bladder cancer

Bladder cancer: description

Bladder cancer (bladder carcinoma) is a malignant tumor that almost always emanates from the urinary bladder (urothelium). This is why doctors also speak of urothelial tumors. There are changing cells that divide faster than normal, healthy cells. Washed out altered cells can be dragged into other organs and tissues and there form daughter tumors (metastases).

Every year more than 29,000 people in Germany contract bladder cancer, estimates the Robert Koch Institute. More than 21,000 of them are men. The risk of a bladder tumor increases with age: only one in five patients is younger than 65 years old when they learn about bladder cancer. On average, men are 72 years old at the time of diagnosis and 74 years old.

The main risk factor for the development of bladder cancer is smoking – it increases the risk of bladder cancer threefold. Also the passive smoking is dangerous. Tobacco use is blamed for about 30 to 70 percent of all cases of bladder cancer.

Bladder cancer: symptoms

Like most malignant tumors, bladder cancer has no specific symptoms. But bladder cancer can still be behind it, just like many other diseases of the urinary tract.

If you notice these bladder cancer symptoms, you should definitely consult a doctor:

A warning sign of a tumor in the bladder is a reddish to brown Discoloration of the urine, which is due to low blood in the urine. This color change occurs in about 80 percent of bladder cancer patients and is often the first sign of a malignant bladder tumor. However, these blood clots are not a characteristic bladder cancer symptom, but occur in many urinary tract and kidney diseases. Only when the urine is significantly bloody, most affected seek a doctor. Often, the bladder cancer is already well advanced. Bladder cancer, the urine also does not have long-term blood. Sometimes it disappears from the urine after some time, although the disease persists.

Also, urinary symptoms (increased urination with the frequent emptying of only small amounts of urine = pollakiuria) are in need of clarification – they may indicate a tumor in the bladder.

Disorders of bladder emptying (Dysuria) may also be a warning sign of bladder cancer. The urination is difficult and often works only in drops; sometimes this is painful. Many mistakenly interpret these symptoms as cystitis.

Also at Pain in the flanks For no apparent reason, care should be taken – you should see a doctor. Pain often occurs only in advanced stages of bladder cancer. Sometimes symptoms become noticeable only when the bladder tumor relocates the ureters or the urethra.

Chronic cystitis may indicate bladder cancer, especially if treatment for cystitis with antibiotics is unsuccessful.

Bladder cancer: causes and risk factors

There are several factors that increase the risk of bladder cancer – often external factors.

Smoke is – as in lung cancer – a significant risk factor for bladder cancer. The pollutants from the cigarette smoke get into the blood, the kidney fishes in turn out of the blood. With the urine they are flushed into the bladder and unfold their harmful effects there until they are excreted. Up to 70 percent of all bladder cancers are due to smoking, doctors estimate. So if you can stop smoking, it also reduces your risk of bladder cancer.

Chemical substances: Contact with certain chemicals also increases bladder cancer risk. Particularly dangerous are aromatic amines that are considered carcinogenic. In the past, they were mainly used in the chemical industry, the rubber, textile and leather industries as well as in the painting trade. For workers who handled these substances and had bladder cancer, the disease was widely recognized as an occupational disease.

This link between chemicals and bladder cancer has been known for some time. At the workplace, such chemicals are therefore used today only under high safety precautions or are completely prohibited. However, bladder cancer is developing very slowly – it can take up to 40 years between the effects of chemicals and the development of bladder cancer (latency). Therefore, bladder cancer can occur in people who have long dealt with such chemicals. In addition to the aromatic amines, there are other chemicals that may play a role in the development of bladder cancer.

Also chronic bladder infections are probably a risk factor for bladder cancer. Common bladder infections can occur, for example, in people with a bladder catheter.

 Painkiller abuse is also a risk factor for bladder cancer. Particularly at risk are people who had to take the active ingredient phenazine in high doses.

