Bladder cancer develops mainly on the inner wall of the organ. Malignant formations of the bladder are also called urothelial carcinoma.
Risk factors are:
occupational exposure to certain chemicals, aromatic amines or polycyclic aromatic hydrocarbons.
Symptoms that may indicate a disease:
the presence of blood in the urine (hematuria)
frequent urination (pollakiuria)
burning sensation during urination
Diagnostics consists of:
Ultrasound of the urinary system, bladder, ureters and both kidneys, urine cytology for the detection of malignant urothelial cells and cystoscopy, which will allow you to examine the wall of the bladder and, if necessary, take samples. In the absence of contraindications, an uro-scanner of the abdominal cavity can also be performed by injection of an iodinated contrast product. An urologist may decide to remove the tumor during cystoscopy.
There are two types of tumors: tumors that do not penetrate the muscle of the bladder, and tumors that penetrate the muscle of the bladder. The diagnosis is made after a complete and deep tumor resection is performed. Conducting fluorescence of the bladder and repeated cystoscopy after 4-6 weeks helps to significantly improve the prognosis.
Treatment with endovascular chemotherapy or BCG instillations may also be suggested. For infiltrating tumors, a thoracic scanner, as well as multi-parameter MRI of the pelvis allow advanced diagnostics.
Cystectomy and courage of the lymph nodes (removal and analysis in the operating room) is a standard treatment for non-metastatic infiltrating tumors. Also, before surgery, (neoadjuvant) chemotherapy based on platinum salts is performed.
In patients with metastases, chemotherapy “gemcitabine cisplatin or carboplatin” is carried out as a first-line treatment. As a second line of treatment, immunotherapy is proposed.
As a therapeutic alternative to surgery (total cystectomy), trimodal treatment can be performed in combination with transurethral resection of the tumor and radio-chemotherapy. Trimodal treatment can be carried out only in the case of unifocal infiltrating T2 tumors, without in situ involvement, without hydronephrosis and which were previously completely removed by the urologist.
Neoadjuvant chemotherapy can be performed before surgery, this is considered individually. The main goal of treatment is not only to cure the patient, but also to preserve the bladder thus preserving the patient's quality of life without compromising treatment results.
During radiotherapy, the total dose is usually 45 Gy in 25 fractions in the area of the pelvic lymph nodes, an additional dose of up to 59.4 Gy in 33 sessions of 1.8 Gy per bladder and affected lymph nodes. Radiotherapy is carried out with concomitant chemotherapy (the type of drug is cisplatin, in the absence of contraindications, or mitomycin C 5FU).