Bladder cancer: symptoms, treatment, men, women
Bladder cancer is not very common tumor, it accounts for only about 3% of human neoplasias, but among tumors of the genitourinary system it is 70%. Source of cancer growth becomes mucosa that is in direct contact with harmful substances contained in the urine, and also very prone to inflammation.
The vast majority of cases, bladder cancer is detected in men, especially prone to bad habits, or working in harmful conditions. In addition, other pathological processes of the male reproductive organs (prostate adenoma, urethritis, strictures) also increase the likelihood of tumor in men. Among women the disease is diagnosed in several times less.
In recent decades there has been an increase in the incidence of bladder cancer that may be associated with the spread of harmful habits among the population, affecting not only the production of carcinogens, but also those who are in the external environment, and the range and concentrations of which will only increase.
The bladder is a hollow organ that acts as a reservoir of urine flowing through the ureters from the kidneys. Its proper functioning is necessary not only to preserve the health of the whole body, but also significantly affects quality of life.
For anybody not a secret that problems with urination seriously complicate life, making it sometimes difficult to visit public places or even out on the street. Cancer of this body, requiring its removal, and creates a whole range of difficulties associated with the further social adaptation of the patient, so need to identify it in early stages.
Old age creates all the preconditions for the development of malignant tumors, and bladder cancer is no exception, he, like other tumors, often diagnosed in older people, and the median age at onset is 40-60 years.
Carcinoma of the mucosa of the bladder can have various structure to grow in the form of single or multiple nodes, but remains unchanged malignant nature of the disease with tissue destruction by cancer cells, the proliferation of metastases and a high risk of adverse outcome.
Risk factors of bladder cancer
The exact mechanisms of bladder cancer are not fully understood, but the reasons, which should be avoided are known:
- The impact of industrial and domestic carcinogens.
- Chronic infections and inflammatory processes of the urinary tract, parasitic infestation.
- Eating habits and lifestyle.
- Side effects of treatment for other diseases.
- Benign tumors and precancerous changes of the mucous membrane of the bladder (papilloma, squamous metaplasia, dysplasia).
Smoking causes a variety of human tumors. Carcinogens that enter the body with inhaled smoke undergo changes that are absorbed into the bloodstream and further penetrate into the urine, where direct contact with the surface of the mucous membrane. The risk of tumor development in smokers is two times higher than among non-smokers. Lovers of pipes and cigars less risk than those who prefer regular cigarettes, but more than those leading a healthy lifestyle. It may be associated with higher quality tobacco and has a lower content of harmful and radioactive products of the combustion of cigars.
Industrial carcinogens that cause cancer of the bladder, typical for the pulp and paint production, tanning plants, chemical plants, etc. For a contact with such harmful substances don’t have to work for a large industrial facility, even hairdressers, painters and designers to a certain extent at risk.
The fact that dyes, paints, varnishes, solvents contain aromatic amines and derivatives aniline series, authentically are and carcinogens enter the body by inhalation of their vapors. Over a hundred years ago it was observed that aniline dyes cause bladder cancer. Their degradation products get into the urine, cause changes of the epithelium of the mucosa up to dysplasia and cancer.
At risk include drivers who not only inhale the aromatic amines with couples lubricants, but also for a long time are forced to accumulate urine, unable to empty the bladder.
The risk of tumor development increases with increasing time and frequency of contact with carcinogens, as the cancer often appears in 15-20 years, when people might have to change jobs and even move to another residence.
Household carcinogens – the same products may be a risk factor for artists, for example, which use harmful dyes or paints.
Chronic inflammatory processes, including infectious nature, can over time lead to atrophic and dysplastic changes of the mucosa of the bladder, which will become a hotbed of tumor growth. So, chronic cystitis are often observed in young women and in older men – sex and age borders, the disease has not. A high probability of cystitis can be traced in patients with BPH, in the presence of a permanent urinary catheter after a brain injury, associated with impaired emptying of the bladder.
