Bladder cancer is a relatively common cancer – we diagnose about 8 in Poland each year. new cases. For 4 patients annually, the cancer turns out to be fatal, because the diagnosis usually occurs in a very advanced stage – says Dr. Iwona Skoneczna, MD, PhD from the Grochowski Hospital. Rafał Masztak, MD, PhD in Warsaw.
- Bladder cancer is rarely mentioned. Too rarely, considering how severe the consequences can be
- When it is detected early, the patient may still be healthy for many years
- One simple test is enough to diagnose bladder cancer
- More current information can be found on the Onet homepage.
Bladder cancer is a “forgotten” cancer, although it is quite common. Who gets bladder cancer most often?
It is true that bladder cancer is a relatively common cancer – we diagnose about 8 people in Poland each year. new cases of this cancer. It is a disease that affects men more often. Bladder cancer results from smoking in around half of patients, and from occupational exposure to various harmful chemicals in around one third of patients. There are also patients who have both of these risk factors at the same time – people who smoke and are exposed to toxic chemicals at the same time. Unfortunately, in Poland, bladder cancer is diagnosed in a large proportion of patients when it is already advanced and invasive. Therefore, about 4 die from bladder cancer. patients per year.
How often and what preventive examinations should be performed in order to detect bladder cancer early?
The basic test that can help detect this cancer early is a simple general urine test. It is cheap, painless and very easy to perform, which we can commission ourselves. It is worth doing them regularly, even if we do not feel any discomfort or observe any disturbing symptoms. Thanks to this, we can find the disease at an early stage of development.
She is an expert in the educational campaign for BLADDER CANCER – DETECT AND TREAT !, conducted by the Polish Coalition of Oncological Patients. The aim of the campaign is to draw attention to the “forgotten” cancer that is bladder cancer.
And what ailments or symptoms should prompt us to do a urinalysis immediately?
The indication for immediate urine general examination is the appearance of blood in the urine, or red or pink urine. It is very important to observe both your urine and stools, and if you notice red discoloration of your urine or stools, even if it has appeared and has passed, you should report it to your GP as soon as possible. Let’s not be glad that the hematuria was episodic and disappeared, let’s just do a checkup. In this case, apart from the general urine examination, an ultrasound examination of the abdominal cavity with the assessment of the bladder should be performed. Remember that in order to assess the bladder in an ultrasound examination, the bladder must be filled like a balloon. Therefore, you should come to the test with a bottle of still water and drink it just before the test.
Not all people with bladder cancer have haematuria, so we should also pay attention to other symptoms. We should be concerned about urinary tract infection lasting more than two weeks, problems with urination, such as: stinging, burning, pain; or frequent urination. Some cancers can irritate the bladder in such a way that it does not bleed but resembles an infection.
What is the diagnostic process in bladder cancer?
If, after a general urine test and ultrasound, the doctor suspects bladder cancer, he should refer the patient to a urologist as soon as possible. The urologist should look inside the bladder with an instrument called a cystoscope. This procedure, called cystoscopy, is performed under anesthesia. The doctor then has the opportunity to carefully inspect the bladder and cut out any suspicious changes. If the lesions are small, it is possible to cut them out entirely, while if they are large and extensive, they are cut. The sections are then analyzed under a microscope. This is called microscopic histopathological examination, the results of which give the final answer whether we are dealing with cancer and what type of cancer.
What is the prognosis for bladder cancer?
As with any cancer, the results of bladder cancer treatment depend on the stage of the disease. We should do everything to recognize such a tumor as soon as possible, i.e. in the so-called non-invasive stage when it has not yet grown deep into the bladder wall. If this is successful, the treatment consists of cutting out the lesions during the so-called transurethral electroresection (TURT / TURBT). The results of such treatment are excellent and patients live for many years. Sometimes after such treatment, control, regular cystoscopes are required, that is, looking into the bladder, sometimes we use infusions with therapists into the bladder, but the bladder remains and continues to work. However, if the diagnostic process takes too long and the cancer has time to grow deep into the walls of the bladder, the situation is completely different. We are then talking about the so-called invasive bladder cancer. Treatment of such cancer is a much more complicated process, which is very burdensome for the patient, and the results are not always as we would like them to be. Therefore, it is so important to diagnose the disease as soon as possible, in a non-invasive stage.
What if it fails? What is invasive bladder cancer treatment?
In patients whose cancer grows into the bladder walls, it is necessary to excise the entire bladder along with the adjacent organs, i.e. in men together with the prostate, and in women – along with a part of the reproductive organ. This operation, called a radical cystectomy, is a large, crippling operation that requires a urostomy. After the surgery, it is not possible to pass urine naturally, but it flows into a special bag glued to the skin. At first, a urostomy looks like the proverbial “end of the world” to the patient – but most often it is not. A urine bag stuck to the skin does not preclude an active, almost normal life with professional activities and sports. Unfortunately, cancer that grows into the bladder wall also tends to grow into blood vessels, which means it can metastasize quite easily. Therefore, even before the cystectomy surgery, the patient should receive preoperative chemotherapy.
Some patients do not agree to the excision of the bladder and in them we resort to treatment combining several methods, i.e. surgical excision of as much tumor area as possible, chemotherapy and radiation. Sometimes good long-term results can be obtained in this way, but the bladder is not an ideal organ for irradiation and therefore not all patients receive the desired results. Therefore, the gold standard in invasive bladder cancer is removal of the bladder along with the administration of perioperative chemotherapy.
What are the current treatment options for advanced bladder cancer?
Advanced bladder cancer is a cancer that we cannot completely remove, or a cancer that has spread to other locations in the body besides the bladder. To confirm this diagnosis, we must take samples from the bladder and perform a routine CT scan of at least the chest, abdomen and pelvis. If, in such a test, we see a tumor outside the bladder, we qualify the patient for systemic chemotherapy. The problem, however, is that in order to administer classic chemotherapy, good renal parameters are required, and unfortunately, in some patients, the tumor in the bladder hinders the outflow of urine from the kidneys, which makes these parameters not good enough for us to safely administer chemotherapy. Then our possibilities of action are limited.
However, if the patient can receive chemotherapy, we use it. After completing the chemotherapy cycles, we evaluate the response to this treatment, and if the response is good, i.e. the disease progression has been stopped, we can use immunotherapy, which maintains the good effect achieved with chemotherapy. Another type of immunotherapy is used in patients for whom chemotherapy has not worked or has stopped working. However, research shows that it is much better for the patient to receive immunotherapy immediately after the end of chemotherapy in order to strengthen its effect and without waiting for the disease to recur.
Yet another type of immunotherapy is one that is used in those patients who are ineligible for chemotherapy and furthermore have sufficiently high expression of a specific marker. This high expression offers a chance for a good response to immunotherapy. The problem is that in Poland, none of these immunotherapies is currently reimbursed. We are glad that there are new drugs for the treatment of advanced bladder cancer, but unfortunately they are not fully available to our Polish patients today. Of course, we would like this to change and that immunotherapy would be reimbursed and thus available to our patients.
Why is the collaboration of different specialists important in the treatment of bladder cancer?
Currently, we use multidisciplinary treatment for most cancers. The team of doctors who treat neoplastic disease usually includes a surgeon, oncologist, radiotherapist and a chemotherapist, i.e. a clinical oncologist. Thanks to this, it is possible to combine surgical methods, i.e. tumor excision with radiation, and with the administration of systemic treatment, i.e. chemotherapy or immunotherapy. This approach produces the best results and it is important that the patient is able to move smoothly from one treatment to the next without delay.
It is worth doing preventive examinations every year. At Medonet Market you can buy:
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