WHAT IS BLADDER CANCER AND HOW DOES IT OCCUR?
The bladder (urinary bladder) is an organ where urine filtered from the kidneys accumulates. They have the functions of storing and discharging urine. Cancer can be seen in some cases, especially after the age of 40. It is among the most common cancers in our country. It is most commonly manifested by bleeding in the urine in patients. In addition, many complaints ranging from frequent urination, burning in urination and even kidney failure can be seen. It is much more common in men than women. The most common cause is SMOKING. Occupational groups exposed to chemicals (paint, textile, chemical industry, tire and rubber industry) are at risk. 70% of bladder tumors are detected at an early stage. The treatment of bladder tumors detected at an early stage is performed successfully with cystoscopy and resection (closed surgery). In late and disseminated disease, much more difficult treatments are applied and the risk of death increases. For this reason, it is vital that people who have complaints about this disease get their diagnosis and treatment as soon as possible. In this regard, specialist centers and physicians should be consulted.
Common complaints and findings in bladder cancer are:
1- Blood in the urine
2- Pain during urination
3- Frequent urination
These are not definitive signs of a bladder tumor. These complaints can also be seen in infection, bladder stones and other problems. A definitive diagnosis can only be made by a doctor.
BLADDER CANCER; Cancer that is limited to the superficial layer (innermost layer) of the bladder is called non-invasive cancer (superficial cancer). After treatment, superficial cancer may recur (recur). Recurrence usually occurs when a superficial cancer with the same features is seen in its old place or in another part of the bladder, and the vast majority of these do not spread to other parts of the body, the event is only in the bladder. Due to this feature, it is of particular importance that patients with bladder tumors come to their regular controls. However, sometimes there may be progression of the disease along with recurrence, and in this case, the cancer may deepen and pass into the muscle layer. This is called invasive (deep) cancer. Bladder cancer that has progressed into the muscle can spread out of the bladder and into the surrounding tissues. Bladder cancer can also spread to the lymph nodes around the bladder. If it has reached these places, it may have jumped to distant places such as the lungs.
This new tumor is called a metastatic bladder tumor.
DIAGNOSIS AND STAGING
Once a bladder tumor is diagnosed, the doctor will want to know the stage (superficial or invasive) and extent of the disease. The grade of cells is important because this examination gives information about how different the cells are from normal or how fast the disease will progress. Low-grade tumors grow more slowly. It is possible to learn this degree and stage correctly only by pathological examination of the tumor tissue taken by biopsy.
Staging, on the other hand, indicates the extent of spread of the cancer in the organ from which it originated, in neighboring tissues, or in organs where it can travel via lymph or blood. The stage of the cancer is determined at the time of diagnosis and for this purpose additional tests, eg: Computed tomography. Magnetic resonance imaging may be required.
BLADDER TUMOR TREATMENT
Treatment of bladder cancer depends on the stage and grade of the tumor, the general condition of the patient, and other factors.
Surgery is a general treatment for bladder tumor. Early bladder tumor, that is, superficial cancer, can be treated with the TUR (transurethral resection-removal of the bladder tumor with closed method) method while being diagnosed at the same time.
In TUR, the doctor inserts the cystoscope into the bladder through the urethra (the urinary tract inside the penis). Then, the doctor breaks the tumor off with the help of a thin ring and burns it. TUR is performed in the operating room and anesthesia (narcosis) is required.
The most common surgery for invasive (deep) bladder tumor is radical cystectomy (surgical removal of the entire bladder), closed surgery (TUR) alone is not sufficient for invasive disease. This surgery (radical cystectomy) is done if the tumor has advanced into the muscle layer. Radical cystectomy operation can also be applied in some cases of superficial bladder cancer (if the superficial tumor covers a large part of the bladder or the treatment methods used in superficial bladder cancer are unsuccessful).
In radical cystectomy, the entire bladder and surrounding lymph nodes are removed. In men, the prostate and its adjacent accessory glands (seminal vesicles) are also removed. In the woman, the ovaries, uterus and part of the vagina are removed. With the bladder removed, the doctor creates a new pathway for urine to be expelled from the body.
