Update: December 20one8
Any malignant tumor is a threat to human life.
Developing imperceptibly, most of them find themselves only
in advanced stages when warning signs appear
disease and the patient’s general condition deteriorates rapidly. Efficiency
treatment, with this degree of cancer, is quite small. Duration
human life is limited to a few years. To such
situations as little as possible, doctors at the slightest suspicion
Oncology should recommend that the patient undergo a thorough
Bladder cancer is one of the few malignant
neoplasms that are timely detected and successfully treated.
More than half of all cases of the disease, according to Professor M.I.
Davydov, found in stages I and II, with the help of elementary
diagnostic methods (ultrasound, cystoscopy). Suspect this pathology,
can be already at the stage of questioning the patient, finding in his past
characteristic predisposing factors in combination with symptoms
The exact cause of bladder cancer for doctors to establish
fails to date. However, reliably known
factors that increase the risk of this disease:
- Smoking is the first important factor. How does it affect urinary
bubble? Each cigarette contains “carcinogens”: phenolic resins,
hydrogen cyanide, benzene, etc. The human body can not destroy
These substances are only excreted through the urinary system. Urine
the smoker contains tobacco carcinogens, which, lingering in
bladder may cause cancer;
- Work in hazardous production (paintwork, fuel and so
further) – due to inhalation of carcinogenic vapors:
polycyclic hydrocarbons (engine oils; any fuel,
made from petroleum), aromatic amines (aniline; various
dyes, especially nitro-dye; film developers);
- Male – bladder cancer in women occurs four times
- Other infectious (cystitis) and parasitic diseases
(especially schistosomiasis). They provoke the development of chronic
inflammation, which causes the cells to lose their normal structure and
Heredity also plays a significant role in the appearance
malignant tumor of the bladder. If parents suffered
this disease, the likelihood of developing cancer in the offspring.
A tumor formed from bladder cells may be
several kinds. First of all, it is necessary to distinguish them by
the degree of “change” of the cell. That is, you need to evaluate how
tumor cells are different from normal. This moment will be
determine the prognosis of bladder cancer for the patient and tactics
treatment. There are the following types:
- Highly differentiated – transitional cell carcinoma. It has
the most favorable prognosis is about 98% of all
malignant formations of the bladder. It is called
�“Transitional cell” because the cells lining the walls of this
organ, are called transient, because of their ability to
- Poorly differentiated: small and large cell tumors. AT
in this case, the cells so lose their normal structure,
that it is impossible to know their identity. Such cancer
it is accepted to classify, depending on the size of the cells. Treat
its much more difficult as the tumor progresses rapidly and
There is also an international classification that is adopted among
clinicians. It characterizes neoplasms on the 3rd
criteria, which allows a more objective assessment of the forecast for
больного и выбирать способ treatment.
T (опухоль –
How deep did the tumor grow?
N (лимфоузлы –
How many lymph nodes hit the tumor?
M (метастазы –
How many metastases gave a tumor?
|X||There is no way to determine|
|0||New growth is absent||ATсе лимфатические узлы в нормальном состоянии||No metastases|
|one||Cancer practically on the surface (no further than submucosal
|Only one node is affected. It is increased to 2 cm.||There are metastases to organs (lungs, kidneys, heart, liver, and so
|2||Tumor affects the muscle layer||Несколько лимфоузлов поражены, размером 2,one-5 см.|
|3||Cancer has germinated through the bladder wall into the surrounding
fiber or organ (prostate, uterus, vagina, rectum)
|Nodes in diameter more than 5 cm. There are multiple
|four||Cancer grows into several organs or in the bones of the pelvis.|
Layers of the bladder wall. We list them from the innermost
to outdoor, to be more understandable gradation of growth
- serous with fatty tissue.
Stages of bladder cancer are determined on the basis of international
classification. To do this, evaluate in aggregate all three signs.
Stage 0 = T0 + N0 + M0;
Stage I = Tone+N0+M0;
Stage II = T2 + N0 + M0;
Stage III = T3 + N0 + M0;
Stage IV = Любая Т+ Любая N (кроме 0)+Mone.
Cancer grades I-II appear in mostly local only
symptoms. The expanded clinical picture appears when
In 96% of patients, early symptoms of bladder cancer
are limited to:
- The presence of blood in the urine (“gross hematuria”), which oozes from
growing tumor. The color of urine becomes the color of “meat slop” –
transparent, with a dirty pink or red tint. Pain / discomfort
during urination the person does not experience – it is a distinctive
a sign of urolithiasis;
- Various urination disorders (“dysuria”). This sign
Bladder cancer may manifest in different ways. Most frequent
вариант – учащение опорожнения мочевого пузыря до one0-one5 раз в
сутки, количество мочи при этом незначительное (50-one50 мл). Often
urine excretion at night prevails in patients (“nocturia”).
This symptom is more common in bladder cancer in men.