The most common benign tumor of the bladder is the papilloma, which has the form of papillary growths on the surface of the mucous membrane, often calling bleeding and dysuric disorders. The risk of malignancy of such papillomas are much higher than similar tumors of the skin, known to many, so in the presence of a papilloma of the bladder do not waste time or take a wait-and-see tactics.
Parasitic infestation in the urinary bladder are often observed in residents of developing countries, especially hot climate. For example, schistosomiasis, common in the middle East, in Africa, some countries in South America, causes damage to the parasite of the mucous membrane of the bladder, hemorrhaging and fibrosis of the wall of the chronic course and, subsequently, such changes lead to cancer.
Living conditions, diet and lifestyle in a significant way determine the health status of the person. Poor hygiene, abuse of meat and fatty foods, untimely emptying of the bladder contribute to the change in character of urine, its stagnation in the bladder, cystitis with all its adverse consequences. Modern man is sometimes forced for a long time to postpone going to the toilet, doing active work, and working, for example, for a pipeline, the ability to timely remove the urine simply may not be. Abuse meat food, sausages and smoked meats leads to increased nitrate concentrations in the contents of the gall-bladder, which has a negative impact on her mucous membranes and may cause cancer.
Some methods of treatment, including tumors at other sites, have a potential carcinogenic effect on the bladder. The use of radiation therapy, chemotherapeutic agents that are excreted with the urine, especially in women treated for the tumors of the uterus, is very dangerous from the point of view of probability of cancer of the genitourinary tract.
Aside from this, there are causes of cancer that we are not able to change, but you need to keep in mind:
With age inevitably increases the contact time with carcinogens, violated the natural mechanisms of antitumor protection, accumulate genetic mutations and, in addition, there are other diseases that indirectly contribute to cancer. In particular, adenoma of the prostate gland causes compression of the urethra, the stagnation of urine and irritation of its mucous membranes, occurrence of cystitis, urethritis, pyelonephritis. Partly from this cause and the associated higher frequency of disease among men. Women, as a rule, problems with bladder emptying does not occur, and in old age, while reducing the level of sex hormones and often occurs incontinence, which, however, contributes to inflammatory processes.
Very careful and attentive to yourself should be to persons whose close relatives have cancer of the bladder, and timely preventive check-UPS will allow you to suspect a tumor in an early stage.
In search of various predisposing factors to cancer, scientists are not spared, and racial identity. So, white-skinned Caucasians bladder cancer is diagnosed twice as often than black inhabitants of Africa or South America.
Types of bladder cancer
Important criteria for the types of malignant bladder tumors is histological structure, degree of maturity (differentiation), growth characteristics and depth of the lesions of the body wall. Among the histological forms a strong lead perekhodnocletocny bladder cancer, constituting approximately 90% of all cases of cancer derived from transitional epithelium lining the inner surface of the bladder. Much less can be detected adenocarcinoma (glandular tumor) and squamous cell carcinoma, which may become the replacement of the transitional epithelium is stratified squamous (metaplasia).
The appearance of the tumor involves the allocation of such cancers as:
- Papillary, which has the form of papillary growths, prone to ulceration, trauma and decay.
- Infiltrative, growing mainly into the wall of an organ and destroys its tissue.
The tumor stage is traditionally determined according to the TNM system, which takes into account not only the most important characteristics of the tumor itself, but also the nature of metastasis, which highly affects the prognosis of the disease. So, at the first stage, the tumor reaches the muscle layer of the bladder, limited only mucosa and submucosal layer, and the latter grows near bodies and actively metastasizes.
The tumor may be located in the bottom, on the front or the rear of the body, but the greatest threat posed cancer of the bladder neck or tumors of the orifices of the ureters. This is due to the rapidly increasing difficulty of excretion of urine through relatively narrow channels, which is fraught with its stagnation in the bladder, ureters, pelvis and kidney. Such changes can cause hydronephrosis, inflammation, renal failure.
