Bladder Tumors | University of Miami Health System

An abnormal growth that develops in the bladder is known as a bladder tumor. Some bladder tumors are benign (noncancerous), while others are malignant (cancerous). Malignant bladder tumors – also known as bladder cancer – can spread (metastasize) into other parts of the body.

Types of benign bladder tumors include:

• Fibromas: originate in the connective tissue of the bladder wall
• Hemangiomas: comprised of a mass or lump of blood vessels of the bladder wall
• Inverted papillomas: develop on the lining of the bladder and have a smooth surface
• Leiomyomas: originate in the muscle layer of the bladder wall
• Lipomas: originate in the cells in the fat layer that surrounds the bladder
• Neurofibromas: originate in the nerve tissue of the bladder
• Papillomas: originate in the urothelial cells, which make up the lining of the bladder and urinary tract

What are the symptoms of a bladder tumor?

• Back pain
• Blood in the urine (hematuria)
• Difficulty urinating
• Increased urinary frequency and urgency
• Pain in the pelvis
• Pain while urinating

The urologists at the Desai Sethi Urology Institute are experts in treating both benign and malignant tumors of the bladder.

Treatments

Surgery

In most cases, your urologist will recommend that you undergo surgery to remove the bladder tumor.

Tests

Cystoscopy

A tool called a cystoscope is inserted through the urethra (tube that transmits urine from the bladder) directly into the bladder to check for abnormalities like tumors or stones. This thin, tube-like instrument has a light and a lens for viewing. It can also have a tool to remove (biopsy) suspicious tissue samples. Pathologists review these samples with a microscope to look for signs of cancer.

Digital Rectal or Vaginal Exam

Your healthcare provider inserts a gloved finger into the rectum or vagina, which allows them to check for lumps or other abnormalities.

Laboratory Tests

A urine sample is checked for blood, chemicals, bacteria, and cells. The urine may be examined microscopically to look for cancer cells, or grown in a culture to check for infection.

Bladder Tumor Marker Studies

These tests look at cellular characteristics and substances released by bladder tumor cells into the urine.

Bladder Biopsy

Tissue samples can be taken from the bladder using a needle or during surgery if not removed with cystectomy. Pathologists review these samples with a microscope to look for signs of cancer or abnormal tissue.

Why Choose UHealth?

Leading experts in urology care. At the Desai Sethi Urology Institute, our team of recognized surgeons, researchers, technologists, and nurses has expertise in every subspecialty of urologic care, including urologic oncology and urologic reconstruction. You receive treatment from an experienced team that can give you the latest therapies.

Leaders in robotic surgery treatment. We have some of the world’s most experienced robotic surgeons for urologic procedures. In fact, doctors come from all over the world to learn at our Urology Robotic Program — the #1 ranked program in South Florida. The University of Miami Health System was the first academic medical center in the world to get the da Vinci Xi robotic surgery system and has completed more than 5,000 robotic surgeries — procedures that offer less pain and scarring and a faster recovery.

A top-ranked program for kidney and bladder cancer treatment. We offer advanced care for urologic cancers and are ranked among the top five kidney and bladder cancer programs in the country. Our urologists are dedicated to identifying cancer early so we can provide more effective treatment. We were the first — and only — medical center in South Florida to use enhanced Blue Light Cystoscopy with Cysview imaging technology to detect and identify bladder cancer. 

Bladder Cancer: Introduction | Cancer.Net

Approved by the Cancer.Net Editorial Board, 12/2021

ON THIS PAGE: You will find some basic information about this disease and the parts of the body it may affect. This is the first page of Cancer.Net’s Guide to Bladder Cancer. Use the menu to see other pages. Think of that menu as a roadmap for this entire guide.

About the bladder, renal pelvis, ureter, and urethra (urinary tract)

The bladder is a hollow organ in the pelvis that stores urine before it leaves the body during urination. This function makes the bladder an important part of the urinary tract. The urinary tract is also made up of the kidneys, ureters, and urethra. The renal pelvis is a funnel-like part of the kidney that collects urine and sends it into the ureter. The ureter is a tube that runs from each kidney into the bladder. The urethra is the tube that carries urine out of the body. The prostate gland is also part of the urinary tract.

The bladder, like other parts of the urinary tract, is lined with a layer of cells called the urothelium. This layer of cells is separated from the bladder wall muscles, called the muscularis propria, by a thin, fibrous band called the lamina propria.

