Internal Medicine

Bladder cancer

definition

At the Bladder cancer it is a malicious one tumor, so a cancerous tumor that bladder. The urinary bladder is part of the urinary drainage organs, which stores the urine, which arises from the filtration of the blood by the kidneys and reaches the bladder via the ureter, up to the so-called. micturition (urinating). In the vast majority of cases, cells of the bladder mucosa degenerate (so-called. Urothelium), which lines the bladder from the inside, into a malignant growth. These are therefore also called Urothelial carcinoma designated. If bladder cancer is not detected early, there is a risk that the cancer could spread to deeper layers of the bladder or possibly even spread beyond the bladder to other organs.

causes

As with most cancers, a group of around 50 chemical substances causes bladder cancer to develop. As the most serious risk factor for Bladder cancer cigarette smoking is clearly seen today; it is estimated to be responsible for half of all bladder cancer cases in men and about a third of the same disease in women. Even passive smoking of cigarettes harbors significant risks with regard to bladder cancer.

However, other chemicals can also lead to the risk of bladder cancer, so there is an increased risk for people who work in the textile or printing industry, or those who are employed in companies in which they work with aluminum, rubber or others Chemicals come into contact. Do workers fall ill who have been shown to have long and often with the above If substances come into contact with bladder cancer, this is recognized as an occupational disease (of course, even if the affected person is already retired).

However, the main known risk factor is a medical condition named Schistosomiasis, also Schistosomiasis called. In this case, after contact with contaminated water, infection occurs through flukes living in water snails (so-called. Schistosomes) resulting in severe urinary tract inflammation. If left untreated, this can lead to the development of bladder cancer. Although the disease is relatively common worldwide, it is predominantly concentrated in subtropical areas.

Under certain circumstances it can even be that a chemotherapy because of a previous cancer, releases cell toxins, which in turn can promote the development of bladder cancer.

Figure ureter: A - cross section in relaxed state and B - retroperitoneal space with ureters (red)

Ureter - Ureter
Transitional epithelium - Urothelium
Shift layer of the
Mucous membrane - Lamina propria
Inner longitudinal layer -
Stratum longitudinal internum
Outer longitudinal layer -
Stratum longitudinal externum
Middle ring layer -
Circular stratum
Connective tissue covering with
Blood vessels - Tunica adventitia
Aortic fork - Aortic bifurcation
Rectum - Rectum
Urinary bladder - Vesica urinaria
Adrenal gland -
Glandula suprarenalis
Right kidney - Ren dexter
Renal pelvis - Pelvis renalis
Lower vena cava - Inferior vena cava

You can find an overview of all Dr-Gumpert images at: medical illustrations

diagnosis

Bladder cancer can be diagnosed with certainty by the so-called Cystoscopy, the Cystoscopy. Here, under local anesthesia, a thin tube is inserted through the urethra into the bladder so that the inside of the bladder can be viewed enlarged. Unfortunately, bladder cancer as such does not have any specific parameters in it Blood count could be investigated. However, examination of a urine sample can provide evidence of a malignant change in the bladder. In any case, however, the cystoscopy is followed by follow-up examinations, such as a X-ray examination, in which the kidneys, renal pelvis and ureters are examined for malignant neoplasms. Magnetic resonance imaging and Computed Tomography If a bladder cancer is found, the lungs and abdomen also connect to clarify how far the cancer has spread.

Ultimately, however, bladder cancer can only be determined if a so-called biopsy (a tissue sample) of the cancerous ulcer was taken as part of a cystoscopy and examined under the microscope by specialist doctors.

Epidemiology

With regard to the frequency distribution, it can be said that bladder cancer is relatively rare with only 3% of all cancers. Men get sick almost three times as often as women - in absolute terms: around 20,000 men and 8,000 women get sick each year Bladder cancer. The vast majority of bladder cancer patients are over 65 years of age; just 5% are younger than 45 years. The bladder cancer can be divided into superficial bladder carcinoma, which are limited to the inner tissue layers of the urinary bladder wall, and so-called infiltrating bladder carcinomasthat have also affected the bladder muscles or other organs. About 80% of the diagnosed bladder cancer cases are superficial bladder cancer.

Symptoms

A typical first symptom of bladder cancer is the painless bleeding from the bladder, which occurs in the majority of patients. However, it is tricky that only a comparatively heavy bleeding is noticed by a reddish-brown color of the urine. This was often preceded by minor bleeding, which, however, did not result in any discoloration of the urine and - since it cannot be seen with the naked eye - goes unnoticed.

