The bladder is a muscular sac located in the center of the lower abdomen just above and behind the pubic bone. When the sac is emptied, it resembles the size and shape of a pear and expands as urine accumulates, thanks to the muscle fibers inside. The function of the bladder is to store the urine formed in the kidneys and to ensure that the urine output is infrequent and controlled with the help of the urethra. More than 90% of bladder cancers begin in cells that make up the innermost lining of the bladder wall.
WHAT IS URINARY BLADDER CANCER?
Bladder cancer is among the most common types of cancer in the excretory system. Abnormal tissue growth, known as a tumor, develops in the bladder lining. In some cases, the tumor may spread to the bladder muscle. Bladder tumors can be benign or malignant. Sometimes benign non-cancerous bladder tumors can also be seen.
Most bladder cancers are diagnosed early when the cancer is highly treatable. But early-stage bladder cancers are likely to recur after treatment. Therefore, it is important for the person with a history of bladder cancer to have routine follow-up tests. Its incidence is higher in men than in women, and it is generally more common in adults.
The most common symptom is blood in the urine, which usually develops without pain. It is important to consult a doctor if you notice blood in your urine.
WHAT ARE THE SIGNS OF BLADDER CANCER?
People with bladder cancer may experience one or more of the following symptoms. One of the most common and obvious symptoms of bladder cancer is the presence of bright red or brown blood in the urine, which is usually painless, called hematuria. Apart from this, other symptoms that can be observed are as follows:
- Blood or blood clots in the urine
- Pain, stinging and burning sensation while urinating
- The urge to urinate more often than usual
- Urgency to urinate
- Difficulty or inability to urinate
- Pain, mass or feeling of fullness in the groin or above the groin
- Presence of blood in the urine detected in the laboratory environment
If the disease spreads to other organs and tissues, that is, if it metastasizes, different symptoms such as sudden weight loss, weakness, or pain in different parts of the body can be seen depending on the affected area.
CAUSES OF BLADDER CANCER
Bladder cancer begins when cells in the bladder develop mutations in their DNA. The abnormal cells form a tumor that can take over and destroy normal body tissue. There are certain risk factors, such as consuming tobacco products and exposure to chemicals. People with a family history of bladder cancer have an increased risk of developing bladder cancer.
WHAT ARE THE TYPES OF BLADDER CANCER?
Different types of cells found in the bladder can become cancerous. Depending on how it looks under the microscope, the 3 main types of bladder cancer are as follows:
Urothelial Carcinoma: It constitutes approximately 95% of all bladder cancers. It occurs in the cells lining the inside of the bladder. These cells stretch when the bladder is full and can shrink when the bladder is empty. It is divided into low and high grade. In case of low grade, it tends to recur frequently after treatment, but rarely spreads to the muscle layer of the bladder and other parts of the body. If it's high-grade, it often comes back after treatment and the disease spreads to the muscle layer of the bladder, other parts of the body, and lymph nodes.
Adenocarcinoma: It is a type of cancer located in the glandular cells that produce secretions and mucus in the lining of the bladder. This very rare type of cancer constitutes 2% of bladder cancers.
Squamous cell carcinoma: (Squamous cell carcinoma): It develops when the bladder is faced with conditions such as irritation after an infection or prolonged use of a urinary catheter. It constitutes 6-8% of bladder cancers.
STAGES OF BLADDER CANCER
After the diagnosis of bladder cancer, it should be staged with a system called TNM and its spread potential should be determined. In this way, the treatment plan to be applied is chosen correctly. The stages are as follows:
T (Tumor): It measures how far the main tumor has grown in the bladder and whether it has spread to nearby tissues.
N (Lymph Nodes): Lymph nodes are groups that act as shields against diseases. It is checked whether the cancer has spread to the lymph nodes in the wall of the bladder.
M (Metastasized): Determines whether the disease has spread from the bladder area to other parts of the body or to the lymph nodes.
Within the framework of the T, N, M classification, the doctor gives information about the stage of bladder cancer. There are stages from 0 to IV. These phases are as follows:
Stage 0: Cancer develops only in the center of the bladder and has not spread to the bladder wall and muscles. It is a superficial cancer of the bladder and does not show lymph node involvement or spread to other organs.