Bladder cancer begins when healthy cells in the bladder lining—most commonly urothelial cells—change and grow out of control, forming a mass called a tumor. Urothelial cells also line the renal pelvis and ureters and urethra. Cancer that develops in the renal pelvis and ureters is also considered a type of urothelial cancer and is often called upper tract urothelial cancer. In most cases, it is treated in much the same way as bladder cancer and is described in this guide. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. A benign tumor means the tumor can grow but will not spread. Benign bladder tumors are very rare.

Types of bladder cancer

The type of bladder cancer depends on how the tumor’s cells look under the microscope. The 3 main types of bladder cancer are:

• Urothelial carcinoma. Urothelial carcinoma (or UCC) accounts for about 90% of all bladder cancers. It also accounts for 10% to 15% of kidney cancers diagnosed in adults. It begins in the urothelial cells that line the urinary tract. Urothelial carcinoma used to be called transitional cell carcinoma or TCC.

• Squamous cell carcinoma. Squamous cells develop in the bladder lining in response to irritation and inflammation. Over time, these cells may become cancerous. Squamous cell carcinoma accounts for about 4% of all bladder cancers.

• Adenocarcinoma. This type accounts for about 2% of all bladder cancers and develops from glandular cells.

There are other, less common types of bladder cancer, including micropapillary, plasmacytoid, sarcomatoid carcinoma of the bladder, and small cell bladder cancer, among others. Sarcomas of the bladder often begin in the fat or muscle layers of the bladder. Small cell bladder cancer is a rare type of bladder cancer that is likely to spread to other parts of the body.

Other ways of describing bladder cancer

In addition to its cell type, bladder cancer may be described as noninvasive, non-muscle-invasive, or muscle-invasive.

• Noninvasive. Noninvasive bladder cancer includes noninvasive papillary carcinoma and carcinoma in situ (CIS). Noninvasive papillary carcinoma is a growth found on a small section of tissue that is easily removed. This is called stage Ta. CIS is cancer that is found only on or near the surface of the bladder, which is called stage Tis. See Stages and Grades for more information.

• Non-muscle-invasive. Non-muscle-invasive bladder cancer typically has only grown into the lamina propria and not into muscle, also called stage I. Non-muscle-invasive cancer may also be called superficial cancer, although this term is being used less often because it may incorrectly suggest that the cancer is not serious.

• Muscle-invasive. Muscle-invasive bladder cancer has grown into the muscle of the bladder wall and sometimes into the fatty layers or surrounding tissues or organs outside the bladder.

It is important to note that non-muscle-invasive bladder cancer has the potential of spreading into the bladder muscle or to other parts of the body. Additionally, all cell types of bladder cancer can spread beyond the bladder to other areas of the body through a process known as metastasis.

If a bladder tumor has spread into the surrounding organs, such as the uterus, vagina, prostate gland, and/or nearby muscles, it is called locally advanced disease. Bladder cancer also often spreads to the lymph nodes in the pelvis. If it has spread into the liver, bones, lungs, lymph nodes outside the pelvis, or other parts of the body, the cancer is called metastatic disease. This is described in more detail in Stages and Grades.

Looking for More of an Introduction?

If you would like more of an introduction, explore this related item. Please note that this link will take you to another section on Cancer.Net.

• ASCO Answers Fact Sheet: Read a 1-page fact sheet that offers an introduction to bladder cancer. This free fact sheet is available as a PDF, so it is easy to print.

• Cancer.Net En Español: Read about bladder cancer in Spanish. Infórmase sobre cáncer de vejiga en español.

The next section in this guide is Statistics. It helps explain the number of people who are diagnosed with bladder cancer and general survival rates. Use the menu to choose a different section to read in this guide.

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Bladder Cancer – Statistics ›

Bladder cancer – stages, symptoms, diagnosis

Bladder cancer is a malignant formation on the wall of the bladder or its mucous membrane. The disease occupies the third position after oncourological pathology of the prostate and kidneys. In men, this disease is diagnosed three times more often than in women. Approximately 79% of cases are people aged 50-80 years. Mortality from complications of this disease is low – from three to eight percent (statistics from developed countries). Every year in our country, bladder cancer is diagnosed in more than 16,000 people. The number of sick people is increasing every year.

Anatomy of the urinary system

The urinary bladder (UB) is a hollow organ of the urinary system located in the small pelvis. It is a reservoir for the accumulation of urine, which is emptied through the urethra. The capacity of a man’s organ is 0.35-0.55 l; women – 0.25-0.45 liters. When the organ is full of 0.15-0.25 l, there is an urge to urinate. The faster the organ is filled, the stronger the irritating effect on muscle receptors occurs and the work of the urinary system becomes more frequent.