Some long-standing infectious diseases are associated with bladder cancer. An example is the Infection with schistosomes (Pair’s leech) that occur in the tropics and subtropics. They cause the disease schistosomiasis, which may also affect the urinary bladder and urethra (urogenital schistosomiasis).

Certain medications taken at one chemotherapy (cyclophosphamide-based cytostatic drugs) are a risk factor for bladder cancer. Such agents are used inter alia in leukemia, breast cancer and ovarian cancer.

Bladder cancer: examinations and diagnosis

Bladder cancer usually causes little or no discomfort. The bladder cancer symptoms are also so initially unspecific that other diseases can be behind it. However, if you have blood in your urine or have persistent symptoms of bladder irritation, you should consult a doctor – preferably a family doctor or urologist. After all, the earlier the bladder cancer is diagnosed, the better it can be treated.

The doctor will first ask you about your observations and complaints (anamnesis). These include, for example, discoloration of the urine, problems with urination or increased urination. Risk factors such as professional contact with chemicals are also inquired. Also important are present diseases and your lifestyle (smoking).

At a Urinalysis can usually detect blood in the urine.

Also one physical examination is carried out. Only very large bladder tumors can be felt through the abdominal wall, the rectum or the vagina.

If there was blood in the urine, bring one X-ray the entire urinary tract (urography) further information about the possible bladder cancer.

One Ultrasound of the abdomen (Sonography) helps to assess the condition of kidney, renal pelvis, ureter and bladder.

If the suspicion of bladder cancer hardens, one becomes cystoscopy (Cystoscopy). The patient receives a local or general anesthetic. A special instrument (cystoscope) is introduced through the urethra and the interior of the bladder is examined. The doctor can use this study to estimate how deep the tumor has invaded the urinary bladder mucosa.

The diagnosis bladder cancer is based on a Tissue sample (biopsy) secured from the suspicious tissue. Subsequently, a pathologist examines the cells under the microscope. The tissue is obtained as part of a bladder mirror by means of an electric loop (Transurethral electrical resection of the bladder, TUR-B). Small, superficially growing tumors can sometimes be completely removed.

The urine is additionally examined in the laboratory for malignant cells (cytology).

There is none tumor markers in the blood, which are specific for bladder cancer.

If the diagnosis of bladder cancer has been confirmed, further investigations will follow to determine how far the cancer has progressed and whether it has already spread to other organs.

Examples are:

• Ultrasound of the liver
• X-ray of the ribcage
• Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) of the abdomen
• Bone scintigraphy suspected bone metastases

Bladder cancer: treatment

In cancer therapy, specialists in a variety of disciplines need to work closely together, including surgeons, urologists, oncologists, and psychologists. It is also important that you are well informed about the cancer and the treatment options – this is the only way you can make informed decisions. Be sure to ask if you did not understand something.

The treatment of bladder cancer depends mainly on the stage of the disease. Important are the tumor size, the location of the bladder tumor, how far it has spread, how malignant the tumor cells are and how fast the bladder cancer is growing. From these results, the exact stage of the disease is determined (staging, staging). A kind of “profile” of the tumor is created (TNM classification).

Endoscopic surgery (TUR) – remove the tumor

About 70 percent of those affected are superficial tumors. That is, the bladder cancer is only in the bladder mucosa and has not yet reached the bladder muscles. Then he can be removed in the cystoscope with the cystoscope. The bladder tumor is removed by an electric sling. After the operation, a histological examination is carried out. It shows whether the tumor was “healthy”, ie completely removed.

Local chemotherapy after TUR: To prevent a recurrence of bladder cancer, some patients receive directly after the surgery preventive medicine for cancer (so-called chemotherapeutic agents). The doctor rinses them directly into the bladder during cystoscopy (instillation therapy, intravesical chemotherapy). Chemotherapy is given to patients with a low to moderate risk of relapse.

