind of a certain education. These are tumors consisting of cells alien to normal health. Cancer is cell growth that occurs at an abnormal rate. This process can begin in various human organs. Cells are additional, with their reproduction, neoplasms are formed, which are called tumors. There is such a type of tumor as bladder cancer. That is, cells are formed precisely in this system of organs and tissues.
The urinary tract consists of several parts, among which is the bladder. Its task is to hold urine until emptying becomes possible. The system is different for men and women. Accordingly, the specificity of the disease is very dependent on the gender of the patient.
Generally, bladder cancer is easily treatable. A share of this is that it needs to be diagnosed as early as possible. The symptoms are fairly easy to recognize.
Bladder cancer comes in different types. This classification depends on what cells the malignant formation consists of:
Bladder cancer of the transitional cell category (carcinoma). It is he who is diagnosed most often, in 90% of the total statistics of cases.
Cancer of the squamous cell category. It is formed much less frequently, and its main cause is cystitis, that is, chronic inflammation.
Among the fairly rare forms of bladder cancer are carcinoma, adenocarcinoma, and so on. Although rare, they are not ruled out when the diagnosis is made.
Bladder Cancer Symptoms
There are many symptoms of this disease. Some of the more common ones include:
Urine filled with blood or blood clots (hematuria). The symptom occurs especially often, in 8 cases out of 10. It is not accompanied by pain symptoms.
Pain during urination (dysuria).
Excessive urination, although the volume of urine is very small.
The urinary tract is often exposed to an infectious disease.
There are symptoms that are characteristic of the later stages, with exacerbations:
Severe pain in the lumbar region, near the kidneys (in the side).
The shins are constantly swollen.
In addition to swelling, in the renal pelvis, in the area of the bladder, tissues develop excessively (you can notice a tumor-like formation from which the small pelvis suffers).
There are symptoms that complement the clinical picture. In parallel with the manifestations of bladder cancer, there are:
Noticeable weight loss.
Painful syndromes in the bones, in the rectal, anal areas, in the small pelvis.
Anemia.
It is often noted that the manifestations of this disease are similar to those of other diseases. Such pains, which are caused by cystitis, can be distinguished when the patient is at rest. It constantly seems that the urinary system is not completely emptied – this phenomenon is called dysuric. Often there are false urges, problems with incontinence, with urinary passage.
Bloody secretions have their own characteristics. Against the background of the development of a tumor formation that occurs in the lumen of an organ such as the bladder, and then the process of destruction begins. Hematuria is formed, and its manifestations can be seen in the bloody impurities formed in the urine. It is recognized by its fresh scarlet color, and at first a few drops or corresponding streaks are visible in the urine. As already mentioned, pain does not occur. General health is described as good. But gradually hemorrhages develop and intensify. More and more clots appear.
If bladder cancer progresses, you can see the manifestations of other diseases:
Renal hydronephrotic transformation leads to urinary outflow disorders.
Chronic renal failure is evident due to the feeling of dryness of the mucous membranes and skin, it becomes lethargic, skin itching is constantly diagnosed.
Severe indigestion.
Next to the urinary system are other organs. If the stage is especially neglected, then complications arise associated with the penetration of cancer cells into them. With extensive development, tumors capture nearby organs.
Then some other symptoms appear:
Pain attacks where the lower abdomen is located.
The formation between the vagina and the bladder of easily diagnosed fistulas; in addition, they appear in the middle of the rectum and bladder.
With metastases to the region of the lymph nodes of the retroperitoneal and inguinal type of lymph nodes, lymph flows from the lower extremities, and lymphatic edema appears in the region of the scrotum and lower extremities.
Causes of bladder cancer
It is important to remember such a feature as the “risk factor”. Because of them, the disease gets the opportunity to develop. When such a risk factor is found, it is difficult to say that this disease is inevitable. But even if they do not take place in this case, then you should not assume that this disease does not threaten the patient. If the disease known as bladder cancer seems to be signaling its presence, it is necessary to have a conversation with a doctor.
