Bladder (Urinary Bladder) Cancer Treatment

Bladder Cancer
(Urine Bladder) Cancer

Our urinary bladder is an organ with a capacity of approximately 350-500 ml, which stores the urine produced in the kidneys and brought with the right and left ureters (upper urinary tracts, carrying the urine from the kidney to the urinary bladder) and throws the urine out of the body when the time comes.

Its inner surface is covered by a mucous layer. There is a muscle layer in the middle part and it allows the urine to be discharged by contraction. On the outside, there is a protective membrane layer. It is located in front of the last part of the large intestine in men and just below the uterus in women.

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A bladder tumor occurs when the cells that make up the wall of the bladder multiply uncontrollably. The majority (more than 90%) of bladder tumors originate from the cells lining its inner layer. These cells are called transitional epithelial cells, and the tumor of these cells is called transitional cell carcinoma (TCC). This tumor is observed on the inner surface of the bladder, usually in the appearance of a fluffy cauliflower.

What Causes Bladder Cancer?

The most important proven cause of bladder cancer is smoking. Excessive and long exposure to some chemicals, a parasite not found in Turkey, and chronic infections can cause bladder tumors.

Bladder cancer is especially common in older people. Most patients are 60 years or older.

What Symptoms Does Bladder Cancer Give?

The most important symptom of bladder cancer is blood in the urine. The patients do not complain of pain or burning. As patients can see this bleeding with their eyes, it can also be detected in urinalysis. However, it would be wrong to say that every patient with bloody urine has bladder cancer.

How Do We Diagnose Bladder Cancer?

Bladder tumors detected during cystoscopy for diagnosis are completely cleared in the same session. For this purpose, the tumorous tissue, including its base and periphery, is cut with an instrument called a resectoscope.

This procedure is called TUR-M or TUR-T (transurethral resection of bladder tumor). The first aim of the treatment is to remove all tumors so that there is no tumor left in the bladder.

These procedures can be performed under general or spinal (waist numbing) anesthesia. A catheter is inserted after the surgery and the bladder is washed for a while with bladder washing liquid.

Our patients, who usually need to stay in the hospital for 1 or 2 days, are discharged after the catheter is removed when the follow-up period is over.

Some factors are important in determining the follow-up and treatment method of discharged patients:

Diameter and number of tumor
type of cancer
Spread to the bladder floors
Grade of aggression (low-medium or high grade)
Whether there is a previous tumor
Whether there is a splash to other places.

All these parameters, the general condition of the patient and additional diseases are evaluated together to determine the most appropriate personalized treatment for our patients.

Treatment of superficial-non-muscle invasive bladder tumor:

Tumors that have not progressed to the muscle layers of the bladder are called superficial-muscular bladder cancer, and those that have advanced to the muscle and deeper layers are called muscle-invasive bladder cancer.

If superficial bladder tumors are non-aggressive (high grade), single and small tumor, if there is no tumor before, that is, if it is not a recurrent tumor, administration of drugs into the bladder after completely scraping the tumor with TUR-M is an adequate treatment. However, due to the risk of recurrence of the disease, it will be necessary to follow up, that is, to perform cystoscopy at certain intervals.

Aggressive (high grade), large tumors that involve the layer above the muscle layer (T1) will require re-scraping of the tumor area (re TUR-M) after 4-6 weeks. After this process, patients are given some drugs into the bladder to prevent recurrence or progression of the tumor.

As can be seen, many factors related to the patient and the tumor affect the treatment method. Even bladder removal surgery performed in muscle-invasive tumors can be performed in aggressive tumors that recur frequently, despite common, intravesical drugs given.

Treatment of muscle-invasive bladder tumors:

In tumors that have reached the muscle base but have not gone further, if the general condition of the patient is suitable for surgery, radical cystectomy is performed, in which the entire bladder is removed (including bladder, lymph nodes and prostate in men, uterus in women). After the bladder is removed, a new bladder is formed from the patient's intestines and the urinary channels (ureters) coming from the kidney are connected to this new sac. This urinary bladder is connected either to the normal external urinary tract (urethra) or to the skin on the side of the abdomen.

Patients with tumor spread in the lymph nodes after surgery may receive additional chemotherapy. Although it is not used in the routine, there is an option such as giving chemotherapy before surgery.

Chemotherapy and radiotherapy (radiation therapy) options are applied to patients who cannot undergo this major surgery due to additional diseases and risks. The patient's bladder is first rendered tumor-free by TUR-M surgery. Afterwards, the patient receives radiation therapy and chemotherapy.

When bladder cancer spreads to other organs, chemotherapy and radiotherapy are usually used. However, in patients with severe bleeding, bladder removal surgery (salvage cystectomy) can be performed, even if the cancer is not cured, in order to control the bleeding and improve the quality of life.

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