What is the Bladder Cancer

What is bladder cancer?

The bladder, whose main task in the body is to store urine, is an organ that can stretch as it fills with hollow urine. Bladder cancer usually begins from the urothelial cells of the mucosa that line the inner side of the bladder. Bladder tumors can be malignant or benign. But benign bladder tumors that are not cancerous can also occur.

What are the symptoms of bladder cancer?

Symptoms of bladder cancer include:;

  • Blood in the urine (hematuria): in bladder cancer, there is usually pain-free bleeding in the urine. There may be visible bleeding in the urine, as well as bleeding that can be seen under a microscope. Bleeding can occur in the form of blood clots, not in the entire urine. Blood seen in the urine can be caused by many other causes than a tumor. It should be noted that different diseases, such as kidney stones or infection, can cause blood to appear in the urine.
  • Painful urination
  • Frequent urination
  • Feeling of urgency in urine
  • Disorders such as straining or even inability to urinate due to a clot can be a sign of bladder cancer.

In some cases, when the first symptoms of bladder cancer appear, the cancer can already spread, metastasizing to another part of the body. Symptoms in patients experiencing metastasis may vary depending on the area where the cancer has spread. Advanced bladder tumors;

  • Back pain
  • Pain in the lower part of the abdomen
  • Symptoms such as loss of appetite and weight loss can be experienced.

What are the causes of bladder cancer?

Although the exact cause of bladder cancer is unknown, there are risk factors that can cause it.

  • Smoking: the most common risk factor for bladder cancer is smoking and tobacco use. Those who use cigarettes and tobacco products are 4-7 times more likely to develop bladder cancer than non-smokers. The risk also increases in passive smoking.
  • Age: bladder cancer is more common after a certain age. The vast majority of people diagnosed with bladder cancer are over the age of 50.
  • Gender: men are 3 -4 times more likely than women to develop bladder cancer. But in recent years, the spread of smoking among women also leads to an increase in the incidence of bladder cancer in women. Women are more likely to die from bladder cancer than men.
  • Chemicals: chemicals used in the textile, rubber, leather, paint, chemical, battery industry or printing industry increase the risk of bladder cancer.
  • Belonging to the white race
  • Chronic bladder infections
  • Not consuming enough fluid and keeping a lot of urine
  • Consuming a lot of high-fat or additive foods
  • A family history of bladder cancer
  • People who have received chemotherapy with cyclophosphamide and patients who have undergone radiation therapy to neighboring areas of the bladder for another reason have a higher risk of developing bladder cancer.

How common is bladder cancer?

Bladder cancer is the seventh most common cancer in men, less common in women. However, bladder cancer is a more deadly cancer in women. The American Cancer Society estimates that 80 thousand people (62 thousand men, 18 thousand women) in the United States will be diagnosed with bladder cancer in 2019.

What doctor should I go to for bladder cancer or benign bladder tumors?

Diagnosis and treatment of bladder cancer or benign tumors of the bladder, which can occur at any age, although they are usually seen after the age of 50, is carried out by Urology doctors. It is important to choose a urology doctor who specializes in this issue, as there are also surgical methods for treating bladder cancer and benign bladder tumors.

How is bladder cancer diagnosed?

Bladder cancer is determined by symptoms experienced or as a result of suspicion during routine checks. First, an experienced urology doctor's examination is required.

Urology doctor's examination

The urology doctor will first evaluate risk factors for bladder cancer, such as genetics, smoking or exposure to radiation. Urology doctor in physical examination;

  • It does a systemic check and determines if there is a sign of cancer.
  • Checks for bloating in the abdomen and liver.
  • Checks for enlarged lymph nodes in the groin, abdomen and neck.

In cases of abnormal and suspected bladder cancer, additional tests may be required to clarify the diagnosis.

Urine tests for bladder cancer

  • Urinalysis is a simple laboratory test. It is done to check the blood and other substances in the urine sample.
  • Urine cytology: the presence of cancer cells is controlled by examining a urine sample under a microscope.
  • Urine culture: in the examinations of the urine sample held in the Laboratory, what types of microbes are examined. It is important to determine whether there is a bladder infection.
  • Urine tumor marker tests: a sensitive and original marker has not yet been found. In these tests, substances released into the blood by bladder cancer cells are searched.

