Bladder cancer is the 7th most common cancer in men and the 11th most common cancer in both genders.
The vast majority (75%) of patients with bladder cancer are low-stage pathologies (non-muscle-invasive cancer) that can be treated with endoscopic surgeries. However, bladder cancer is unfortunately frequently recurrent.
In addition, since the bladder is a lumen organ just like the large intestine (colon, rectum),endoscopy (cystoscopy) should be included in the follow-ups besides imaging methods (Tomography, Ultrasonography).
Among the risk factors for bladder cancer, smoking and tobacco products are the most important risk factors. Other important risk factors are chemicals (aromatic amines) exposed to paint jobs and petroleum industry workers. Other known risk factors are genetics, some infections (cystosoma),bladder stones (chronic irritation),radiotherapy for some reasons, male gender and advanced age.
In the guidelines published by the European Urology Association, it was stated that smoking cessation at the time of diagnosis of bladder cancer positively affects oncological outcomes.
The most common symptom of bladder cancer is blood in the urine. This bleeding is usually accompanied by clot particles and pain is often absent. Apart from bleeding in the urine, frequent urination, prolonged burning in the urine, sudden urge to urinate may also be seen.
In the advanced stages of the disease, weakness, weight loss, findings related to kidney failure, urinary incontinence, widespread body pain can be seen.
Especially cancers that invade the deep layers of the bladder spread lymphatic and hematogenous (via blood) to other parts of the body and the surrouinding tissue of the bladder.
Bladder cancer most commonly spread to the lungs, bones and liver except for regional lymph nodes. The course of metastatic disease progresses aggressively. This why early diagnosis is very important for bladder cancer.
When patients apply with complaints matching the symptoms of bladder cancer, the decision is made according to risk factors.
For example, when a 30-year-old non-smoker female patient presents with bleeding in the urine, ultrasonography and blood urinalysis would be a more appropriate approach, since this patient does not have a risk factor and may have urinary tract infection and kidney stones. However, the gold standard diagnostic method for patients with significant risk factors is cystoscopy.
Enlarged imaging of the bladder inside is made by entering the urinary canal with a camera and fiber optic system, so that even very small tumors are detected at the initial stage. This procedure can be performed under local, regional or general anesthesia. If a tumor is detected, biopsy or complete removal of the tumor can also be performed by endoscpic resection(TUR-BT).
Urine cytology is also an important marker in both follow-up and initial diagnosis. In addition, computed tomography (CT),CT Urography, Magnetic resonance (MR) and rarely PET-CT may be required in the initial diagnosis, staging and follow-up of the disease.
The treatment of patients diagnosed with bladder cancer is performed with endoscopic surgeries in the early stages (Ta, T1, CIS). In some cases medical teratment (immunotherapy, chemotherapy) is also administered in to the bladder. However, after pathological examinations, in cancers that have spread to the muscle tissue of the bladder (T2) or deeper, the entire bladder must be removed.
Since the majority (75%) of the disease is detected in the superficial stage (Ta, T1),endoscopic transurethral resection (TUR-BT) is usually sufficient for this stage, and radical surgery is not required. However, additional intravesical (applied into the bladder) drug treatments may be required for these stages.
It is known that the BCG (bacillus calmetta guerin) vaccine, which is administered especially for patients in T1 stage and sometimes Ta stage with a high probability of recurrence, reduces the possibility of both recurrence and progression of the disease.
It is known that BCG application, which is a kind of immunotherapy (fighting cancer through immune cells) method, has some side effects. Again, depending on the tumor focus number, size and recurrence rate, chemotherapeutic agents such as Epirubicin and Mitomycin-C may need to be administered intravesically (into the bladder) to patients with superficial bladder cancer.
For bladder tumors that have spread to the deep layers (muscle layers) of the bladder, the first choice treatment method is Radical Cystectomy, in which the bladder is completely removed. In this surgical procedure, according to gender, the surrounding organs (prostate and semen glands in men; a small part of the vagina, ovaries and uterus in women) and lymph nodes in a certain area should be removed.
Yes it is a major surgery but also the most effective treatment of advanced stage baldder cancer. It is the most important treatment to increase life expectancy for T2 stage bladder tumor.
After the bladder is removed and considering the other factors of the patient, an artificial bladder is created from the intestines. it can be designed to open to the skin or to be connected to the urinary tract for ensuring the continuation of the urine output.
The chance of cure is very high especially for non-muscle invasive bladder cancer. Muscle invasive bladder cancer can also be cured with radical cystectomy surgery.
Unfortunately, there is no sufficient sensitive blood or urine test for the follow-up of bladder cancer. The most commonly used methods for the follow-up course of the disease are cystoscopy, urine cytology and computed tomography.
The main follow-up method in low-stage superficial bladder cancer (Ta, T1) is Cystoscopy, which is a method of visualizing the urinary bladder with a camera. It can be easily applied even with local anesthesia, and it is performed at regular intervals according to the initial stage of the disease (the number of tumors in the first diagnosis, size, recurrence rate and other factors related to the patient).
Especially in the T1 stage, urine cytology (examination of the urine sample in the pathology laboratory) is also an important tool used in the follow-up of the disease.
Computed tomography is an important imaging method in the post-surgical follow-up of both low- and advanced-stage bladder cancer, showing possible tumor recurrence in the kidney and ureter and metastases to other organs.
In advanced bladder cancer, the question of "Is there an alternative treatment method for removing the bladder and making a new bladder from the intestine?" is frequently and rightfully asked by our patients. Because radical cystectomy surgery is a surgical procedure that can disrupt life comfort to a certain extent and may have undesirable effects.
One of the points that should not be forgotten is that the gold standard treatment method for cancer that has spread to the muscle tissue of the bladder is radical cystectomy. However, sometimes due to serious comorbidities of the patients and sometimes because the patient does not want this surgical method, a 'bladder sparing approach' can be performed by combining chemotherapy, radiotherapy and cystoscopy (TUR-BT if necessary) with the triple method as an alternative (multimodal treatment).
It should not be forgotten that the side effects of this approach can sometimes be serious, and patients should consult with medical oncology and radiation oncology.
Radical cystectomy surgery prices range from 6000 to 10.000 USD.
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Assoc. Prof. Dr. Arif Demirbaş
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