Bladder Cancer



They currently make up more than 2% of newly diagnosed malignancies.

Epidemiology

 * Morbidity is still rising, mortality is decreasing, it affects men 3 times more often ,
 * high incidence - in SW Europe, low in India and Japan,
 * the main occurrence is between the 50s and 70s.

Etiology

 * The main risk factor is smoking (mainly black tobacco smoking),
 * exposure to certain industrial pollutants - aromatic amines (benzidine, 2-naphthylamine,…),
 * chronic infection, in endemic areas - schistosomiasis (does mainly squamous cell ca).

Clinical manifestations

 * Hematuria and pollakiuria ,
 * increased bladder irritation indicates involvement of the throat, hydronephrosis and secondary pyelonephritis may occur in the area of ​​the urethral orifice ,
 * sometimes it can be completely asymptomatic,
 * general symptoms (anorexia, weight loss, anemia ) - are only in very advanced tumors.

Diagnostics

 * 1) Cystoscopy ,
 * 2) endoscopic biopsy, or transurethral resection → it is necessary to determine the level.

Histopathology

 * 97% are carcinomas from the urothelium, rarely adenocarcinomas and undifferentiated carcinomas , squamous cell carcinomas are endemic (schistosomiasis),
 * macro - different appearance - papillary, infiltrating, probably in ¼ they arise multicentricly (this is the cause of frequent recurrences),
 * they can start as ca in situ and then change into a papillary or infiltrating form,
 * initially the tumor grows in the mucosa, then grows early into the submucosa, muscle and surrounding fat, metastasizes to the pelvic nodes, later paraaortic , more rarely hematogenously.

Therapy
The method of therapy depends on a careful evaluation of histology, degree of invasion, extent of the disease.

Surgical treatment

 * Non-invasive tumors can be treated by transurethral resection (TUR) - it is a relatively minor damaging procedure, it does not affect bladder function,
 * for the treatment of surface structures - coagulation or laser vaporization ,
 * but often there is a recurrence within 1 year, so the five-year survival does not exceed 80%,
 * therefore, it is recommended to supplement adjuvant intravesical CHT, intravesical application of IFN, BCG vaccine, adriamycin, irradiation,
 * if the tumor grows into the muscle - partial cystectomy ,
 * the rationality of this procedure is questioned given the multifocal origin of urothelial
 * moreover, there is a risk of implantation targets, so it is practically not implemented today,
 * for larger tumors - radical cystectomy with lymphadenectomy, in men with prostatectomy in women with hysterectomy , adnexectomy ,
 * it is a very demanding performance and its indications must be carefully considered.

Radiotherapy

 * It is most often not used as an external radiation, as a separate treatment, for numerous emergency services,
 * even as a neoadjuvant, no significant effect has been confirmed,
 * So far, radiochemotherapy (RCHT) could have a good effect, but this is not substantiated by studies
 * however, it is irreplaceable as palliation (skeletal meta analgesia, suppression of hemorrhagic complications).

Chemotherapy

 * It is administered either locally or systemically ,


 * 1) local - in diffuse ca in situ, in superficial tumors after TUR and in papillary (the most advantageous today seems mitomycin C, which is practically not absorbed from the bladder and does not endanger toxicity),
 * 2) systemic - the main palliative treatment of advanced forms, the tumor responds to a number of cytostatics,


 * corresponds most to - Pt derivatives, anthracyclines, ifosfamide ,
 * adjuvant CHT - very useful especially for nodal involvement,
 * neoadjuvance - has many disadvantages, it is not done by default.

Photodynamic therapy

 * It can act in ca in situ and in papillary ca.

Immunotherapy

 * Mainly in the form of local application of BCG.

Prognosis

 * In non-invasives, 5-year survival is 75-80%.

related articles

 * Kidney tumors
 * Kidney cancer

Source

 * BENEŠ, Jiří. Study materials  [online]. © 2010. [feeling. 16-06-2010]. < http://jirben.wz.cz >.