The feature of bladder cancer is its ability to germinate quickly the body wall and infiltrating surrounding tissue, which creates significant difficulties in the treatment. Recurrences are common even after radical surgery. Metastasis occurs most often lymphogenous way, and cancer cells can be detected in the pelvic, retroperitoneal lymph nodes. Hematogenous metastases appear relatively rare and represent a running process, it is possible to defeat lung, bones and liver.
Video: bladder cancer — medical animation
The symptoms and signs of disease
Symptoms of bladder cancer do not differ a great variety, but there is a sign, always disturbing in relation to malignant tumors is hematuria, or blood in the urine. The appearance of hematuria must immediately consult an urologist or oncourology for exclusion of malignancy.
Hematuria is the first symptom of tumor in two thirds of patients, while other complaints may be absent altogether. She appears suddenly, often in «full health», as a surprise. In the urine can be detected a significant amount of blood, and a convolution formed in the cavity of the bladder may cause obstruction (blockage) of the ureter or mouth of the urethra, which will lead to acute urinary retention or hydronephrosis.
Other symptoms of bladder cancer think:
Dysuric disorders associated with increased tumor size, its ingrowth into the surrounding tissue, obstruction of the urinary tract. Over time the bladder volume decreases, and patients experience frequent urination, while the bladder is a small amount of content.
Often the disease is complicated by the accession of inflammation, including infectious nature, which is manifested by cystitis, urethritis and pyelonephritis when the infection spread by ascending to the kidneys. The closure of the orifices of the ureters by tumor or blood clot may cause obstruction of urine outflow from the kidney, which can lead to hydronephrosis – increased urine diversion system with compression of the parenchyma of accumulated liquid. Hydronephrosis is accompanied by the development of chronic renal failure with violation of nitrogen metabolism, accumulation of toxic products in the blood, anemia, uremic encephalopathy and damage to other organs and tissues.
Pain syndrome appears quite late and is associated with the growing of the cancer into the surrounding tissue, blood vessels and nerve trunks. The pain is of a lesser intensity appears earlier due to the accompanying inflammatory processes.
The growth of the tumor mass, the patient displays symptoms of intoxication as weight loss, fever, loss of appetite, disorders of disability, weakness etc. In case of development of distant metastases can receive complaints of bone pain in the right hypochondrium, jaundice.
How to detect cancer?
On the way to accurate diagnosis the patient will have to undergo a sequence of procedures, which in each case are selected individually, complicating and going deeper as needed. It is important to identify the tumor and to prove its malignancy because of the treatments at different stages are different, and the prognosis depends on its efficiency.
Diagnosis of bladder cancer includes such studies as:
- The cystoscopy.
- X-ray technique with contrast, CT.
- Morphology (Cytology, histology) of the tumor fragments.
- Photodynamic method.
Turning to the doctor, the latter will conduct inspection, palpation of the bladder, in detail find out the nature of the complaints. In all cases, necessarily two-handed study, however, it only allows to suspect of a tumor of large size, while small, intraepithelial lesions will remain undetected.
Cystoscopy is the most important method of diagnosis of bladder cancer, which is carried out in all suspicious cases. For this purpose, optical devices (endoscopes), such as those many people have seen during the passage of gastrofibroscopy. Mandatory condition for research is the anesthesia. Through cystoscopy, the doctor is able to examine the inner surface of the bladder wall to identify foci of tumor growth and take their fragments for morphological analysis.
Ultrasound is characterized by ease of play, accessibility and a fairly large amount of information received. Consistent application of the various options (through the abdominal wall, urethra, rectum) increases the diagnostic value and accuracy is higher, the greater the size of the tumor, reaching more than 80% in the case when the cancer exceeded 5 mm.
Do not lose their relevance and radiographic with contrast. Excretory urography allows to check not only the existence of the defect of the bladder wall, but also to assess the condition of the ureter and excretory system of the kidneys. The double contrast study with the injection of gas provides the opportunity to clarify the nature of cancer spread in the body wall and beyond.
CT is performed to study the pelvic lymph nodes, liver, lung with suspected metastases. By CT can detect recurrence of cancer even in the absence of symptoms, while in other cases, the method is useful only in one third of patients.
