Bladder cancer

Bladder cancer is a malignant tumor that occurs in the mucous membrane or in the wall of an organ. If left untreated, it grows through the muscle layer, spreading to adjacent organs. When detected in the early stages, the disease responds well to treatment.

Causes

The causes of bladder cancer include the genetic predisposition and lifestyle of the patient. Here are the risk factors that trigger the onset of the disease:

• Smoking. Carcinogenic substances released during tobacco combustion damage the DNA of bladder cells.

• Frequent interaction with toxic chemicals. For example, workers in the paint and varnish, paper, oil refining, and rubber industries.

• Diseases of the genitourinary system. Especially those characterized by urinary retention (prostatic hyperplasia, prostatitis, urolithiasis).

• Parasitic infections (genitourinary schistosomiasis).

The main risk group is men over 60 years of age. Women, as well as young people under 40 years of age, suffer from malignant neoplasms in the bladder less often.

What is the danger of the disease

Malignant formation in the bladder is a serious and dangerous disease with potentially negative consequences. A growing tumor, depending on the location, can cause various complications:

• Impaired renal function (up to renal failure and uremia). Occurs due to compression of the ureters.

• Fistulas. They occur as a result of the growth of a tumor into the rectum or vagina.

• Infectious diseases (cystitis, pyelonephritis). They are often accompanied by invasive cancers.

• Anemia. One of the symptoms of cancer is blood in the urine, so anemia can develop as a result of constant blood loss.
  

Another serious complication that is typical for various oncological diseases is the spread of cancer cells to other organs. Bladder cancer is more likely to affect neighboring ones, such as the prostate, uterus, or rectum. Then distant organs are also affected through the lymphatic system or blood. This can lead to a worse prognosis and complicate cancer treatment.

Symptoms

The disease can manifest itself in various symptoms. They are often nonspecific, and are also characteristic of other pathologies of the genitourinary system. Here are the signs that you need to see a doctor right away:

• Blood in the urine. It may be noticeable to the patient himself or be determined only by laboratory examination (microhematuria). This is the most characteristic symptom, it is observed in most patients.

• Frequent and irresistible urge to urinate.

• Pain or burning sensation when urinating.

• Pain in the lower back and pelvis.

• Changes in the color and smell of urine.

• Frequent urinary tract infections.

There are other symptoms that are characteristic of many cancers. These are unexplained weight loss, lack of appetite, chronic fatigue, fever, weakness, and general ill health.

Stages of the disease

Oncologists divide the disease into stages depending on how the malignant cells spread in the body. There are 4 stages in total. At the initial stage, a neoplasm occurs on the inner lining of the bladder, and then, in the absence of treatment, the tumor grows into neighboring organs and metastases appear.

At the EMC clinic, we handle even difficult cases and are able to treat patients at any stage. It is important to understand that the earlier the disease is detected and therapy is initiated, the better the prognosis. That is why it is important to consult a doctor at the first symptoms.

Accurate determination of the stage of bladder cancer in each specific case requires a medical examination, including special methods: ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI), PET-CT, and, first of all, a biopsy to establish an accurate diagnosis and stage of the disease.

Diagnostics

There is no single screening system for bladder cancer. Examinations are performed in the presence of symptoms. Many of them are characteristic of other diseases of the genitourinary system, which is why cancer is often not detected in the early stages. If cancer is suspected, the following methods are used for diagnosis:

• General and cytological analysis of urine. They can detect changes in the chemical composition, detect traces of blood, and find atypical cells.

• Analysis for cancer markers. It is used as an additional diagnostic method, as well as to monitor the progress of cancer treatment and to detect relapses.

• Ultrasound examination. Ultrasound helps to visualize tumors or other abnormalities in the bladder.

• Magnetic resonance imaging (MRI). It allows you to determine the size, location of the tumor and the degree of germination into the surrounding tissue.

• Computed tomography (CT) scan. It allows you to determine the size, location and extent of the spread of a cancerous tumor.

• Cystoscopy. A procedure in which a doctor uses a special instrument with a video camera (cystoscope) to examine the inner wall of the bladder. At the same time, a biopsy can also be performed, that is, tissue samples can be taken for analysis.

Several research methods are usually used to make a correct diagnosis. An integrated approach helps to identify a specific disease, rule out other possible causes of symptoms, and prescribe the most effective treatment for the patient.

Treatment of bladder cancer

The treatment strategy depends on the stage of the disease, the general condition of the patient, and other factors. At an early stage, transurethral resection of the tumor (TOUR of the bladder) is used. This is a gentle procedure that does not require tissue incision. Manipulations are performed through the patient's urethra (urethra). The tumor is removed along with the base, and the samples are sent to the laboratory for histological examination.

In the later stages, removal of the bladder (cystectomy) and lymph nodes in the surrounding areas is performed. If the tumor has spread to neighboring organs, they can also be removed. This may be a part of the intestine, in men ― the prostate gland, in women − the uterus, ovaries, fallopian tubes.

If the tumor has reached a large size and surgical excision is impossible, chemotherapy and radiosurgery and radiation therapy are used. These methods help to destroy cancer cells and reduce the size of the malignancy, reducing the risk of bleeding. Chemotherapy and radiotherapy can also be used before or after surgery.

In the EMC multidisciplinary clinic, patients have access to all modern cancer treatment methods, including minimally invasive surgery, chemotherapy, radiosurgery, and radiation therapy. We work according to modern international protocols, choosing personalized treatment tactics in each specific case.

To treat bladder cancer, we perform robot-assisted surgeries. The DaVinci robot is an ultra―modern surgical system that allows for interventions with minimal injury and blood loss. Robotic surgeries help to shorten the recovery period, reduce pain after treatment, and make postoperative scars inconspicuous.

List of sources and literature

1. Dolgikh Dmitry Vladimirovich, Shirokorad Valery Ivanovich, Dolgikh Vladimir Terentievich Diagnosis of bladder cancer // BMJ. 2015. №6.


2. Dolgikh Dmitry Vladimirovich, Shirokorad Valery Ivanovich, Dolgikh Vladimir Terentyevich Treatment of patients with bladder cancer // BMJ. 2016. No.1.
3. Bellmunt J. Bladder cancer. Hematol Oncol Clin North Am. 2015 Apr;29(2):xiii-xiv. doi: 10.1016/j.hoc.2014.12.001. Epub 2015 Jan 9. PMID: 25836942.
4. Kirkali Z, Chan T, Manoharan M, Algaba F, Busch C, Cheng L, Kiemeney L, Kriegmair M, Montironi R, Murphy WM, Sesterhenn IA, Tachibana M, Weider J. Bladder cancer: epidemiology, staging and grading, and diagnosis. Urology. 2005 Dec;66(6 Suppl 1):4-34. doi: 10.1016/j.urology.2005.07.062. PMID: 16399414.