Let’s clarify what circumstances you need to remember. Risk factors for bladder cancer include:
Smoking habit. Because of it, the risk of entering the number of patients in this category increases markedly, since this provokes such a process as the transformation of the urine composition into harmful. Chemicals enter the smoker’s body through the smoke, and they are processed, ending up in the urine. Their harm lies in the fact that they are able to act on the mucous membrane in which the lining of the bladder is clothed, while increasing the risk of the appearance of malignant cells.
Achieved age. As you know, this disease is not limited in terms of age, but every year this danger only increases. This type of cancer occurs at different ages, and is extremely rare in those who have not yet celebrated their 40th birthday.
Race. Those with fair skin are more at risk.
Gender belonging. In men, the disease occurs more often than in women.
Contact with certain substances, which are called chemical. It is the kidneys that are responsible for such a process as the natural filtration of substances that are in the body. They enter there through the blood, that is, first they end up in its cells, with their further movement – that is, they end up in the bladder. This, presumably, explains why this disease develops so often. The chemicals that can cause this disease are quite diverse, and they include not only arsenic, but also numerous chemicals involved in the production of dyes, rubber batches, etc.
Cancer treatment in the past. If Cyclophosphamide (Cytoxan) was used, special care must be taken so that the pathology does not develop. First, people with cancer must receive exposure to radiation therapy. As you know, its task is to treat the pelvic region, which increases the risk of developing cancer of this organ.
Taking courses of diabetes medications. There are drugs that greatly facilitate the task of malignant cells – for example, pioglitazone, at least more than a year.
Chronic inflammation of the bladder. Among these manifestations is cystitis, and then it matters whether a urinary catheter was used, leading to such consequences as squamous cell carcinoma of this organ. There are countries where squamous cell carcinoma is caused by a dangerous inflammation of an organ such as the bladder, and it is caused by a parasite that causes an infection called schistosomiasis.
Family or personal history of cancer. There are cases when the patient has already suffered from this disease – and the risk of a secondary occurrence of the disease increases. If the disease affected one of the relatives, then the patient is also at risk. In the case of a family history of hereditary non-polyposis colorectal cancer, also known as “Lynch syndrome”, the risk of cancer in the urinary system increases, as well as in the colon, uterus and several other organs.
Changes in the genetic material (DNA) in this case are of great importance. In everyday life, people are constantly exposed to chemicals. They, like smoking, are a strong risk factor. Quite often, the cause is irritation of the mucous membrane of this organ – that is, the bladder. Because of this, it begins to change in the functioning of cells. It is important to remember about other circumstances – radiation therapy, catheters that have been in the microflora of the urinary ducts for a long time, the ingestion of parasites (schistosomiasis), which also causes bladder cancer.
Smoking is especially dangerous. Experts are convinced that this bad habit provokes more than half of the cases of diagnosing bladder cancer in men, and in women – more than a quarter. Also, the disease often occurs in those who are forced to deal with splashes of varnish, leather dust, and so on.
Stages of bladder cancer
In such a field of knowledge as medicine, many professional techniques have been collected. Their task is to enable the specialist to identify as soon as possible which treatment makes sense for each patient. Medical professionals usually rely on various options for setting the type of cancer, which can effectively identify the condition and features of a malignant tumor. The staging procedure is considered as an option to classify oncological diseases. It is thanks to the determination of the stage of cancer that a prognosis is made for a period of 5 years of the patient’s life.
When a specialist must determine the stage of the disease, it is required to conscientiously treat the diagnosis. Only surgery indicates the most accurate state of the tumor. It often happens that during the diagnosis one stage was revealed, and during surgical treatment it turned out to be another.