Imaging methods for diagnosis of bladder cancer

  • Ultrasonography (USG):ultrasound, which does not require contrast agent application, easily detects bladder tumors larger than 5 mm, and can also help to find out if the kidneys or ureters are blocked. Ultrasound can also be used to determine the size of bladder cancer, whether it has spread to nearby organs or tissues.
  • Computed tomography (CT urogram): it can provide information about the size, shape and location of all tumors in the urinary tract, including the bladder. It can also help show enlarged lymph nodes, which can contain cancer, as well as other organs in the abdomen and pelvis. In order to obtain a more detailed image, sometimes a contrasting substance is given to the patient orally or intravenously. Those who are allergic to iodine and other substances should tell their doctor earlier.
  • Intravenous pyelogram (IVP): this method, which was used in the past to determine abnormalities in the bladder and urinary system, has left its place in New and better informed methods.
  • Retrograde pyelogram: an application similar to the intravenous pyalogram process. The contrast agent used is injected directly into the urinary system using cystoscopy, not intravenously. The retrograde pyelogram process is used to find out what causes blockage in the normal flow of urine. It can also help diagnose cancer on the inner surface of the urethra or kidney.
  • MRI (magnetic resonance imaging): can be used to measure the depth, size of the bladder tumor and to view the lymph where the cancer has spread. In order to get a detailed image of the tumor and its effects, the patient needs to be given a contrast agent.
  • PET CT scan: a small amount of radioactive material is injected into the patient's body. Because this radioactive material is absorbed by cancerous cells that tend to use energy, it is displayed where the cancer has spread in the body. PET CT is not considered the standard imaging for bladder cancer. It may have a potential place in the evaluation of metastatic bladder cancer.
  • Chest X-ray: it can be used to determine whether bladder cancer has spread to the lungs. A chest X-ray is not required if a chest CT scan has been performed.

Cystoscopy is one of the gold standard procedures for diagnosing bladder cancer. A thin flexible endoscope with light and a camera at the end examines the urethra and the inside of the bladder. During cystoscopy, the size, location and growth patterns of abnormalities in the bladder can be determined. Biopsy and urine samples can also be performed during cystostopia.

Biopsy-transurethral resection of bladder tumor (TUR-CT)

During cystoscopy, the urology doctor takes parts of the tissue that he considers abnormal and sends them to the laboratory for examination. During this procedure, also called transurethral resection of the bladder tumor (TUR-CT), it can also remove a sample of the bladder muscle close to the tumor with the bladder tumor. It can evaluate the bladder to see if any mass is felt during the biopsy process. TUR-BT can also be used in the treatment of novelistic non-invasive bladder tumors.

What are the types of bladder cancer?

Different types of cells in the bladder can be cancerous. It can be divided into types of bladder cancer according to the bladder cell where the cancer begins.  The type and stage of bladder cancer is also determined by the tests used to diagnose bladder cancer.

  • Urothelial carcinoma: urothelial carcinoma, also known as transitional cell carcinoma, is the most common type of bladder tumor. It occurs in the urothelial cells lining the inside of the bladder. Urothelial cells are also present in other parts of the urinary tract. For this reason, patients with bladder cancer should check the entire urinary tract.
  • Squamous cell carcinoma: a long-term infection in the bladder begins with the formation of thin, flat cells in the bladder after irritation in the bladder or when using a long-term probe. When viewed with a microscope, the cells closely resemble flat cells located on the surface of the skin.
  • Adenocarcinoma: about 1% of bladder cancers are adenocarcinomas. It occurs in the mucus-secreting glands of the bladder. It occurs after prolonged irritation or infection in the bladder.
  • Small cell carcinoma: less than 1% of bladder cancers are small cell carcinomas. It begins in nerve-like cells called neuroendocrine cells. These cancers often grow fast and need to be treated with chemotherapy, which is usually used in small cell carcinoma of the lung.
  • Sarcoma: sarcomas begin in the muscle cells of the bladder however, it is very rare.

Classification of bladder cancer tumors can also be done according to microscopic images of cancer cells.

  • Low-grade bladder tumor: also called a well-differentiated bladder tumor. The image and organization of cancer cells is close to normal healthy cells. A lower degree of bladder tumor grows more slowly.
  • Low-grade bladder tumor: also called a well-differentiated bladder tumor. The appearance of cancer cells and tumors does not resemble normal healthy cells. High-grade bladder tumors show more aggressive behavior.

Bladder cancer can also be diversified by its proximity to the wall of the bladder.

There are many layers of different cells in the wall of the bladder. Most bladder cancers spread to the muscles of the bladder over time, starting from the innermost layer of the bladder that comes into contact with urine. After reaching the muscle layer of the bladder, it is seen to bounce out of the bladder and into nearby neighboring structures Nov. Cancer of the bladder can metastasize to nearby lymph nodes or other parts of the body. Bladder cancer usually spreads to distant lymph nodes, bones, lungs, or liver.