Local immunotherapy after TUR: In patients at high risk of relapse, doctors sometimes also use the tuberculosis vaccine BCG (Bacillus Calmette-Guérin), which is also injected directly into the bladder. The vaccine triggers an intense immune response in the body, which is also intended to fight the tumor cells. The immunotherapy should begin at the earliest two weeks after the operation.

The medical follow-up treatment of bladder cancer usually lasts six to eight weeks and is usually performed once a week (induction phase). The treatment is outpatient and takes about two hours. Afterwards, patients can go home. In some cases, this induction phase is followed by a so-called maintenance phase, which can take several months to years. During this period, the person receiving the medication is also given an outpatient once a month via a catheter into the bladder.

Bladder removal (cystectomy)

In some patients, bladder cancer has grown deeper into the wall. Here, a major surgery is required, in which the bladder is surgically partially or completely removed (cystectomy). In addition, the surrounding lymph nodes are removed. This reduces the risk that the disease will spread again via possibly affected lymph nodes. In men, the prostate and seminal vesicles are removed at the same time, in case of tumor invasion of the urethra even this. In women with advanced bladder cancer, the uterus, ovaries, part of the vaginal wall and most of the urethra are removed.

If a complete removal of the bladder is required, the doctor then creates an artificial outlet, through which the urine runs outward. The simplest form is the implantation of the two ureters in an off, about 15 centimeters long thin or large intestine piece. The open end of this piece of intestine is discharged through the abdominal skin (ileum conduit). Because urine is always drained from the abdominal opening in this form of urinary diversion, the person must constantly wear a urine bag.

Another possibility is to form a “new” bubble (neobladder). In this case, a collecting bag is formed from a turned-off intestinal part, which is connected to the urethra. The prerequisite for this is that the transition from bladder to urethra in the histological examination was free from malignant cells. Otherwise, the urethra must be removed as well. The advantage of this variant is that urination is possible in the normal way. However, the patients have no urinary frequency. The bladder must be evacuated at regular intervals by pressing, depending on the fluid intake every three to four hours or at a slightly longer intervals.

If all this is not possible, the two ureters are connected from the renal pelvis to the last part of the large intestine (ureterosigmoidostomy). The urine then runs off during bowel movement.

chemotherapy

Sometimes the removal of the bladder is not possible or the patient refuses the procedure – here is a chemotherapy in question, which affects the entire body and tumor cells should switch off (systemic therapy).

Chemotherapy also helps with bladder cancer when the tumor is already too advanced (for example, when it spreads to the lymph nodes of the abdominal cavity or other organs). The therapy relieves the symptoms and has a life-prolonging effect.

radiotherapy

A bladder carcinoma is radiosensitive – the tumor cells can often be completely destroyed by irradiation. Radiation treatment is an alternative to bladder removal – sometimes the bladder is preserved. Most radiotherapy is combined with chemotherapy. The drugs used (cytostatics) to make the tumor even more sensitive to radioactive rays. Doctors speak of chemoradiotherapy. The irradiation often lasts several weeks and usually takes place daily for a few minutes.

Bladder cancer: disease course and prognosis

Patients with bladder cancer should be regularly followed up for follow-up. In this way possible relapses (recurrences) can be identified and treated in good time.

About 70 percent of bladder cancer patients have superficial bladder cancer at the time of diagnosis. The prospects are favorable because these tumors relatively rarely form secondary tumors (metastases) and the cancer can usually be removed completely surgically.

As soon as the bladder cancer penetrates into the muscle layer of the bladder (muscle-invasive tumors), the risk of metastasis increases. Because the muscle tissue is well supplied with blood and then tumor cells pass through the blood stream to other organs. If the bladder cancer has spread in this way, the prognosis is worse.

If the tumor cells have already grown locally beyond the bladder or if distant metastases are present, the chances of survival for bladder cancer continue to decline. Therefore, bladder cancer should be detected and treated as early as possible.

Around 76 percent of male and 70 percent of female patients still live five years after diagnosis bladder cancer (5-year survival rate).