There is a qualification that uses the numerical designation of the actual categories, which indicate the spread of the tumor, and also clarify the state of local and distant metastases:
T — tumor. This is a description and ordering of the main focus of the tumor. Tis or T0 is a disease when the tumor has not grown through the basal layer of the epithelium. T1-4 is a fairly variable degree of focal intensity. Each organ is marked with some kind of cipher – an index. Tx is the least used. It is rarely used in cases where metastases have already been identified, but what the focus is is still unknown.
N — nodule, denotes regional metastases, that is, the cancer goes to the regional lymph nodes. Nx is a procedure for establishing the fact of regional metastases, and if it was not carried out in this case, then their presence is not known. N0 is a code when regional metastases are not detected as a result of an appropriate study. N1 is a cipher saying that regional formations have been discovered.
M — metastasis. This is how it is indicated whether there are metastases in distant lymph nodes, other organs (excluding tumor growth). The Mx coding indicates the detection of distant metastases, which has not yet been carried out, their presence has not been established. M0 is a cipher that is set if, as a result of the study, it is established that there are no such metastases. Code M1 says: Distant metastases have been accurately identified.
P, G rarely installed. Their meaning is a signal about the differentiation of its cells.
Bladder cancer is classified by modern specialists based on the TNM system. This gives the most complete, reliable and concise description of the disease, while taking into account all the criteria and features of this disease.
Bladder cancer stage 1
Stage 1 bladder cancer is the most commonly diagnosed. The earlier the disease is diagnosed, the higher the chance of recovery.
These are the most frequent, according to statistics, cases. It is at this stage of bladder cancer that one or more foci of malignant cells can be detected. The neoplasm is classified as invasive because it has the appropriate characteristics. They are not yet able to penetrate the muscle fibers, but the mucous membrane is accessible to them. It has the ability to progress. The statistics maintained in this field of medicine show that this disease accounts for almost half of all cases of cancerous tumors, if we talk about the initial stage. Their composition is based on poorly differentiated cells, and the tumor is able to develop rapidly and acquire the status of malignant.
Bladder cancer stage 2
Stage 2 bladder cancer is more dangerous. He is able to capture the muscle level. If only this part of the body, which is located inside, has suffered, as well as in the case of a highly differentiated formation, there is a high probability that the disease is not so severe. That is, the lymphatic system is not yet infected.
If just such a case is diagnosed, then there is a favorable prognosis and the exclusion of relapses in the future. Further, it makes sense to rely on a certain systematization, including two categories – A and B. If the code is 2A, the neoplasm has already metastasized into the microflora of the inner layer of muscles, but still keeps within it. Code 2B is set when the tumor has grown into the outer layers of the muscle layer.
Bladder cancer stage 3
Stage 3 bladder cancer is quite dangerous. With it, harmful cells grow beyond the boundaries of this organ system, with simultaneous damage to the nearest volumes of fiber. The capture of adipose tissue around parts of the body such as the bladder or peritoneum begins.
The formations of this stage, due to their striking characteristics, were divided into 2 substages. They differ in their intensity – the cells begin to get out into areas that are located on the nearest periphery – this is the outer shell of the bubble, without visualization. Cancer cells that have already appeared in the microflora of the perivesical tissue can be detected, but only with the help of special tools. In this case, we are talking about a microscope. Stage 3B means that the focus of malignant cells is already visible if you carefully examine the outer wall of the bladder.
Bladder cancer stage 4
Stage 4 bladder cancer stands out as the most severe when it is most difficult to talk about treatment. Malicious cells are very widespread, with the capture of adipose tissue that envelops the bladder. Distribution to third parties begins.
Most often, on the basis of stage 4 bladder cancer, a connection is formed with the prostate gland according to gender – that is, for men it is also removed because it becomes infected. In women, malignant cells begin to spread into the vagina. Metastasis is also characteristic of this stage. The lesion captures all regional systems of lymph nodes, even if they are distant from the focus of the disease. The pelvic bones, areas of the walls of the abdominal cavity are affected. At this point, the patient begins to experience severe pain, suffer from severe hematuria. There is no specific treatment for this stage of cancer. Surgical intervention is excluded, chemotherapy and radiotherapy are ineffective. Palliative care is a method that alleviates the manifestations of the disease, and in addition, it is the means that most often allows diagnosing the disease.