In radiotherapy (radiation therapy), high-energy rays are used to kill cancer cells. Like surgery, radiotherapy is a local (regional) treatment, it only affects cancer cells in the treated area. Sometimes this treatment is given before or after surgery or in combination with chemotherapy (drug therapy).
When bladder cancer spreads to other organs, radiotherapy can also be applied to these areas and play a role in relieving the discomfort caused by cancer here.
Chemotherapy means using drugs to kill cancer cells. The doctor may use one or more medications. Chemotherapy can usually be used for post-TUR treatment.
In the treatment called intravesical chemotherapy, the chemotherapeutic agent is given to the bladder through the urethra with the help of a catheter (tube). In this type of treatment, because anticancer drugs remain in the bladder, they affect the cancer cells in the bladder. Treatment is usually given once a week for several weeks. Only superficial disease can be treated with intravesical chemotherapy, this treatment method is not used for invasive disease.
Biological therapy (immunotherapy) is also used when bladder cancer is superficial. Biological therapy is treatment that uses the natural ability of the human body to fight cancer under normal conditions. Like intravesical chemotherapy, biologic therapy can be used alone or after TUR to prevent recurrence. This form of treatment is applied by injecting a substance called BCG, which triggers the defense system, into the bladder. This medicine is kept in the bladder for 2 hours. This treatment is usually applied once a week for 6 weeks and can be extended or repeated if necessary.
SURGERY IN BLADDER TUMOR
Surgical Methods Used in Bladder Cancer Surgery
- Transurethral Resection of Bladder Tumor (TURBT): It is a method used to remove cancer cells in the stage before cancer cells spread to the muscle structure of the bladder. In the procedure performed under local anesthesia, cancer cells in the bladder are burned with a wire with electric current used through a cystoscope (a thin tube-shaped instrument sent from the urinary tract to the bladder in men and women). Alternatively, a high-energy laser can be used.
- Cystectomy: It is the operation in which the bladder is removed from the body in bladder cancer surgeries.
- Restructuring of the bladder: It is the creation of a new way for urine to leave the body after bladder cancer surgery (cystectomy). The surgeon creates a spherical chamber from part of the patient’s intestine. This reservoir is connected to the urethra (the tube through which urine exits the bladder and leaves the body) inside the body and allows urine to exit the body.
- Establishing the urinary tract from the intestine: The tube (ileal tube) formed from the intestine of the patient is extended from the ureters to the outside of the body. From here, the urine empties into a pouch attached to the patient’s abdomen.
- Formation of a urinary bladder from the intestine: A small reservoir is created from a piece of intestine for the accumulation of urine. The urine in this chamber has to be drained through the opening in the abdomen using a catheter (a thin tube) several times a day.
The surgical methods used in bladder cancer surgery (cystectomy) are:
ROBOTIC SURGERY (ROBOT ASSISTED LAPAROSCOPIC CYSTECTOMY
MINIMALLY INVASIVE SURGERY)
Bladder cancer surgeries (cystectomy) involve removing the bladder, part of the ureter, and surrounding lymph nodes. When necessary, prostate and semen sacs in men; in women, it may also involve removing the uterus, ovaries, and vagina. In robotic bladder cancer surgeries, 1 cm incisions are made in the lower part of the patient’s abdomen. The surgeon performs the surgery by simultaneously managing the robotic instruments sent through these incisions from the console in the operating room. At the same time, a camera is sent from one of the incisions to the surgeon’s console, which simultaneously transmits a real 3-dimensional image. In bladder cancer surgery, after the bladder and necessary surrounding tissues are removed, a new outlet for urine is created and the surgery is terminated. One of the advantages of robotic surgery for bladder cancer surgeries is to ensure that the surrounding tissues are not damaged by performing smaller maneuvers in very narrow areas. This advantage is of great importance in the protection of the vascular and nerve structures that provide sexual function, especially in men. The very small incisions made in robotic surgery allow the patient to return to his daily life faster after the surgery.
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