Bladder tumors

How common are bladder tumors and why do they occur?

Both benign and malignant bladder tumors make up 4 percent of all tumors in general. The question of the causes of bladder tumors still remains unclear. It is known that bladder tumors often occur in people involved in the production of aniline dyes. However, in the majority of patients, prior to illness, there is no contact with substances formed in the production cycle of aniline dyes. The disease is also promoted by smoking, abuse of phenacetin, and treatment with cyclophosphamide.

It is known that in people with bladder cancer, their urine contains much more endogenous carcinogens – carcinogens produced in the human body. These carcinogens include breakdown products of certain amino acids. There is a connection between the parasitic disease schistosomiasis and the occurrence of cancer. This disease occurs most often in Africa and the Middle East. Most often, bladder tumors occur in men.

What are bladder tumors?

There are tumors that arise from the most superficial layer of the wall – from the epithelium, as well as tumors that arise from other tissues, in particular from connective tissue (fibromas, fibromyxomas, hemangiomas, leiomyomas, etc.). Tumors are divided into benign and malignant. The first include adenomas, endometriotic tumors, and pheochromocytomas. Conventionally, this group includes papillomas. The latter often behave like the initial stages of cancer. Malignant tumors include cancer and sarcomas. The most common type is transitional cell carcinoma.

Reasons.

It is generally accepted that the main cause of bladder cancer is the effect of carcinogenic substances excreted in the urine on the bladder mucosa. Proven risk factors for the occurrence of a malignant tumor of the bladder are:work in direct contact with aromatic amines (plastic, dye, aluminum, rubber, etc. production) – increases the risk of disease up to 30 times;

Smoking – increases the risk from 3 to 7-10 times;

drinking chlorinated water – 2 times;

chronic stagnation of urine and cystitis (for example, with prostate adenoma) – up to 2 times;

radiation exposure – up to 3 times;

schistosomiasis of the bladder – up to 5 times.

How does bladder cancer manifest?

The most common sign of bladder tumors is the passage of blood in the urine (hematuria). Usually blood appears for no apparent reason, against the background of normal health. Hematuria can last for several hours, after which it may stop and then reappear. Sometimes, the amount of blood lost is not large and hematuria is determined only by a clinical urine test. Unfortunately, the appearance of blood in the urine may already be a sign of an advanced tumor.

Growing into the wall of the bladder, cancer causes disruption of the functioning of this organ, which is manifested by the appearance of pain during urination or constantly. Pain increases at the end of urination. With advanced cancer, the pain is constant, excruciating, radiating to the perineum, pubic area, anus, and in men, to the scrotum. When the tumor disintegrates, an infection occurs, which causes cystitis.

A tumor can block the entrance of the ureter to the bladder. As a result, there is a violation of the outflow of urine, expansion of the ureters and renal pelvis. Pyelonephritis may develop, and with a long course – hydronephrosis and shutdown of kidney function.

Bladder cancer spreads through the lymphatic and blood vessels to other organs, causing them to be damaged.

Diagnostics

The main method for diagnosing bladder tumors, including cancer, is cystoscopy – an endoscopic examination. A thin metal tube is inserted through the urethra, through which the bladder is examined. Urine sediment is also examined, in which cancer cells can be detected. The tumor is examined before surgery using a special cystoscope. During the examination, a piece of tissue is taken.

X-ray studies are of great importance in diagnosis. Contrast agents are injected intravenously, after which images of the bladder are taken, which can reveal a tumor. Contrast agents can also be administered through the urethra.

Not long ago, urologists had access to a test strip for the rapid diagnosis of bladder cancer – NMP22, which works on the principle of a pregnancy test. This will likely allow this approach to be used in disease screening. The method is not yet widespread in the world.

Radiation methods are of great importance in the diagnosis of bladder tumors: ultrasound, CT, MRI. They allow you to non-invasively identify a tumor during a routine examination (ultrasound), determine the extent of the tumor process at the preoperative stage (MRI, CT), and also track the results of treatment (MRI, CT).