Bladder cancer metastases
Metastases of bladder cancer develop in a certain sequence. Often this disease leads to lymphogenous metastasis. If we talk about metastases in regional lymph nodes, then such a health disorder is detected in 66% -75% of people with invasive and 5% with superficial oncology of this organ.
Most often, metastases appear in the paravesical (16%), lymph nodes, which are characterized as external iliac (65%) and obturator (74%). Half of patients in the invasive cancer category develop distant bladder metastases. Most often, the disease captures the liver, lungs and skeletal system, as well as the adrenal glands.
Cases of metastasis to other organs are rare. According to statistics, no more than 7% of patients during this period suffer from clinical manifestations of distant metastases.
At the same time, it should be noted that paraneoplastic processes occur much more often, taking the form of such diseases as hyperpyrexia (18,6%), anemia (20,3%), increased ESR (56,3%), abnormal liver function (46,2 %).
During the life of the patient, all metastases of bladder cancer are not always detected. This is explained by the fact that many patients die earlier than the process of generalization begins not from cancer, but from its complications, among which kidney failure is often found. Considerable importance remains for the biological properties of the tumor itself.
As a rule, with superficial tumors, patients continue to live. If you apply the treatment, then the life span is noticeably extended. Bladder resection, TUR, electrocoagulation are performed. The development of the disease in the bladder remains local for a long time.
Bladder cancer undergoes megastasis in lymphogenous, hematogenous and mixed lymphogenous-hematogenous form. First, the cells originate in the regional lymph nodes, liver, lungs, and bones.
Hematogenous metastases are found mainly in very late stages, and as a rule, in squamous and undifferentiated cancers. Its transitional cell variety rarely metastasizes hematogenously, even if there is invasion of the bladder wall.
If an autopsy is performed, metastases are found in the nodes of the para-aortic lymphatic type. They are somewhat further in location than the perivesical, hypogastric, and iliac systems. Metastases in organs such as the liver and lungs are most often multiple, taking the form of small nodules, but there are also quite large, and in rare cases, solitary.
Bone tissue becomes infected in a certain order. First, the skeleton of the spine, pelvis is affected, then the ribs. Metastases, as a rule, are solitary, their character is osteolytic.
Diagnosis of bladder cancer
In case of detection of certain symptoms, it is necessary to visit diagnostic procedures.
Oncomarker of bladder cancer – procedure with UBC antigen. It is detected in the urine (with its accumulation for at least 3 hours). This is a tumor marker for bladder cancer, which allows for early diagnosis. A protracted form of cystitis develops beforehand, and symptoms similar to bladder cancer appear. The oncomarker is used for the timely detection of specific biological signs of cancer, and then the diagnosis is clarified by other methods.
Cystoscopy is recognized as the most important method of examination for bladder cancer. Using an endoscope, a specialist examines the mucous membrane of the bladder step by step, paying great attention to suspicious areas. If required, a biopsy is taken. During cystoscopy, the specialist comes to a definite conclusion regarding the spread and stage of the alien neoplasm.
Urography is acceptable if evidence of bladder cancer has been identified during the cystoscopy procedure. This is an X-ray examination of this organ system. A number of additional studies are also relevant – computed tomography (CT), MRI. This allows you to understand how far the tumor cells have spread.
If we are talking about a late stage, when the cancer has already grown into the muscle layer and surrounding organs, a study on metastases is already needed. Their standard way of formation is the lungs, liver and skeleton.
Protein analysis is considered a fairly new method. It is built on non-routine procedures. It is based on the fact that when the disease changes the concentration of certain proteins in the urine. As a rule, this is a procedure that precedes the symptoms of the disease. This study has certain advantages – so, contrary to the principles of a blood test and a biopsy, it is completely painless, without bearing any risks.
