Bladder Cancer Symptoms, Diagnosis and Treatment Process
Bladder cancer is the second most common cancer among cancers that occur throughout the urinary tract, starting from the kidneys. Approximately two-thirds of bladder cancers are formations that do not follow a fatal course but tend to recur, while one-third are formations with a poor course that have the potential to spread (metastasize) to muscle tissue and then to the rest of the body.
The kidneys filter and clean an average of 200 liters of blood a day. After this process, the kidneys produce an average of 1.5 liters of urine per day in order to establish intra-body fluid balance and purify the blood. It transmits the substances that need to be removed from the body to the bladder through the urinary tract in the urine created.
The main function of the bladder is the storage of urine. The functioning of the bladder takes place under the control of the central nervous system. When the urine stored in the bladder reaches a certain level, the person feels the urge to urinate.
What is Bladder Cancer?
Bladder cancer is the second most common cancer among cancers that occur throughout the urinary tract, starting from the kidneys. Approximately two-thirds of bladder cancers are formations that do not follow a fatal course but tend to recur, while one-third are formations with a poor course that have the potential to spread (metastasize) to muscle tissue and then to the rest of the body.
Bladder cancer occurs more in men than women, and the disease usually occurs in adults. When the most common cancers among genders in Turkey are examined, bladder cancer is the 3rd most common in men and the 13th most common in women.
What are the symptoms of bladder cancer?
The most important symptom that prompts patients to consult a physician after bladder cancer occurs is urination, which is usually painless and has a visible color change close to red due to the presence of red blood cells in the urine. This symptom is called macroscopic hematuria.
In addition to blood in the urine, many other symptoms may occur during the course of the disease.
- Pain in the groin and upper groin area
- frequent urination
- urgent need to urinate
- Presence of blood in the urine that can be detected microscopically (microscopic hematuria)
- Presence of blood clot in urine
- painful urination
- Feeling of mass and fullness in the groin area
- Back pain
- Weakness
- weight loss
If the disease spreads (metastasizes) to other tissues and organs, it may cause various symptoms depending on the area where it spreads. For example; Complaints such as cough or bloody sputum may indicate that bladder cancer has spread to the lungs. The occurrence of bone pain in bladder cancer patients may be a sign of the disease spreading to the skeletal system.
What are the Stages of Bladder Cancer?
A system called TNM classification is used in the staging of bladder cancers.
- T is evaluated according to findings regarding the presence and spread of bladder cancer. While T1 tumors are in the more superficial parts of the bladder, T2 tumors indicate the presence of spread to muscle structures, T3 tumors to the fatty tissue around the bladder, and T4 tumors to other organ structures.
- N is classified according to whether bladder cancer has spread to the lymph nodes. A single lymph node involvement smaller than 2 centimeters is classified as N1, while involvement of more than one lymph node between 2-5 centimeters is classified as N2, and involvement of any number of lymph nodes larger than 5 centimeters is classified as N3.
- In M staging, evaluation is made according to whether the cancer has spread to organs other than the bladder. If metastasis is detected, it is evaluated as M1, if not detected, it is evaluated as M0.
Clinical staging of bladder cancer, created using the TNM classification, is divided into 4 stages:
Stage 1 bladder cancer is a superficial cancer of the bladder with no lymph node involvement and no spread to another organ.
Stage 2 describes the clinical stage in which spread to other tissues and organs is not detected, as in stage 1, but the cancer progresses to deeper muscle structures.
Stage 3 is a more advanced clinical stage in which no spread to organs distant from the bladder is detected and is usually accompanied by lymph node involvement.
Stage 4 bladder cancer means that the disease has spread to other distant tissues and organs.
How Does Bladder Cancer Happen?
The cells that make up the human body have their own life cycle. Cells grow, develop and also age during their life cycle. Aging cells sacrifice themselves when the time comes, leaving their place to new cells in a delicate balance.
This cycle is broken depending on various factors, and if a cell tends to proliferate and spread uncontrollably, it is defined as cancer. Cancers usually get their names according to the tissue and organ from which they originate.
What Causes Bladder Cancer?
There are many risk factors that can cause bladder cancer. The most frequently detected ones are chemical substances, and various infections and drugs are also considered risk factors.
- genetic mutations
- smoking
- Various professions such as paint industry, dry cleaning, rubber and chemical industry
- Schistosomiasis disease, which is a parasite that settles in the bladder
- Irritation caused by bladder stones in the bladder for long periods of time
- Some painkillers and cancer medications
Bladder Cancer Diagnosis
Urologists can benefit from various imaging methods, laboratory examinations, evaluation of cells excreted in urine, and microscopic examination of biopsy material in the diagnosis of bladder cancer.
- Biochemical laboratory tests
Examinations such as urine tests, blood values, kidney and liver function tests can be evaluated in bladder cancer patients.
- urine cytology
It refers to the examination of the presence of normal or cancerous cells in the bladder, which are excreted with urine, using a microscope.
- Imaging tools
Ultrasonography, intravenous urography, computed tomography, magnetic resonance imaging and cystoscopy can be given as examples of imaging methods that can be used in the diagnosis of bladder cancer.
Computed tomography and magnetic resonance imaging are used to determine whether the disease has spread outside the bladder.
In bladder cancer patients complaining of bone pain, bone scintigraphy can be used to evaluate the spread to the skeletal system.
Cystoscopy allows endoscopic evaluation of the bladder. The method called transurethral resection (TUR) can be applied during cystoscopy examination and the piece can be removed. The TUR procedure can be used for both diagnosis and treatment purposes.
Bladder Cancer Treatment
Different methods are used in treatment planning for bladder cancer, depending on whether the disease has spread to the muscle tissue. If there is no spread in the muscle tissue, intravesical BCG can be administered depending on the patient’s risk status, following endoscopic removal of the lesion.
With the BCG procedure, a nearly 40% reduction in the recurrence and progression of the disease can be achieved. After this procedure, side effects such as muscle fatigue, weakness, nausea-vomiting, diarrhea, fever, and pain during urination may occur.
Surgical procedures for bladder cancer can be performed by completely removing the bladder or removing part of it, depending on the stage and location of the tumor. In bladder cancers that have spread to muscle tissue, a surgical approach called radical cystectomy is usually applied. In this method, in which surrounding tissues and lymph nodes are removed in addition to the bladder, chemotherapy can be used as an additional treatment approach to surgery.
The treatment method that aims to destroy cancer cells using high-energy rays is called radiation therapy. Radiotherapy applications come to the fore especially in patient groups who are not suitable for surgical interventions or for whom surgical interventions are not preferred.
Bladder-sparing treatment approaches are the process of preserving the bladder instead of completely removing it, by removing as much part of the cancer structure as possible by transurethral resection (TUR), reducing its size, and using chemotherapy and radiotherapy together. Such organ-preserving approaches may be considered in appropriate patient groups following the evaluation of the physician.
If bladder cancer has spread to other parts of the body, systemic chemotherapy and/or targeted immunotherapy come to the fore in the treatment that can be applied in response to this situation.
