Bladder cancer is one of the most common types of cancer worldwide, affecting hundreds of thousands of people, and is more frequently observed in men. While this cancer can occur at any age, it most often affects older adults.
Bladder cancer is caused by malignant tumors that develop in the wall tissue of the bladder, an organ of the urinary system. About 90% of cancers are caused by ‘transitional cell carcinomas’ originating from the inner lining of the bladder.
The bladder is a hollow, muscular organ located in the lower abdomen that stores urine. Tumor formation begins with the proliferation of cancer cells in the cells lining the inside of the bladder. Although bladder tumors are most commonly found in the bladder, they can also arise in other parts of the excretory system. The disease is detected in an early stage in 75% of cases. However, since this disease carries a risk of recurrence after treatment, close follow-up is important, even when detected early, to prevent it from progressing to a higher stage.
What Are the Risk Factors for Bladder Cancer?
- Smoking: Tobacco consumption leads to the accumulation of chemicals in the urine, which can increase the risk of cancer. When you smoke, your body processes the chemicals in the smoke and excretes some in your urine. These harmful chemicals can damage the inner lining of the bladder.
- Increasing Age: The risk of cancer increases with age. While cancer can occur at any age, it is rare in people under 40.
- Being Male: Men are more likely than women to develop tumors in the bladder.
- Exposure to Chemicals: The kidneys filter harmful chemicals from the blood and transport them to the bladder. The accumulation of these chemicals in the bladder is thought to increase the risk of bladder cancer. Chemicals used in the manufacture of arsenic, dyes, rubber, leather, and textiles carry this risk.
- Previous Cancer Treatment: Having taken the anti-cancer drug (cyclophosphamide) or having undergone previous cancer treatment can increase cancer risk.
- Chronic Bladder Inflammation: Long-term use of a urinary catheter creates a risk for tumor formation in the bladder. Repeated urinary infections or inflammation (cystitis) can increase the risk of bladder cancer.
- Personal or Family History of Cancer: Individuals who have previously had bladder cancer have a high risk of recurrence. There is also a risk for those with a cancer history in first-degree relatives.
Symptoms of Bladder Cancer
The most typical sign of bladder cancer is the presence of blood, with or without clots, in the urine (gross hematuria), which is usually painless. Sometimes the bleeding is not visible to the naked eye but is detected during a urinalysis (microscopic hematuria). Although blood detected in the urine may not be due to cancer, it must be investigated seriously for bladder cancer. Besides bleeding, less common symptoms like frequent urination and burning during urination may be signs of bladder cancer. These symptoms are caused by cancer cells creating irritating focuses on the bladder surface.
Diagnosis of Bladder Cancer
There are several tests and procedures used to diagnose bladder cancer:
- Cystoscopy: To perform a cystoscopy, your doctor inserts a small, narrow device with a camera (cystoscope) into the urethra. The cystoscope allows the doctor to view the inside of the urethra and bladder and examine the disease.
- Biopsy: The urologist uses a special instrument during cystoscopy to take a biopsy sample for examination. This procedure is sometimes referred to as Transurethral Resection of a Bladder Tumor (TURBT). TURBT can also be used to treat the cancer.
- Urine Cytology: A urine sample is taken in a procedure called urine cytology. The sample is analyzed under a microscope.
- Imaging Tests: Tests such as Computed Tomography (CT), urogram, and retrograde pyelogram are applied. These imaging technologies allow the structure of the patient’s urinary tract to be examined.
Treatment of Bladder Cancer
When planning bladder cancer treatment, the decision must be made by considering the tumor’s type, pathological stage and grade, as well as the patient’s age and current health status.
- In early-stage patients where the tumor is localized only in the bladder epithelium and has not invaded the muscle layer, the TURBT surgery (Transurethral Resection) to remove the tumor tissue endoscopically is often sufficient.
- These patients may also receive intravesical BCG (Bacillus Calmette-Guérin) or chemotherapy drugs into the bladder, which increase the body’s immune response to destroy the tumor tissue. These medications reduce the risk of tumor recurrence.
- Nevertheless, patients must be periodically followed up with cystoscopy and imaging methods due to the possibility of tumor recurrence.
- For tumors that have invaded the muscle layer of the bladder (Stage 2), the gold standard approach is “Radical Cystectomy”, the surgical removal of the entire bladder.
- During Radical Cystectomy, after the bladder is removed, a new artificial bladder can be constructed using the patient’s small intestines, or the urinary tracts can be diverted to an opening in the abdomen (ileal conduit) using different techniques.
- While Radical Cystectomy can be performed via the classic open method, it can also be carried out using advanced laparoscopic or robotic surgery, as performed by our practice.
- In cases where the tumor involves the outer layer (serosa) of the bladder (Stage 3) or where cancer spread to other organs is detected (Stage 4), Systemic Chemotherapy is primarily applied. Depending on the response obtained, Radiotherapy or Surgery (Radical Cystectomy) options may then be employed.