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Urology
Bladder Cancer
Bladder cancer begins with the uncontrolled proliferation of the cells lining the inner surface of the urinary bladder. Its most common type is Urothelial Carcinoma, and the treatment success rate is quite high with early diagnosis.
ℹWhat is Bladder Cancer?
Bladder cancer is the development of malignant cells in the tissues inside the urinary bladder. Cancer cells may remain limited to the inner layer (superficial/non-muscle invasive) or may show a tendency to spread by progressing into the muscle layer (invasive).
Types:
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Urothelial Carcinoma (90%): The most common type, starting in the urothelial cells.
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Squamous Cell Carcinoma: Associated with chronic irritation or infections.
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Adenocarcinoma: A rare but aggressive type.
Common Symptoms
Painless Bleeding (Hematuria)
Tea-colored, pink, or bright red urine. Usually painless, bleeding may stop and recur spontaneously.
Changes in Urinary Habits
Frequent urination, sudden sensation of urgency.
Dysuria
Burning sensation during urination.
Back Pain
Due to tumor obstruction of the ureter or bone metastases.
Advanced Stage Symptoms
Weight loss, loss of appetite, and swelling in the legs due to lymph node involvement.
Diagnosis Methods
Urinalysis and Cytology
Investigation of blood cells or cancer cells in urine.
Cystoscopy
Gold standard. Direct visualization of the bladder interior with endoscope; biopsy from suspicious areas.
Radiological Imaging
USG, CT, and MRI for staging. FDG PET-CT for distant metastasis evaluation.
Causes
Smoking
The greatest cause of bladder cancer. Tobacco chemicals excreted in urine damage the bladder wall.
Chemical Exposure
Prolonged exposure to chemicals in dye, rubber, leather, and textile industries.
Age and Gender
More common in men over 65.
Chronic Bladder Problems
History of chronic infections or bladder stones.
Treatments
TUR-BT (Endoscopic Surgery)
Endoscopic resection of superficial tumors. Serves as both diagnosis and initial treatment.
Intravesical Therapy
BCG immunotherapy or chemotherapy agents (Mitomycin-C, Gemcitabine) instilled into the bladder.
Radical Cystectomy
Complete removal of the bladder, lymph nodes, and adjacent organs for invasive cancer. Robotic or open surgery.
Urinary Diversion
Creating a Neobladder from the small intestine or using the Ileal Loop method.
Chemotherapy
Neoadjuvant (pre-operative) and adjuvant (post-operative). Gemcitabine + Cisplatin or dd-MVAC protocols.
Targeted Therapy and Immunotherapy
Enfortumab Vedotin (Nectin-4 targeted ADC), Pembrolizumab, Nivolumab, Avelumab, and Durvalumab.
Bladder-Sparing Treatment (TMT)
Maximal TUR-BT + Radiotherapy + concurrent chemotherapy to preserve the bladder.