Epidemiology. The tumor is referred to the most frequent malignant neoplasms (within 3% of all tumors and 30-50% of tumors of the genitourinary organs). Bladder cancer in men is noted 3-4 times more often. Most often registered in 40-60 years. Etiology. The occurrence of urinary cancer
- Industrial carcinogens used in rubber, paint, paper, and chemical industries are implicated in bladder cancer.
- Bladder bilharzia is a common cause of squamous cell carcinoma.
- Other etiologic agents are cyclophosphamide, phenacetin, kidney stones, and chronic infection. Histological variants of bladder cancer (bladder tumors are most often of transitional cell origin)
- transitional cell
TNM classification (see Tumor, stages) Clinical classification (by stages)
- I – the tumor does not extend beyond the bladder mucosa
- II – the tumor infiltrates the muscular layer
- III – the tumor sprouts all the membranes of the bladder and spreads to within the bladder tissue, metastases in the regional lymph nodes
- IV – the tumor grows into neighboring organs, there are distant metastases.
- Gross hematuria
- A characteristic symptom of bladder cancer is dysuria.
- When an infection is attached due to obstructed outflow of urine, pyuria occurs
- Pain syndrome is optional.
- A bimanual study will be needed to determine the prevalence of the process. Papillary tumors are traditionally not palpable. A palpable mass is indicative of an invasive lesion
- Excretory urography is necessary for every patient with gross hematuria. With its help, it is possible to determine the damage to the filling and to identify signs of damage to the upper urinary tract.
- Urethrocystoscopy is the leading research method for suspected cancer, it is absolutely necessary to assess the condition of the mucous membrane of the urethra and bladder
- An endoscopic biopsy of the tumor is performed to determine the volume of the lesion and the histological type. Examine the mucous membrane. In the presence of carcinoma in situ, the mucosa is not externally changed, or diffusely hyperemic, or resembles a cobblestone pavement (bullous change in the mucosa)
- Cytological examination of urine is informative both in case of severe tumor lesions and in situ carcinoma.
- Ultrasound: reveal the depth of germination of the primary tumor and the presence of metastases in regional lymph nodes
- CT and MRI are the most informative for determining the prevalence of the process
- Chest x-ray: detect lung metastases
- Bone x-ray is used to detect metastases. Bone lesions in primary diagnosed tumors are rare. With a highly invasive carcinoma, they may be the first signs of the disease.
Treatment depends on the stage of the disease.
- In situ carcinoma, neoplastic transformation of mucosal cells occurs
- Possibility of topical chemotherapy
- In the case of a widespread lesion (urethra, prostate ducts) and progression of symptoms, early cystectomy with simultaneous bladder plastic surgery or drainage of the ureters is indicated.
- Transurethral resection: used for superficial tumor growth without damage to the muscular membrane of the organ. However, relapses are quite frequent.
- Intravesical chemotherapy reduces the recurrence rate of superficial bladder tumors. Doxorubicin and mitomycin C are effective
- Local immunotherapy with BCG reduces recurrence rate
- External radiation therapy does not give long-term remission (relapses within 5 years in 50% of cases). Interstitial radiotherapy is rarely used
- Cystectomy is used in patients with diffuse superficial lesions if transurethral resection and intravesical chemotherapy fail.
- Invasive cancers of the bladder. This group includes all histological types, except for adenocarcinoma in the intraepithelial stage and cancer in situ. Tumors with infiltrating growth can germinate within the vesicular tissue
- Intensive local treatment with cytostatics is prescribed to patients to eliminate a rapidly progressing tumor without metastasis.
- Partial resection of the bladder is used for tumors that affect the bottom of the bladder. The tumor must have clear boundaries. Biopsies of tissue adjacent to the tumor are checked for
the presence of atypical cells. Preoperative radiotherapy and pelvic lymphadenectomy indicated
- Radiation therapy. In some tumors, irradiation in a total dose of 60–70 Gy per zone of the bladder proved to be effective.
- Radical cystectomy is the method of choice in the treatment of deeply infiltrating tumors. Includes removal of the bladder and prostate in men; removal of the bladder, urethra, anterior wall of the vagina and uterus in women. Simultaneous plastic surgery of the bladder is performed with the small or large intestine. Mortality after such operations is less than 5%. The recurrence rate is within 25%.
The prognosis depends on the stage of the process and the nature of the treatment. After radical surgery, the 5-year survival rate reaches 50%. The best results are observed with combined treatment (bladder resection with radiation therapy). also Tumor, radiotherapy; Tumor, markers; Tumor,
methods of treatment; Tumor, stages
ICD. C67 Malignant neoplasm of urinary bladder