Bladder cancer – a malignant tumoral invasion of a mucous membrane or a wall of a bladder. As displays of cancer of bladder serve the gematuriya, a dizuriya, pains over a pubis. Diagnosis of cancer of bladder demands carrying out a cytologic research of urine, an endovezikalny biopsy, a tsistografiya, excretory urography, ultrasonography of a bladder, a tomography. Medical tactics at cancer of a bladder can include surgical approach (the TOUR of a bladder, a tsistektomiya) or conservative tactics (system chemotherapy, an immunotherapy, radiation therapy).
Cancer of a bladder meets rather often, in 70% of cases of all new growths of urinary bodies which the urology in the practice faces. In structure of the general oncopathology the share of cancer of bladder makes 2-4%. Among malignant tumors of various localizations on development frequency cancer of a bladder takes the 11th place at women and the 5th at men. Bladder cancer meets at residents of industrially developed countries more often; the age of the diseased is mainly more senior than 65-70 years.
Bladder cancer reasons
The conventional hypothesis concerning an etiology of cancer of bladder does not exist. However separate risk factors which substantially promote development of cancer of bladder are known.
A number of researches indicates the increased probability of developing of cancer at a long staz of urine in a bladder. Various metabolites which are contained in urine in high concentration possess opukholegenny action and cause malignant transformation an uroteliya. The long delay of urine in a bladder can be promoted by various urogenital pathology: prostatitis, adenoma and prostate cancer, bladder diverticulums, , chronic cystitis, urethra striktura, etc. The question of a human papillomavirus infection role in an etiology of cancer of bladder remains debatable. The parasitic infection - urinogenital considerably promotes carcinogenesis.
Correlation between the frequency of cases of cancer of bladder and professional vrednost, in particular, long contact with aromatic amines, phenols, phthalates, antineoplastic medicines is proved. In group - risk drivers, painters, designers, artists, workers of tanning, textile, chemical, paint and varnish, oil-processing industry, medics.
Tobacco smoking has high cancerogenic potential: smokers suffer from cancer a bladder by 2-3 times more often than non-smoking. An adverse effect on urotely is made by the use of the chlorinated drinking water increasing probability of developing of cancer of bladder by 1,6-1,8 times. In certain cases cancer of a bladder can be determined genetically and connected with family predisposition.
Classification of cancer of bladder
The tumoral processes united by the concept "bladder cancer" differ on histologic type, degree of a differentiation of cages, the nature of growth, tendency to metastasis. The accounting of these characteristics is extremely important when planning medical tactics.
On morphological features in an onkourologiya transitional and cellular (80-90%), planocellular cancer of a bladder (3%), an adenocarcinoma (3%), papilloma (1%), sarcoma (3%) most often meet.
On degree of an anaplaziya of cellular elements distinguish low - the moderate and high-differentiated bladder cancer.
Practical value has degree of an involvement into cancer process of various layers of a bladder in this connection speak about superficial cancer of a bladder of a low stage or high-phasic invasive cancer. The tumor can have the papillary, infiltrative, flat, nodular, vnutriepitelialny, mixed nature of growth.
According to the international TNM system distinguish the following stages of cancer of bladder.
- T1 – the tumoral invasion mentions a submucous layer
- T2 – a tumoral invasion extends to a superficial muscular layer
- The t3 – a tumoral invasion extends to a deep muscular layer of a wall of a bladder
- T4 – the tumoral invasion mentions pelvic cellulose and/or adjacent bodies (a vagina, a prostate gland, a belly wall)
- N1-3 – comes to light metastasis in regionarny or adjacent lymph nodes
- M1 - comes to light metastasis in the remote bodies
Bladder cancer symptoms
As early display of cancer of bladder serves release of blood with urine – a mikrogematuriya or a makrogematuriya. The insignificant gematuriya leads to coloring of urine in pinkish color, can be incidental and not repeat a long time. In other cases the total gematuriya at once develops: at the same time urine becomes bloody color, blood clots can be allocated. The long or massive gematuriya sometimes causes development of a tamponada of a bladder and a sharp delay of urine. Against the background of a gematuriya there is a progressing decrease in hemoglobin and the patient's anemization.
In process of growth of cancer of bladder of patients dizurichesky symptoms and pains begin to disturb. The urination, as a rule, becomes painful and speeded up, with imperative desires, sometimes – complicated. Pains in the field of a bosom, in a groin, in a crotch, in a sacrum are noted. In the beginning pain arises only against the background of the filled bladder, then, at germination of a muscular wall and adjacent bodies, becomes constants.