Treatment of cancer of the bladder
Bladder cancer treatment is best started with prevention. It is believed that bladder cancer is a fairly irreversible disease, but the patient himself is able to take some measures:
To give up smoking. This dangerous habit is able to collect carcinogenic chemicals in the microflora of the bladder. If there is no such habit, you do not need to start it. If it has already been acquired, it makes sense to talk with a doctor, discuss with a specialist ways to get rid of this habit.
Care must be taken when contacting chemicals. If this is unavoidable, you need to know all the instructions regarding safety, and this will help to avoid their harm.
Frequent use of water. Liquid, in particular, such as water, can weaken toxic substances, that is, reduce the risk of their accumulation in the urine, and they are washed out of the bladder before the disease develops.
Proper nutrition with an emphasis on fruits and vegetables. You need to develop a diet where these products will prevail. They contain antioxidants that reduce the risk of disease.
They resort to various types of treatment, focusing on the diagnosis. Some approaches are considered as standards of therapy used. A number of them are undergoing clinical trials, improving and providing the necessary data on new methods of treatment. This allows in the future to more effectively treat patients with this disease. If clinical trials show that a new treatment is more productive than standard treatment, then it has every chance of becoming the recommended standard treatment.
Chemotherapy for bladder cancer
Chemotherapy for bladder cancer is based on medications. It is carried out in order to guarantee the destruction of the formation of cancer cells. It may be recommended, depending on the situation, before and after surgery.
This is a set of activities that are built according to a specific system. There are several types of chemotherapy:
transurethral. In the early stages of the disease, a catheter is inserted into the urethra and through it, and the drug should pass through it into the bladder. The substances supplied with the drug remain in the bladder, acting for several hours. Such therapy is carried out repeatedly – once a week, the total duration of the course is six weeks.
Orally. This method consists in taking certain drugs – usually tablets, they must be taken according to the recommendation before or after surgery.
Intravenously. This method is inevitable if the stage of spread to the muscle fibers of the bladder and adjacent tissue layers has come. The drug enters the bloodstream, starting to spread throughout the body. Such therapy is prescribed at a certain time – before or after the organization of the resection of the bladder.
As a rule, treatment is carried out on an outpatient basis. Less often resort to stationary methods. Chemotherapy should consist of several stages. Each of them should end with a rest period.
A number of side effects must be taken into account – this is due to how the drug is required to be administered to the patient. When the catheter is already inserted, the urge to urinate is diagnosed, quite frequent and uncomfortable, and pain is felt. Blood clots appear in the urine. There are times when a rash appears. When treatment is stopped, all painful symptoms disappear.
If there is a procedure for oral and intravenous administration of drugs, it is worth waiting for side effects of a more serious nature. The action of the drug affects the cells of the whole organism, that is, it also captures their healthy part. When their level goes down, the risk of suffering from all kinds of infections increases.
A feeling of weakness and fatigue is characteristic. With a significant decrease in the number of such cells, the dose of treatment is reviewed, and the possibility of its termination is also considered. Taking certain drugs can increase the number of blood cells. Chemotherapy has a detrimental effect on hair cells. They start falling out. When exposed to the cells of the digestive system, attacks of nausea, vomiting, diarrhea and other disorders begin. A number of drugs cause such a reaction as a feeling of numbness and tingling in the limbs – that is, the areas of the arms and legs. After some time passes, the symptoms disappear.
Removal of the bladder for cancer
Radical cystectomy is used when the cancer has invaded deeper areas and bladder cells. The procedure is an operation that removes the bladder, any lymph nodes and the closest organs that are already infected.
This is a surgical procedure that involves the removal of the bladder. If it is radical, then the bladder will have to be removed simultaneously with the prostate and a certain amount of seminal vesicles in men. In women, the uterus with ovaries and fallopian tubes is removed instead. At the same time, it is necessary to eliminate the proximal urethra – it is located immediately after the bladder, as well as the removal of the pelvic lymph nodes.