AT течение нескольких лет, при медленном прогрессировании рака,
The above symptoms may be the only ones. They
may be supplemented by acute urinary retention and the occurrence of renal
colic due to blockage of the urethra coagulated
by blood. However, this situation occurs quite rarely.
Symptoms почечной колики. It is an acute condition requiring
urgent hospitalization. A person experiences intense pain in
lower back, which is enhanced by tapping under the ribs and
walking Pain radiating to the perineum and to the front surface
thighs As a rule, all the symptoms occur on one side.
Decreases after taking antispasmodics (Drotaverin, No-spa) and
combination drugs (Spazmalgon,
Local symptoms due to bladder damage,
supplemented by signs of “tumor intoxication”:
- weakness that persists for weeks and
- sleep disorder;
- небольшой лихорадкой (37,one-37,6) в течение долгого времени
- постепенным снижением веса — на one-2 кг в месяц, при сохранении
former diet and exercise.
They проявляются при разных стадиях, но обязательно сопровождают
Stage 4 Bladder Cancer
This stage is characterized by a number of additional symptoms besides
of the above. Because of damage to the lymph nodes located in
pelvic cavities, severe swelling of the legs and perineum
(especially scrotal / labia majora).
How to determine the swelling? The algorithm is as follows: press with two fingers
on the skin, wait 3-5 seconds, then quickly release and
observe local changes. If there is a “dimple” in
a place of pressure that gradually gets rid of is
reliable sign of edema.
The germination of cancer in the fatty tissue and the nearest organs leads
to the development of chronic pain in the suprapubic area, dull
nature, medium or low intensity, aggravated by
urination, straining and physical exertion.
Metastases to distant organs lead to a decrease in their function and
polyorgan failure. Respiratory disorders may occur,
irregular / increased heartbeat, decreased immunity, and so
Further. This condition is the main cause of death.
You can suspect bladder cancer by detecting symptoms on
early stage. AT настоящее время, существует ряд диагностических
techniques (laboratory and instrumental) that allow
confirm / deny diagnosis. Unfortunately, most of them
performed only in large regional clinics or regional
centers, making it difficult to timely detect the tumor.
General (UAC) and biochemical blood tests are not informative when
cancer AT ОАК может отмечаться повышение WITHОЭ (более 20) и небольшой
лейкоцитоз (больше one0*one09/л), однако это не подтверждает
the presence of the disease.
Urinalysis allows you to diagnose bladder cancer with
вероятностью four2%. The most accessible method is to study its sediment under
microscope (included in the general analysis of urine), in order to detect
altered (atypical) cells. The method is not informative if
patient transitional cell differentiated cancer, because
in this case, the tumor cells will not differ from
There is an additional way to determine malignant
neoplasm, which is called “BTA-TRAK”. This is peculiar
test for cancer, due to which specific substances are found in urine
for a bladder tumor. Точность способа – 7four%. Unfortunately,
the method is available only in large diagnostic centers, research institutes and
private clinics, because of its high prices.
The most common way that you can spend in
any clinic, is an ultrasound of the bladder (or just small
pelvis). The tumor will be visible on the monitor as a darker area.
(due to the increased density of tissues in this place), often
irregular shape. This is not a valid method, however, allows
to orient the doctor at the stage of primary diagnosis.
How to prepare for an ultrasound? Diets do not affect the result
ultrasound because the intestinal loops before
bladder no. From the patient only needs to do one thing –
за 2-3 часа до процедуры выпить около one,5 литров жидкости и не
urinate until the end of the procedure. This is necessary for the diagnostician,
to improve the visualization of the organ.
The gold standard for confirming the diagnosis of bladder cancer
is cystoscopy. This is a medical procedure during which
start a cystoscope (a tool with a camera and small forceps on
end) into the cavity of the bladder, through the external opening of the urethra. Via
- inspect the entire cavity, in search of a defect;
- take to study cells from several places (biopsy);
- in difficult diagnostic cases, through it enter
a special glowing paint in the bladder that is going to
at the site of the tumor. This is a fluorescence method.
Additional methods of instrumental examination,
which determine the stage of oncology, are CT and MRI. They
allow not only to examine the bladder, but also to examine
the nearest fatty tissue, lymph nodes, and other organs to
determine whether the cancer grows in them and the presence of metastases.
Urological technologies are developing rapidly, so
new bladder cancer treatments are being introduced. AT
depending on the stage and type of malignant tumor, is selected
the most suitable way. ATажно, чтобы он был безопасным для
sick (as far as possible) and had a small percentage
relapse (return of the disease).
In the early stages of the disease (I, II), it is preferable
surgical treatment. AT настоящее время, его можно провести без
cuts on the skin – for this plant tools through
urethra, without damaging the urethra. Thereafter
remove the tumor and suture the wound. This is a new way that was
put into practice just 5-6 years ago. His name –
transurethral resection (or TUR).