The diagnosis of bladder cancer is made more difficult by the fact that it is also caused by symptoms such as frequent urination or also Painful urination expresses. However, since that is also typical of a harmless one Cystitis bladder cancer can easily be overlooked. Symptoms such as side pain (the urine backs up to the kidney due to the overgrown tumor), weight loss and Anemia are already signs of a more advanced stage of the cancer.

therapy

The Therapy for bladder cancer depends on which type of bladder cancer it is. In the case of superficial bladder cancer, doctors surgically remove it using a procedure that includes ,DOOR' is abbreviated. This stands for 'Transurethral resection'. What is meant here is a surgical removal of the carcinoma, in which the surgeon uses the necessary instruments via (lat .: trans) the urethra (lat .: urethra) introduces. In this way, e.g. a current-carrying loop is inserted into the bladder, with which the pathological neoplasms are removed in layers.

This type of procedure only requires a short hospital stay of just a few days and is associated with significantly fewer risks than an operation in which the abdominal cavity is opened. This type of procedure used to be more common and involved considerable risks, such as internal bleeding (if blood vessels were damaged) or internal organs such as the kidneys. With superficial bladder carcinoma there is also the possibility of so-called Instillation therapy, which is a type of chemotherapy. A catheter is used to do this. Cytostatics inserted into the bladder, where they act for about 30 minutes.

Cytostatics are chemotherapy drugs that attack and kill cancer cells, but unfortunately sometimes have severe side effects. Since the chemotherapeutic substances only work in the bladder during instillation therapy, the otherwise serious side effects such as severe exhaustion, fatigue, Hair loss, diarrhea, Vomit etc. After the procedure, they are simply excreted when you urinate. There is also the option of a so-called. Immunotherapy to connect. In this case, bacteria become part of the so-called vaccine group BCG (Bacille Calmette-Guérin) inserted into the bladder. They are weakened Tuberculosis pathogenthat cause an inflammatory reaction in the bladder that kills tumor cells.

This subsequent additional treatment has the goal of a so-called. Relapse (prevent recurrence of the same disease). Their successes are considerable: after a successful procedure and three months of follow-up treatment, two thirds of the patients are cured.

If the bladder cancer has advanced or infiltrating bladder cancer, such as when e.g. If the muscle layer of the urinary bladder is also affected, the affected person can usually only be healed by completely removing the urinary bladder Cystectomy) under general anesthetic can be achieved. In the course of this intervention, the man also has prostate and Seminal vesicles, at the woman uterus, Ovaries and surrounding Lymph nodes with removed. This leads to in both men and women infertility.

Since such an operation can lead to inflammation and infections in the wound area but also in the abdominal cavity, the risks of such an operation must be carefully considered, especially in older patients who are weakened by serious previous illnesses. In fact, this operation is so extensive and severe that the death rate, even if performed optimally, is 2-3% today. If an operation seems too risky, there is also the option of chemotherapy. Statistically, however, this offers significantly lower chances of recovery.

In the case of a complete removal of the urinary bladder, the urine must of course be given a new form of drainage. There are two possibilities here: The one of the inner derivation (so-called. continents) and those of the outer (so-called. incontinent) Urinary diversion. With internal drainage, a new bladder is formed from a piece of intestine, which is sewn to the urethra. With an external urinary diversion, the patient is given an artificial urine outlet (artificial bladder), through which the urine flows into a bag that is stuck to the abdomen and that has to be emptied or changed regularly.

prophylaxis

Bladder cancer can be indirectly prevented by avoiding cigarette smoking in any case (care should also be taken here to expose yourself to the risk of passive smoking as rarely as possible). Increased contact with the above Chemicals that have been proven to be carcinogenic should also be avoided at all costs. It should also be noted that, as stated above, certain cytostatic drugs (drugs of choice for cancer) such as Cyclophosphamide are at risk of developing bladder cancer. Furthermore, bathing in lakes and rivers should be avoided when traveling to subtropical areas, as this is a risk Schistosomiasis is bypassed. But also diseases in the area of the lower urinary tract that are harmless as such - e.g. a bladder infection - should be treated well. Chronic cystitis increases the risk of developing bladder cancer.

forecast

The prognosis in the case of a Bladder cancer depends crucially on how far the cancer has progressed when it becomes known. The best chance of a cure exists in the case of superficial bladder cancer. However, these also have the highest probability for the above Relapse (recurrence). In about half of all cases of patients whose superficial bladder carcinoma means transurethral resection is removed, the same new formation will occur again within five years. This consequently makes regular follow-up checks necessary after a transurethral resection.

In the case of infiltrating bladder carcinomas that require complete removal of the bladder (see above), the probability of survival for the next five years is around 80% after the operation. If the cancer was diagnosed at a late stage, so that it has already affected adjacent lymph nodes or even other organs, both the chances of a cure and the life expectancy of the person affected decrease. If the urinary bladder has been completely removed, this can reduce the person's ability to work by 80 to 90%.

With regard to the description of the disease bladder cancer in medical history, it can be said that the connection between bladder cancer and the carcinogenic aniline from industry as early as 1895 by the German surgeon Ludwig Rehn. The method of building a new bladder from parts of the human intestine is also older than is often assumed. It was developed by US surgeons back in the 1950s.

Further information

Further information on this topic can be found at: