Treatment of bladder cancer in Germany
Only 3-4% of bladder cancer results in malignant malformation structures. This type of cancer affects 3-4 males more often than females.
The disease is more common among patients of an elderly age. Only 5% of patients get sick with bladder cancer before the age of 45.
Causes of Bladder cancer
The most influential risk factors of bladder cancer occurrence are as follows:
- Exposure to aromatic amines. These substances are used as concomitant or intermediate products in different kinds of productions (textile, paints, rubber).
- Smoking. It increases the risk of developing bladder cancer by 2-3 times. The risk also increases with passive smoking.
- Heredity. The risk of cancer of the bladder is increased among people with low blood levels of N-acetyltransferase (liver enzymes). This condition is transmitted genetically.
- Parasitic diseases. The highest incidence of bladder cancer is observed in regions where parasitic diseases such as leishmaniasis and schistosomiasis are commonly found.
- Appearance of blood clots in the urine
- Pain at the time of the passing of the clot through the urinary tract
- Symptom of "slamming" is an abrupt discontinuation of the stream of urine during urination, and its recovery after a change in a body position
- The allocation of several drops of blood at the end of urination happens if the tumour is localized in the neck of the bladder
- Anemia - develops if gross hematuria is permanent
- Ultrasound helps to detect the malformation in the bladder.
- Excretory urography with descending cystography. The patient drinks a contrasting liquid. It is excreted with the urine. This helps get a clear picture of the structure of the urinary tract. Then an X-ray picture is done that can further detect signs of bladder cancer.
- Cystoscopy with biopsy is an endoscopic examination method. Optical system and surgical instruments are inserted into the bladder introduced through the urethra. Mucosal biopsy is taken from the suspicious areas for a subsequent cytology.
- Transurethral resection of the bladder. The method is used as treatment during the first stage of the pathological process, and it used as a diagnostics measure during the latter stages. The portion of the bladder with tumour is removed through the urethra. According to its degree of invasion into the organ wall is, the stage of the disease process is determined.
- CT or MRI. It is used for detection of the tumour itself and its metastases. It allows you to specify the location of the tumour and the nature of its growth.
- Gastroscopy and colonoscopy. These methods presuppose the endoscopic examination of the stomach and intestines, which are indicated while planning the radical cystectomy (bladder removal).
- Pelvic angiography is an X-ray method together with the introduction of contrast medium into the blood vessels. It is used in cases of a suspected tumour invasion into major arteries or veins.
- Transurethral resection of the bladder. The operation is performed with the access through the urethra. First, the exophytic area of the tumour is removed (that is growing into the bladder lumen) and then its base. To prevent the cancer relapse, the doctor also removes 1-2 centimetres of the healthy mucosa.
- Radical cystectomy with lymphadenectomy. This is the operation in cases where the cancer is invasive. Bladder and regional lymph nodes are completely removed. Men may have the removal of the prostate and seminal vesicles,while women undergo the removal of the uterus with appendages, and the front wall of the vagina.
- Bladder reconstruction is performed together with the cystectomy. A patient will have to use the special bag to collect urine in a special tank without this operation.
- Chemotherapy and radiation therapy are additional methods to the surgical treatment. They can be applied also without the surgery, if the tumour is not resectable or there are contraindications to the surgery.
- Intravesical immunotherapy. Regular introduction into the urinary bladder of the BCG vaccine increases the survival of patients after transurethral resection of the bladder.
Bladder cancer - Symptoms
Clinical symptoms are determined by the character of the tumour growth. It can grow inside the organ and decrease the bladder cavity and outside the organ, penetrating into all its layers.
The classic clinical picture occurs in three syndromes:
Hematuria syndrome is found among80-90% of patients in the form of gross hematuria (red urine) or microscopic hematuria (the appearance of red blood cells in the urine, which appear only during microscopic examination).The appearance of blood in the urine increases after taking alcohol or exercise.
Additional symptoms, connected with the development of hematuria syndrome include:
Dysuria syndrome is observed among the 30% of patients and is more common in the case of infiltrative tumour growth (in the direction of the bladder wall). The symptom is usually manifested by the frequent urge to urinate. Sometimes there is a rare urination and a weak urine stream (with the growth of the tumour in the lumen of the bladder).
Pain. It usually occurs during the final stages when the cancer has advanced. The reason for the pain is the tumour necrosis, its ulceration and germination into the neighbouring structures. Initially, pain occurs only at night, then a person is constantly bothered. It is often localized in the suprapubic area, perineum or lower back. But the irradiation into the inner thighs is also possible.
Sometimes acute urinary retention can occur, if the tumour compresses the urethra or blood clots cover the urinary tract. Such patients require emergency medical help.
Bladder cancer - Diagnostics
Bladder cancer can be suspected with a digital rectal examination (presence of the palpable malformation) and laboratory diagnostics (blood in the urine). A cytological examination of urine sediment is also possible.
Main diagnostics methods:
Treatment of Bladder cancer abroad
The main way to treat the bladder cancer is surgery. Organ conserving techniques are used if possible. Basic treatment methods are:
The latest (innovative) treatment and diagnostics methods of Bladder cancer abroad
New methods of treatment are constantly being developed. In the last years the following therapeutic techniques have been introduced:
Robotic surgery. Cystectomy, performed with the help of a robot can significantly reduce tissue trauma. It reduces the mortality rate of patients with intraoperative and postoperative complications risk.
Photodynamic therapy. Photosensitive medications are administered to the patient for several days. They selectively accumulate in tumoUr tissues. Then, the cystoscope is inserted into the bladder and with its help the cells are irradiated with a wave of the desired length. The wave then is absorbed by the accumulated dye in the tumour tissue.
The advantage of this method is the possibility to destroy the cancerous cells without affecting the healthy tissues. The disadvantage is the impossibility of the light waves’ penetration into the depth of the affected organ. Therefore, only the part of the tumour that is located no deeper than the bladder mucosa can be destroyed.
Gene therapy. A special virus which infects tumour cells is placed inside the bladder. It builds into the DNA of the tumour cells. After that, the immune system recognizes and destroys these cells.
Bladder cancer - Prognosis
Following the transurethral resection of the bladder 30% of patients recover completely. 70% of patients experience a recurrence within five years. After using this method of treatment the five-year survival rate is 60-80%.
After radical cystectomy five-year survival rate is 65-85% in case of the absence of metastases in the lymph nodes. In this case, when performing concomitant lymphadenectomy 30% of patients can obtain a complete cure from the disease.
The use of chemotherapy and radiation therapy without surgical techniques enables a five-year survival rate of 20-40% (depending on the stage of the pathological process and the treatment regimen used).
Here you can find the cost of treatment for this disease at the German University Hospitals. Leave a request and we will provide a free consultation with a doctor and will start organizing the whole treatment process.
The program includes the following:
- Issuing of an invitation for getting a visa for treatment as quick as possible
- Fixing an appointment at a time convenient for you
- Preliminary organization of a comprehensive examination and discussion of the forthcoming treatment plan
- Arranging transfer from the airport to the hospital and back to the airport
- Provision of interpreting services and services of a personal medical coordinator
- If necessary, assistance in the organization of further surgical treatment
- Provision of a medical insurance against treatment complications covering up to 200,000 euro
- Preparation and translation of medical records and recommendations from the hospital
- Assistance in the subsequent communication with your attending physician, including consultations on repeated X-ray images through the unique medical document management system E-doc