Bladder Cancer
Bladder cancer is a type of cancer that occurs when the cells lining the inner surface of the bladder grow uncontrollably. As a urology specialist, I frequently encounter this disease in the diagnosis and treatment processes of bladder cancer. Although it can be seen in both men and women, it is more commonly found in men. Bladder cancer is generally diagnosed in individuals over the age of 50, but it can also occur in younger age groups.
TYPES OF BLADDER CANCER
Bladder cancer can arise from various cell types. The main types include Transitional Cell Carcinoma, Squamous Cell Carcinoma, and Adenocarcinoma, among other cancers originating from different cell types.
RISK FACTORS
The exact causes of bladder cancer are not fully understood, but it has been scientifically shown that certain risk factors increase the likelihood of developing this cancer. The most significant risk factor is tobacco use. Individuals who smoke have a 3 to 4 times higher risk of developing bladder cancer compared to non-smokers. The toxic chemicals in cigarette smoke are filtered by the kidneys and carried to the bladder through urine. The accumulation of these chemicals in the bladder wall can have carcinogenic effects.
Additionally, individuals working in industries such as dye, rubber, leather, and chemicals may be at increased risk of bladder cancer when exposed to certain harmful substances. Chronic parasitic urinary tract infections or long-term irritation of the urinary tract can also increase the risk of squamous cell carcinoma. Previous radiation therapy to the pelvic region may also elevate the risk of bladder cancer.
SYMPTOMS
The most common symptom of bladder cancer is the presence of painless blood in the urine (hematuria). There may be visible bleeding in the urine, or it may be present at levels detectable only under a microscope. However, not every instance of hematuria indicates bladder cancer; such symptoms can also arise from kidney stones, infections, or other causes. Nonetheless, these symptoms should not be ignored, and a urology specialist should be consulted as soon as possible.
Other possible symptoms include:
- Frequent urination
- Burning or pain during urination
- Inability to urinate or weak urine flow
- Pelvic pain
- Weight loss and fatigue (in advanced stages)
DIAGNOSIS
Several different methods are used to diagnose bladder cancer. Patients presenting with complaints of blood in their urine typically undergo the following tests:
Urinalysis: A urinalysis can determine whether there is microscopic blood in the urine. Additionally, a cytological examination of the urine can investigate the presence of cancer cells.
Cystoscopy: In this procedure, a thin camera is inserted through the urinary tract to directly visualize the bladder. If a suspicious lesion is seen, a biopsy can be taken for pathological examination. If a clear tumor is visible, scraping under closed conditions may be recommended in the operating room.
Imaging Techniques: Ultrasound is the first preferred imaging method. After the diagnosis of a bladder tumor is confirmed, advanced imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI) are used to determine the tumor's spread and whether it has extended beyond the bladder.
TREATMENT
Bladder cancer treatment varies depending on the stage of the cancer and the patient's overall health status. Treatment options include:
Transurethral Resection (TUR): This is the most frequently employed treatment method for early-stage bladder cancer. In this surgical procedure, the tumor in the bladder is removed during cystoscopy. The TUR procedure is also used to establish a definitive diagnosis of bladder cancer.
Immunotherapy: A substance called BCG (Bacillus Calmette-Guerin), which stimulates the immune system, can be directly applied to the bladder. This treatment method is used to reduce the risk of tumor recurrence and progression.
Bladder removal and reconstruction: Radical Cystectomy; This procedure involves the surgical removal of the entire bladder and is applied in more advanced stages of bladder cancer. Following this operation, if the patient's condition permits, a new bladder can be constructed from the small intestine to store urine. If the patient is not suitable for a new bladder, a pouch may be placed on the abdominal wall.
Chemotherapy: In advanced cases of bladder cancer, systemic chemotherapy may be applied to shrink the tumor or control its spread. In suitable patients, neoadjuvant chemotherapy may be administered before cystectomy.
FOLLOW-UP AND OUTCOME
Bladder cancer is a treatable disease, especially when caught in its early stages. However, due to the risk of recurrence after treatment, regular follow-up is crucial. During these follow-ups, cystoscopy and imaging techniques are typically employed at specific intervals (generally every three months in the first few years).
In the fight against bladder cancer, early diagnosis and appropriate treatment are vital. Patients should seek medical attention without delay if they notice any suspicious symptoms, as this can positively impact the treatment process. Additionally, lifestyle changes such as quitting smoking and protecting against risk factors, along with increased fluid intake, are essential steps in preventing bladder cancer.
