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.
The most influential risk factors of bladder cancer occurrence are as follows:
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 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:
The main way to treat the bladder cancer is surgery. Organ conserving techniques are used if possible. Basic treatment methods are:
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.
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).
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