The most accurate information about the tumor provide a morphological diagnostic techniques – Cytology, histology. Fragments of the tumor and cancer cells can be obtained in various ways, but the best carrying out target biopsy during cystoscopy.
Modern way consider accurate diagnosis of cancer photodynamic examination (PDD), in which the patient is introduced a substance that can accumulate in cancer cells and to give red color into the blue light. This method not only gives false negative results in diagnosis, but also allows you to remove all foci of tumor growth that would otherwise manipulation may not be visible.
Among laboratory studies compulsory General and biochemical blood tests, and urinalysis to detect in her blood (erythrocytes), white blood cells, evidence of secondary inflammation as well as cancer cells if the urine is subjected to cytological analysis.
Treatment of bladder cancer
When choosing a method of treatment of bladder cancer oncologists are guided by the stage of the process, the nature of the lesion and the surrounding organs and tissues, the presence or absence of metastasis and patient’s age and the nature of comorbidity.
Surgical treatment remains the main method of combating the disease, and removal of the bladder cancer (cystectomy) is considered the «gold standard» in identifying invasive variants of the tumor.
Among methods of removal of the tumor is used:
The TOUR is a fairly gentle method of tumor removal, which is done through the urethra. Complementing its photodynamic method, you can greatly increase the effectiveness of the procedure, since in this case the physician will see all foci of tumor growth. TUR is indicated for patients with I-II stages of cancer that grow superficially or slightly affects the muscular layer. Resection can be performed in parallel with chemotherapy or radiation therapy, thereby reducing the likelihood of relapse and increase the life expectancy of patients up to 5 years or more.
Radical cystectomy is complete removal of the bladder, the cellular tissue of the pelvis, the lymph collectors, the wall of the rectum, prostate in men and uterus in women. This is the most traumatic type of treatment, but at the same time, and the most effective. The number of patients who qualify surgery, is constantly growing. After carrying out cystectomy patients in need of plastic and reconstructive operations aimed at re-establishment of normal conditions of mocheotdelenia while maintaining a high quality of life. Ideal is the outcome, when as a reservoir of urine is a fragment of the colon, and there is no need to remove the outer sphincter of the urethra. The patient in such cases, retains the ability to usual urination.
Chemotherapy can be performed before surgery and after, patients with early forms of the tumor and in advanced stages as palliative treatment. Drugs are injected into the bladder or the system is assigned to their application, in this case using cisplatin, adriamycin, thiotepa, etc.
Chemotherapy reduces relapse and is sick after the TOUR for minimally invasive options for cancer. If a tumor is stage 4, when there is considerable tissue damage and cancer metastasis, the purpose of chemotherapy is often the only possible means of alleviating suffering.
Among conservative methods of treatment of bladder cancer can be mentioned virotherapy and BCG therapy. The use of the BCG vaccine is most effective at 0-I stages of the disease, but can also be used after surgery. Developing the inflammation contributes not only to remove the tumor, but also prevents relapses.
Virotherapy has not found widespread use, however, known anti-cancer activity of oncolytic viruses. This method of treatment only applies in some countries.
Radiation therapy has not acquired independent meaning, but in conjunction with other treatments improves disease-free survival of patients.
In addition to specific treatment, supportive therapy, adequate pain relief, hygiene and care in cases of violations drain urine. Diet for bladder cancer has no significant features, but food should be easily digestible, should avoid excess meat, fatty foods, and excessive volume of fluids that can create unnecessary load on the urinary system.
The prognosis of patients with bladder cancer depends on how timely the tumor was discovered. In the early stages of the disease 5 or more years of living to 80% of patients with adequate treatment by an oncologist, while in delayed diagnosis, this indicator does not exceed 20-30%.
In order to avoid the appearance of bladder cancer, should be active prevention and dispensary observation of persons at risk. These simple conditions, such as inflammatory processes and benign tumors, with the exception of Smoking and the observance of safety measures when working with carcinogens, and timely emptying of the bladder is largely able to reduce the risk of cancer.