  • Non-invasive bladder cancer: it is a cancer that does not spread to the muscle of the bladder and remains in its inner layer. It is also defined as Superficial Bladder cancer or early stage bladder cancer.
  • Invasive bladder cancer: this means that cancer cells spread deeper than the inner layer of the bladder, into the novelized layer. If left untreated, there is a risk that the cancer will spread to other parts of the body. These cancers are more likely to spread and must be treated.

Bladder cancer is also diversified according to the way it grows.

  • Papillary urothelial carcinoma: papillary tumors begin in the urothelial cells in the bladder mucosa and are growths that extend to the inner cavity of the bladder. Sometimes, although these cancers grow, they remain in the bladder without spreading. But more aggressive types of this cancer can spread to the deep layers of the bladder and then to other organs.
  • Flat carcinoma( carcinoma insitu): does not grow into the deep part of the bladder or its internal cavity. It is an invasive form of tumor that spreads through the bladder wall in a flat tumor layer structure.

What are the stages of bladder cancer?

3 criteria are taken into account to determine the stage of bladder cancer.

  • The depth of the cancerous tumor in the bladder wall and the degree of the tumor
  • Whether the bladder tumor has spread to the regional lymph nodes
  • It is examined whether bladder cancer has metastasized to other organs, such as the lungs or liver.

Information obtained from pathology and examinations is used to find out which parts of the bladder are cancerous, whether the cancer has spread from where it first started, and where the cancer has spread. Bladder cancer staging is performed according to the international TNM system.

Treatment of bladder cancer

Bladder cancer treatment options depend on various factors, such as the patient's general health status, the type of cancer, the degree of cancer, and the stage of cancer.

Surgical treatment of bladder cancer

The type of surgical treatment for bladder cancer can vary depending on the type of bladder tumor and the stage of the cancer.

TUR surgery (transurethral resection): Transurethral resection of the bladder tumor, ie TUR surgery, is generally used to remove non-muscle invasive tumors that are located in the mucosa of the bladder and have not extended to the muscle layer of the bladder wall. The TUR can also be used in the diagnosis and staging of bladder cancer.

TUR surgery can be performed with general anesthesia or under regional anesthesia. TUR surgery is performed by entering through the natural hole at the end of the urinary tract without making any incision in the body.

During TUR surgery, the bladder is reached by an endoscope with a small “U” - shaped wire at the end of the urologist. By electric current, cancerous tissue is cut and removed from the body. After removal of parts in very small tumors, the cancer cells area is burned and the treatment is eliminated.

After TUR surgery, the urologist may recommend chemotherapy that can be applied with a probe into the bladder once or once a week for 6-8 weeks to destroy the remaining cancer cells and prevent them from recurrence.

Partial or segmental cystectomy: this is the process of surgical removal of the tumor and part of the bladder. The place of partial cystectomy surgery in the treatment of bladder cancer is extremely limited, but it is used to treat some cancers with special histology.

Radical cystectomy: a surgical method in which the entire bladder and nearby tissues and organs are removed along with the tumor. In radical cystectomy surgery, the bladder, as well as men's, prostate and semen sacs, and the entire urinary tract are removed in necessary patients. In women, in the classic definition, the uterus, fallopian tubes, ovaries and all or part of the uterus are removed, but the removal of the bladder with safe limits, leaving the gynecological organs in place, has also been practiced in recent years.

In both men and women, the removal of lymph in the pelvis, called pelvic lymph node dissection, is also part of the operation. Pelvic lymph node dissection is the most accurate way to determine cancer that has spread to the lymph.

In radical cystectomy surgery, which can be performed laparoscopically or robotically, the surgical procedure can be completed with smaller incisions instead of a large incision in open operations.

A new bladder from the intestine (neobladder reconstruction):since the bladder of patients who have undergone radical cystectomy surgery is removed, a new way to exit urine from the body is required. There are also different urinary diversion surgeries along with methods in which a new bladder is created from part of the intestine. The patient's biological age, current diseases, the stage of the disease and the possibility of treatments such as chemotherapy, radiation therapy that may be required later are decided by the urology doctor. This decision is made by talking in detail with the patient and the final decision is made.

Risk and side effects of surgical treatment for bladder cancer

TUR surgery

  • The side effects of bladder cancer TUR surgery are usually mild and do not last long. Pain and slight bleeding may occur when urinating after surgery. The effects seen return to normal within 1-2 weeks.
  • Although the bladder tumor has been completely removed after TUR surgery, the tumor can recur.
  • More than one round of surgery can lead to problems such as strictures in the urinary tract.

