Bladder cancer - one of the first cancer, the cause of which could be identified.Back in the 19th century, it was noted that bladder cancer is much more likely to develop people who are employed in the manufacture of dyes.A little later it was discovered that cancer provoking substance is a carcinogen beta naphthylamide.Increased incidence of the oncology also observed among smokers, rubber industry workers, as well as in humans infested tropical parasite that penetrates the wall of the bladder.According to data from multiple studies have shown that there are about forty potentially hazardous occupations can lead to the development of the disease.Smokers bladder cancer observed in two-three times more likely than non-smokers.The risk of developing the disease is significantly reduced in persons who consume large amounts of potassium, vitamin C, beta-carotene, and are used in cooking oils with a content of polyunsaturated fatty acids.At the use of chlorinated water the risk of d
Bladder Cancer - Symptoms
In the initial stages of this oncological disease is almost always asymptomatic and did not cause any concern to the patient.One of the earliest signs of cancer is most often blood staining urine (hematuria) varying intensity from slight (urine becomes pale pink hue) to form larger clots that cause tamponade bladder and as a consequence, the acute urinary retention.At the very beginning of the disease bleeding more often by single and repeated not long enough period of time, so that delayed the necessary surveys.It is therefore necessary to know that in case of any episode of hematuria, to identify its causes must immediately conduct a comprehensive survey.
With the spread of the accession process is observed other symptoms.It appears painful urination difficulty, joined by pain in the lower abdomen, perineum, sacrum, and in the groin.Initially, the pain occur only during the filling of the bladder, and a little later become permanent.The intensity of pain depends on the degree of tumor invasion of the bladder wall.With further progression of the disease bladder capacity decreases bleeding episodes become more frequent, resulting in anemia and a significant deterioration of the general health of the patient.In the case of lesions of the ureters and bladder neck, observed the development of chronic renal failure and the accession of urinary infection that without timely surgical intervention often leads to death of the patient.
very important to know , that the presence of these symptoms (bleeding, pain, impaired urination) can talk about completely different disease symptoms of the urinary tract.These symptoms may be accompanied by the following diseases: urolithiasis, sclerosis of the bladder neck, benign prostatic hyperplasia, tuberculosis, prostatitis, cystitis, and so on. Very often, patients with bladder cancer is assigned a long ineffective treatment in outpatient conditions, characterized by the persistence of symptoms or the presence of frequent relapses.Specialists of pre-hospital phase are guided only by data of ultrasonic diagnosis and laboratory parameters (blood and urine) that does not allow them in due time to put the correct diagnosis, and results in a significant delay the start of appropriate treatment
Bladder Cancer - Diagnostics
to establish the exactdiagnosis, assessment of the prevalence of cancer process and stage of the lesion is necessary to conduct a comprehensive survey, which includes carrying out the instrumental and laboratory tests, palpation and objective inspection.
Laboratory studies include :
- bacteriological urine culture (to avoid urinary tract infections)
- Urinalysis (in the absence of active bleeding, possible detection of fresh red blood cells in the urine sediment)
- cytology (40% of the cases reveals cancer cells in the urine sediment)
- Tumor markers (laboratory tests to suspected bladder cancer based on the presence in urine of specific antigens)
- Biochemical blood test (evaluate the functional ability of the kidneys)
conducted followinginstrumental studies:
- ultrasound (ultrasound diagnostics).This method has a non-traumatic, and very informative, allowing to determine the localization of the tumor, its structure, dimensions, features of blood supply to estimate the prevalence of tumor process, to identify the signs of the ureters, to determine loss of pelvic lymph nodes and the presence of distant metastases.Used as intracavitary, and external methods of diagnosis
- MRI (magnetic resonance imaging) and CT (computed tomography) are used to estimate the state of the regional lymph nodes, but do not allow to distinguish them from metastatic lesion inflammatory manifestations.With the growth of the tumor, the diagnostic capabilities of MRI and CT significantly increased, so the definition of the extent of damage the bladder wall occurs at later stages of the cancer process
- mandatory and the main method of diagnosis of malignancy is cystoscopy (examination of the bladder using an endoscopic equipmentinjected into the urethra) in combination with a biopsy.It is because cystoscopy is possible to detect bladder cancer in early stages.On examination, determined by location, number and size of tumors, as well as the nature of their growth.On examination to assess their malignancy and the structure is not possible, as the benign tumors and inflammatory processes give a similar picture of changes.In order to establish a definitive diagnosis of biopsy followed by histological examination of selected material
- radiological examinations and chest X-rays are used in already confirmed diagnosis of bladder cancer to determine the metastatic lesions of bones and lungs
Differential diagnosis :
To eliminate installation misdiagnosis, in some cases, shows the differential diagnosis of bladder tumors with different pathological processes that have many similarities (with cystoscopy), and sometimes indistinguishable from the tumor itself.These processes include: syphilitic or tubercular tumor-granulation bladder simple and tuberculosis bladder ulcers, chronic hemorrhagic cystitis, bladder endometriosis, cystitis and granulomatous nodular periarteritis bladder.
Children (especially girls) is shown holding a differential diagnosis with primarily chronic cystitis.If a bladder tumor combined with chronic cystitis, diagnosis is much more difficult.These children previously held anti-inflammatory therapy aimed at eliminating cystitis
Bladder Cancer - Treatment
All methods of treatment of malignant tumors of the bladder are divided into operating (transvezikalnye surgical and endovezikalnye instrumental interference) and conservative (drug and radiation therapy)
Surgical treatment includes several options.For the treatment of tumors neinfiltriruyuschih (common warts) is used endovezikalnuyu electrocoagulation.This procedure is well tolerated, does not require the opening of the bladder and easily destroys papilloma small.But often after electrocoagulation of tumor relapses, so this method is recommended for use only weak and the elderly.Better results are obtained endovezikalnaya electrocoagulation.Transurethral resection of
carried out using a special endoscopic instrument resectoscope (kinky electrode) to which a high frequency alternating current.Accurate motion loop is cut the base of the bladder cancer, together with the neighboring layers of its wall, but within the limits of healthy tissues;then the same loop coagulate bleeding vessels.
resection of the bladder (excised part of the body) allows you to keep body and normal urination.That is why this method is widely used in modern urological practice.If the resection of the bladder for any reason (total damage of the bladder tumor is very large, struck bladder neck) can not be performed, it is carried cystectomy.This operation is quite traumatic intervention and it is usually performed in cases of advanced bladder cancer.Carrying cystectomy is only possible diversion from the kidneys (ureters are transplanted into the skin, intestines, and other convenient locations).Mortality after this operation varies between 5-15%.
In some cases, due to tamponade bladder blood clots, or in the case of cancerous infiltration of the bladder neck, showing the extra holding epitsistostomii
drug therapy (chemotherapy) as an independent method of treatment of cancer of the bladder is not very effective, however, in conjunction withradiotherapy and surgical treatment of this method is able to significantly improve the outcome.Antineoplastic, giving the most favorable results: cisplatin, vinblastine, adriablastin, methotrexate.
Radiation therapy as an independent method of treatment of this cancer is rarely used.Most often it is combined with the holding of conduct surgery.Preoperative radiotherapy reduces tumor itself and perifocal inflammatory changes, which greatly facilitates surgery and sometimes makes inoperable tumors operable.Carrying postoperative radiotherapy was shown in the case of insufficiently radical intervention made, as well as for the prevention of recurrence.Of all the radiation is most effective-proven kilocuritherapy.