Laboratory methods for diagnosing bladder cancer include a general urinalysis and cytological examination of urine sediment.

Stages.

Depending on the degree of prevalence (neglect), bladder cancer can be divided into 3 types: superficial, invasive and generalized.

Before considering the clinical forms of bladder cancer, it should be noted that the wall of this organ consists of four layers:

1. Epithelium (mucosa) – a layer that is in direct contact with urine and in which tumor growth “begins”;

2. The submucosal connective tissue layer (lamina propria) is a fibrous plate that serves as the “base” for the epithelium and contains a large number of vessels and nerve endings;

3. The muscle layer (detrusor), whose function is to expel urine from the bladder;

4. The outer layer of the bladder wall can be represented by adventitia (at the retroperitoneal part of the organ) or peritoneum (at the intra-abdominal part of the organ).

Treatment methods.

With superficial cancer the tumor is located within the epithelium of the bladder (or extends no deeper than the lamina propria) and does not affect its muscular layer. This form of the disease has the best prognosis.

The main treatment method in this situation is transurethral electroresection of the bladder wall with a tumor (TUR). This technique has diagnostic and therapeutic value – it allows you to take material for histological examination (confirmation of diagnosis) and remove the tumor within healthy tissue. Unfortunately, after a TUR of the bladder wall with a tumor, the probability of tumor recurrence is on average 50%. This percentage can be reduced by the use of photodynamic diagnostics and intravesical administration of the BCG vaccine or chemotherapy drugs (mitomycin, doxorubicin, etc.). Promising intravesical drug electrophoresis techniques are in the development phase. After performing a TOUR, it is absolutely MANDATORY to perform repeated control examinations of the bladder to exclude a relapse. In case of multiple relapses after TUR and detection of poorly differentiated (“evil”) cancer, it is often advisable to resort to radical surgery – cystectomy (removal of the bladder) with the formation of a new bladder from a segment of the intestine. This operation is especially effective in early forms of cancer and provides high oncological results. With adequate treatment, the 5-year survival rate of patients with superficial bladder cancer exceeds 80%.

Invasive bladder cancer is characterized by the spread of tumor damage to the muscular layer and beyond the organ – to the peri-vesical fatty tissue or adjacent structures (in advanced cases). During this phase of bladder tumor development, the likelihood of metastasis to the lymph nodes increases significantly. The main treatment for invasive bladder cancer is radical cystectomy with lymphadenectomy (removal of regional lymph nodes). In a limited number of cases, TUR and open resection of the bladder are used to treat patients with muscle-invasive cancer. To increase the effectiveness of surgical treatment in some patients, it is advisable to prescribe antitumor chemotherapy drugs. The 5-year survival rate of patients with invasive bladder cancer averages 50-55%.

When metastases (tumor screenings in lymph nodes and organs) appear, bladder cancer is called generalized (metastatic). Most often, the disease metastasizes to regional lymph nodes, liver, lungs and bones. Almost the only effective treatment for generalized bladder cancer that can prolong the patient’s life is powerful chemotherapy with several drugs (methotrexate, vinblastine, doxorubicin, cisplatin, etc.). Unfortunately, all of these drugs are not safe. The mortality rate when using them is 2-4%. Often it is necessary to resort to surgical treatment, the purpose of which is to prevent the patient from dying from life-threatening complications that accompany the tumor process (for example, bleeding). The 5-year survival rate in patients with advanced bladder cancer does not exceed 20%.

The main thing:

Don’t be lazy, spend ONE day once a year (in a good clinic) and undergo a QUALITY clinical examination, which necessarily includes an ultrasound of a full bladder and a urine test. If you suddenly notice an admixture of blood in your urine, be sure to consult a competent urologist who has the opportunity and, most importantly, the desire to find out the cause of this episode. Compliance with the above will most likely allow you to avoid such “news” as advanced bladder cancer.