Radical cystectomy and new bladder or ileal loop diversion surgery from the intestine

  • Radical cystectomy operations are heavier than TUR surgery. Side effects of anesthesia may occur.
  • Bleeding
  • Infection
  • Blood clots in the legs or lungs
  • Damage to adjacent organs
  • Urinary incontinence or blockage of the flow of urine
  • Men may experience the disappearance of sperm output, erection problem. Erection problems and sexual reluctance can be prevented with new nerve-protective surgical techniques. In women, menopause and sexual reluctance can be experienced, but organ protective techniques are preferred in age-appropriate patients.

Chemotherapy treatment for bladder cancer

It is used to destroy bladder cancer cells that have spread throughout the body. Living without a bladder can sometimes negatively affect the patient's social life. Chemotherapy and radiation therapy can be used as an alternative to bladder removal for patients who are suitable for maintaining all or part of the bladder.

Chemotherapy for bladder cancer can be applied in two different ways.

  • Systemic chemotherapy:systemic chemotherapy is also known as whole-body or intravenous chemotherapy. A method used by a medical oncologist is also aimed at the destruction of cancer cells by circulating the entire body of intravenous chemotherapy drugs. It is used after radical cystectomy operations in metastasized bladder cancer or in selected cases. Systemic chemotherapy can also be used to shrink the tumor before surgery.
  • Intravesical chemotherapy: intravesical or local chemotherapy is usually performed by a urologist. In Superficial Bladder Cancer, intravesical chemotherapy can be used as a complement to TUR therapy in these patients, as cancer cells do not reach deep novelties. In intravesical chemotherapy, drugs are transmitted to the bladder through a catheter inserted into the urethra.

Radiation therapy for bladder cancer

It can be used in addition to round a or in combination with chemotherapy after round to treat bladder cancer in patients who are not suitable for surgery or do not want surgical treatment. It may be preferred to reduce complaints caused by a tumor, such as pain, bleeding, or blockage, or to treat metastasized cancers.

Chemotherapy treatment for bladder cancer

Immunotherapy, also called biological therapy, is the use of drugs to help the immune system recognize and destroy cancer cells. In the treatment of bladder cancer, immunotherapy is usually applied directly into the bladder. BCG vaccine is used as the standard immunotherapy drug for bladder cancer. BCG vaccine, administered with a catheter as a liquid inside the bladder, provides treatment by activating immune system cells in the bladder.

In recent years, studies on T cells that support the immune system, which are known to have a protective effect against infection and cancer, have shown positive results.

Questions about bladder cancer

How should the follow-up process be after bladder cancer treatment?

Because there is a risk of recurrence (recurrence) of bladder cancer after treatment in patients with bladder cancer, the follow-up process is very important. Follow-up is an important part of cancer treatment. Follow-up after treatment for bladder cancer can vary depending on the stage, degree, and type of treatment. Bladder cancer is also likely to relapse for the first 2 years after treatment, and follow-up is extended for up to 10 years, although the probability of relapse decreases after that.

Although the follow-up process varies depending on the patient, it is important to check every 3 months in the first year. In follow-up, the liver is observed inside the bladder by cystoscopy to determine if there is any recurrence in the bladder while the lymph nodes are checked. In cases where the doctor conducting the treatment deems it necessary, imaging methods such as CT, MRI, ultrasound, PET CT are also used satirized.

What is the duration of survival for bladder cancer?

The duration of getting rid of or surviving bladder cancer varies from person to person. Success varies depending on the type of bladder cancer, stage, number of tumors, size, characteristics of the cancer, recurrence, selected treatments and the patient's response to treatment. This is why survival rates for bladder cancer are actually personalized. In consideration of all stages of bladder cancer the American Cancer Society study conducted for people with bladder cancer 5-year survival rate is 77%, 10-year survival rate is 70%, and 15-year survival rate of 65%.

 Is Bladder cancer commonly metastasizes at which organ?

Bladder cancer most often metastasizes to the lungs, liver, or bones.

How should bladder cancer be fed?

It is not known exactly what reduces the recurrence rate after treatment for bladder cancer. The benefit of nutrition in the development of bladder cancer or after treatment is not clear in scientific studies. However, it can be useful to quit smoking, eat a natural and balanced diet, and engage in regular physical activities.

Is there a herbal or natural treatment method for bladder cancer?

There is no scientific evidence that diet, herbal products, vitamins and minerals prevent the development of bladder cancer or reduce the likelihood of recurrence. Many studies have been conducted on this subject, in general, natural and healthy eating and active mobility are recommended.