BCG after TOUR. ATелика вероятность рецидива рака, без полного
remove the bubble. To reduce it, urologists have developed a method –
the introduction of the tuberculosis vaccine (BCG) inside the bladder
through the catheter. Therapy begins no earlier than a month after
ТУР и продолжают 6 или one0 недель.
At stage II or in case of recurrence of cancer it is recommended
complete removal of the bladder, with the creation of an artificial
An effective alternative to TUR at stages I-II is
brachytherapy – by injecting radioactive substances into the bladder cavity,
urologists seek complete destruction of the tumor. AT прошлом году, на
Russian urology conference was invited to use the new
isotope (radioactive substance) that can break down cancer cells
for 6-7 days. This is the most promising treatment method.
but he does not exclude the occurrence of relapses.
With a far advanced process (stage III-IV), preference is given
radiation or chemotherapy that can only be prescribed
We summarize the recommended methods of treatment, at different stages
|Stage and type of cancer||Preferred treatment|
|ATысокодифференцированный I и II стадии, без метастазов||
one. Трансуретральная резезекция
2. Тотальная резекция мочевого
|III, IV stage||Radiation therapy / chemotherapy.|
AT каждом случае, врачи-онкологи подходят индивидуально, выбирая
treatment tactics for the patient. This is not only readable
the nature of the process, but also the patient’s desire to preserve the organ. AT
anyway, modern technologies provide good
survival in bladder cancer, with timely initiated
This cancer has a peculiarity – after any treatment (except for complete
removal of the bladder) is likely new
tumors. AT случае рецидива болезни, рекомендуется сразу удалять
5-year patient survival, with highly differentiated
small stage I-II tumors and after adequate treatment,
составляет 88-9four%. As a rule, the death of patients is associated with
postoperative complications (violation of urine diversion, colitis,
проктиты и так Further), а не с повторным раковым ростом.
A timely visit to the doctor can prevent death
such a patient.
With a far advanced process (up to stage III-IV), the survival rate in
5 years has a lower percentage and depends on the time of commencement
therapy and “malignancy” (degree of differentiation)
|Stage||5 year survival rate|
|IV (if metastases are only in the pelvic tissues)||26%|
|IV (if metastases throughout the body)||Not more than 7%|
Surveillance after treatment
After successful treatment and disappearance of cancer symptoms
bladder patients should be monitored regularly in
oncologist. AT настоящее время, действуют следующие нормы
- the first two years – every 3 months;
- на 3-й год – каждые four месяца;
- на four-5 года после выздоровления – каждые 6 months;
- after the 5th year – every year.
Most patients (up to 80%) stop attending an oncologist,
если у них не было повторных симптомов в течение four-х лет.
It is recommended not to stop regular surveys since
recurrence of cancer occurs very often.
Bladder cancer is a dangerous disease that lasts a long time.
may not manifest itself. In the early stages, its often
detected by chance – when examining for cystitis or
urolithiasis (on ultrasound). AT этом случае, прогноз для больного
will be favorable. If the tumor is diagnosed later –
the probability of successful treatment does not exceed 60%. Unfortunately,
adequate therapy does not guarantee a complete cure, since
recurrence rate of about 70%. It is therefore very important for the patient not to
vigilance and be examined regularly
Frequently asked questions from patients
How many live after cure for bladder cancer?
It depends on the stage of the disease, the response of the tumor to treatment and
general condition of the body. After brachytherapy or removal
bladder (at stages I-II) patient’s life expectancy
reduced slightly. With III-IV, it varies greatly
и нередко ограничивается 5-one0-ю годами.
How is the bladder replaced after it is removed?
There are two main options:
- Use part of the small intestine, which is taken from the patient. WITH
ureters are hemmed to one end, and the other end is brought to
the skin of the abdomen and connected to the urinal (wet stoma). This
manipulation is called the Bricker operation;
- Taking away any part of the intestine (thick or thin
intestines), the patient creates an artificial bladder from him,
which functions as normal, it excretes urine through the urethra. AT
In this case, the patient is able to independently hold the urine.
ATторой вариант является предпочтительным, так как улучшает
quality of life of the patient, but the surgeon does not always have the opportunity
perform such an operation.
Will chemotherapy affect my health?
Yes – it affects the blood, skin and many other systems.
But in this case, you should think about saving the life of the patient. therefore
Oncologists use this method of treatment due to lack of
Is it possible to permanently get rid of urinary cancer?
WITHчитается, что такая возможность есть при полном удалении
bladder in I-II stages. AT остальных случаях высока
probability of recurrence.
Will cancer pass by inheritance?
AT настоящее время, считается, что все онкологические заболевания
have the risk of transmission to descendants.
How fast can I recover?
It depends on many factors: the stage of the process, the response of the tumor.
on therapy, the patient’s condition. With early treatment of early
Stages – Brachytherapy week completely eliminates the tumor. AT
In other cases, the forecast is made individually for each