Stage I: The cancer has grown in the inner lining of the bladder, but not in the muscle of the bladder wall. It still has not spread to other tissues and organs.
Stage II: Although it does not metastasize to any organ, it is the stage in which the cancer progresses from the connective tissue of the bladder to the muscle layer.
Stage III: The cancer is now in the fatty tissue layer surrounding the bladder. Prostate, uterus and vagina may also be involved, but no spread to organs distant to the bladder has been detected.
Stage IV: This stage may refer to any of the following:
- The cancer has spread to the pelvic or abdominal wall, but no involvement is yet seen in the lymph nodes or distant organs of the bladder.
- Cancer has spread to nearby lymph nodes, but has not metastasized to distant organs.
- Cancer has metastasized to lymph nodes, distant organs and tissues of the body such as bones, liver, lungs.
Knowing the stage of bladder cancer will provide you with a guideline about the best treatment options.
RISK FACTORS OF BLADDER CANCER
Smoking is considered to be the main risk factor for bladder cancers, and more than half of the cases in developed countries develop due to this reason. Risk factors that increase bladder cancer incidence are as follows:
- Use of tobacco products
- Exposure to chemicals
- Previous cancer treatments such as chemotherapy, pain relievers and drugs
- Chronic bladder inflammations
- Family history of bladder cancer
- Chlorinated and arsenic contaminated drinking water
- Other urinary tract infections
- Schistosoma hematobium infections in endemic countries
- Men have 3 times more increased risk than women.
DIAGNOSTIC METHODS OF BLADDER CANCER
First of all, your doctor will question whether you have been exposed to possible causes of bladder cancer such as associated symptoms, family history, smoking. In some cases, urine tests are ordered to detect the presence of blood, bacteria, or abnormal cell tissues. A physical examination of the rectum and vagina may be done, as bladder cancer sometimes causes a visible lump. Further testing will be done if bladder cancer is suspected, and if cancer is found, some additional testing will be done to help find its stage.
Urologists use various methods in the diagnosis of bladder cancer.
Most doctors recommend cystoscopy if bladder cancer is suspected. A urologist examines the inside of the bladder by entering the urethra with a thin tube (cystoscope) with a camera and light at the end. If necessary, a sample of suspicious tissues can be taken. Anesthetic gel is applied to the urethra beforehand.
If a more detailed view of the bladder is needed, a CT or MRI scan may be recommended. An intravenous urogram may also be used to look at the entire excretory system before and after treatment. During this procedure, dye is injected into the bloodstream and X-rays are used to monitor its passage through the urinary tract.
If abnormalities are observed in the bladder during cystoscopy, TURBT operation (transurethral resection of bladder tumor) is recommended. This procedure takes a biopsy sample. It is a procedure performed under general anesthesia.
TREATMENT OF BLADDER CANCER
As a result of biochemistry tests, the degree and stage of the disease are determined and a personalized treatment plan is planned.
In the treatment planning of bladder cancer, different methods are used for the patient, depending on whether the disease has spread to the muscle tissue. In low-grade cancers that have not progressed to the muscle tissue, cystoscopy is performed and the cancerous tissue is removed or cleaned with TURBT operation. Since it can be taken during cystoscopy in some cases, the cystoscopy technique is sometimes used for diagnostic purposes and sometimes for therapeutic purposes.
Radical cystectomy can be applied in cancer types that have advanced to the muscle tissue but have not spread to the lymph nodes and organs. In this surgical method, where the bladder, lymph nodes and surrounding tissues are removed, additional chemotherapy can be applied.
In some patients, artificial bladder therapy can be applied. It is the process of removing the diseased bladder and making an artificial pouch from the intestine to expel the urine from the body.
In metastasized cases, chemotherapy may be chosen for the whole body as a treatment. Radiation therapy may be used when surgery is not an option.
IN WHICH AGE RANGE IS BLADDER CANCER MOST COMMON?
Bladder cancers can be seen in all age groups, including childhood. The most common group is the elderly. 9 out of 10 people with this cancer are over the age of 55. The average age of occurrence is between 65-70 years.