Sdavleny mouths of a mochetochnik in tumoral knot are caused by violation of outflow of urine from the corresponding kidney. In such cases the bad painful attack as renal colic develops . When squeezing both mouths the renal failure which can end with uraemia accrues. Some types of cancer of bladder with infiltriruyushchy growth are inclined to disintegration and an ulceration of a puzyrny wall. On this background easily there are uric infections (cystitis, pyelonephritis), urine gains purulent character and a fetid smell. Germination of cancer of bladder in a rectum or in a vagina leads to formation of the puzyrno-pryamokishechny and puzyrno-vaginal fistulas which are followed by the corresponding symptomatology.
Many symptoms of cancer of bladder are not specific and can meet at other urological diseases: cystitis, prostatitis, urolithic disease, tuberculosis, prostate adenoma, bladder neck sclerosis etc. Therefore often patients at early stages of cancer of bladder it is long and are inefficiently treated conservatively. In turn, it delays timely diagnostics and an initiation of treatment of cancer of bladder, worsening the forecast.
Diagnosis of cancer of bladder
Detection of cancer of bladder, definition of a stage of an onkoprotsess requires carrying out comprehensive clinical laboratory and tool examination. In certain cases the new growth of a bladder manages to be propalpirovat at a gynecologic bimanualny research at women or a rectal research at men.
The standard of laboratory diagnostics at suspicion of cancer of a bladder includes carrying out the general analysis of urine for definition of a gematuriya, a cytologic research of a deposit for detection of atypical cages, bacteriological crops of urine for an exception of an infection, the test for a specific anti-gene of VTA. Blood test, as a rule, reveals the anemia of various degree indicating bleeding.
Transabdominal ultrasonography of a bladder reveals the tumoral educations with a diameter more than 0,5 cm located mainly in the field of side puzyrny walls. For detection of cancer of the bladder located in a neck zone, the most informatively transrectal scanning. In some cases the transurethral endolyuminalny ekhografiya which is carried out by means of the sensor entered into a bladder cavity is used. At identification at the patient of cancer of bladder also ultrasound examination of kidneys (ultrasonography of kidneys) and mochetochnik is necessary.
As the obligatory visualizing method of diagnosis of cancer of bladder serves the tsistoskopiya at which specification of localization, the sizes, appearance of a tumor, a condition of mouths of mochetochnik is made. Except everything, the endoscopic research can be supplemented with the biopsy allowing to carry out morphological verification of a new growth.
From radiodiagnosis methods at cancer of a bladder it is carried out the tsistografiya and excretory urography revealing defect of filling and deformation of contours of a puzyrny wall and allowing to judge the nature of growth of a tumor. The pelvic venografiya and a limfangioadenografiya is carried out for identification of an involvement of pelvic veins and the lymphatic device. With the same purposes can be used computer and magnetic and resonant diagnostics. For identification of the local and remote metastasises of cancer of bladder resort to performing ultrasonography of abdominal organs, a X-ray analysis of a thorax, ultrasonography of a small pelvis, a stsintigrafiya of bones of a skeleton.
Cancer therapy of a bladder
At patients with the localized, superficially growing cancer performance of a transurethral resection is possible (TOUR) of a bladder. The TOUR can be radical intervention at T1-T2 bladder cancer stages; at widespread process (T3) it is carried out with the palliative purpose. During a transurethral resection of a bladder the tumor is removed by means of the resectoscope through an urethra. Further the TOUR of a bladder can be supplemented with local chemotherapy.
In recent years resort to an open partial tsistektomiya of a bladder in view of high percent of a recurrence, complications and low survival more and more seldom.
In most cases at invasive cancer of a bladder the radical tsistektomiya is shown. At a radical tsistektomiya the bladder is deleted with the uniform block with a prostate gland and seed bubbles at men; appendages and a uterus at women. Removal of a part or all urethra, pelvic lymph nodes is at the same time made.
For replacement of a remote bladder the next ways are used: removal of urine outside (implantation of mochetochnik in skin, or in a segment of the gut brought to a forward belly wall); removal of urine in a sigmovidny gut; formation of the intestinal tank (an ortotopichesky bladder) from fabrics of a small intestine, a stomach, a thick gut. The radical tsistektomiya with intestinal plasticity is optimum as allows to keep a possibility of deduction of urine and an independent urination.
Forecast and prevention of cancer of bladder
At noninvasive cancer of a bladder the indicator of 5-year survival makes about 85%. The forecast is much less favorable for invasively growing and recurrent tumors, and also cancer of the bladder giving the remote metastasises.
The refusal of smoking, exception of professional vrednost, the use of the purified drinking water, elimination of an urostaz will help to reduce probability of development of cancer of bladder. Performing preventive ultrasonography, a research of urine, timely inspection and treatment at the urologist (nephrologist) at symptoms of dysfunction of uric ways is necessary.