Cancer of the urinary tract: classification and stages

The urinary bladder (UB) is a hollow organ of the urinary system located in the small pelvis. It is a reservoir for the accumulation of urine, which is emptied through the urethra. The capacity of a man’s organ is 0.35-0.55 l; women – 0.25-0.45 liters. When the organ is full of 0.15-0.25 l, there is an urge to urinate. The faster the organ is filled, the stronger the irritating effect on muscle receptors occurs and the work of the urinary system becomes more frequent.

Cancer of the bladder: classification and stages

A malignant tumor of this organ is detected by histological examination, according to the degree of cell differentiation, the formation of secondary foci (metastases), and the nature of growth. These parameters are extremely important for planning a therapy strategy.

The morphology of malignant tumors is as follows: over 90% falls on the share of transitional cell tumors; up to 5% – squamous; adenocarcinoma and sarcoma – up to 2%; 1% – papilloma. The rarest bladder cancer is small cell and spindle cell carcinoma.

The degree of anaplasia is divided into low-, moderate- and highly differentiated neoplasms. One of the main roles is played by the involvement of different layers of the bladder wall in the tumorogenic action. For this reason, the disease is invasive in a high or low stage, or proceeds superficially.

And also the tumor is subdivided into papillary, infiltrative, flat, nodular, intraepithelial growth patterns. Perhaps the combined development of neoplasms – cancer simultaneously has several signs.

Bladder cancer is classified according to the international TNM system.

Stages:

• T – primary neoplasia.
• TX – Primary neoplasia not assessable.
• TO – primary neoplasia without any data.
• Ta – superficial papillary carcinoma.
• Tis – flat carcinoma in situ – stage zero neoplasia.
• T1 – cancer cells penetrate into the vessels.
• T2 – neoplasia of the muscular layer (T2a – cancer that proceeds superficially; T2b – cancer that has penetrated deep into the tissues).
• T3 – the pathology is transmitted to the paravesical tissue. At the same time: T3a – at the microscopic level; T3b – at the macroscopic level.
• T4a – penetration of cancer at any stage into neighboring organs – the uterus, vagina, prostate are affected.
• T4b – penetration of cancer cells into the pelvic bones, abdominal wall.
• N1-3 – Metastases occur in one (N1) or several (N2) pelvic lymph nodes.
• M1 – penetration of metastases into neighboring organs – liver cancer, lung cancer, stomach cancer; in certain cases – damage to the bones.

Cancer of the bladder: signs

The onset of cancer at the initial stage may not manifest itself in any way, pass even without weak signs. That is, the tumor is at the primary stage of development, but the patient does not feel it at all.

The first manifestation of cancer of this unpaired hollow organ is hematuria – the presence of blood in the urine. This symptom is subdivided into microhematuria – when the urine is periodically stained pink; and gross hematuria – urine acquires a clear bloody hue and may contain clotted blood. Blood clots can cause urinary retention; difficulty and frequent urination.

Too frequent urination can also be caused by tumor formation. When neoplasia is sufficiently developed and reaches several centimeters in size, it reduces the capacity of the bladder. Therefore, less urine accumulates in it, which is the reason for too frequent urination.

Against the background of the development of a neoplasm, pain in the pelvic area increases both during urination and at rest. The pains are often aching and rarely sharp. In the later stages, pain can be intense and prolonged. The condition is aggravated by progressive anemia and the general weakness caused by it.

Sometimes the tumor is located in such a way that it does not allow urine to pass from the upper urinary tract (the flow of urine from the kidneys to the organ is difficult), this leads to the development of chronic renal failure. In this case, a biochemical blood test will show an increased content of urea and creatine.

But not all signs are direct symptoms of bladder cancer. Many of them relate to other diseases of the pelvic organs: cystitis, urethritis, the presence of stones in the urinary system, a benign tumor of the prostate. The similarity of the symptoms of the initial periods leads to the fact that patients are engaged in prolonged self-medication, and this aggravates the overall clinical picture.

Causes

Doctors have not come to a generally accepted etiology of this disease, but have identified sources of risk that contribute to tumor formation:

Rare urination and prolonged stasis of urine. An increased content of metabolites in the urine has a tumorigenic effect, which can provoke a malignant change in the transitional epithelium.

Diseases of the pelvic organs. Prostate adenoma, prostatitis, urolithiasis, chronic cystitis – these pathologies can also cause prolonged stasis of urine, which will negatively affect the epithelium.

Infectious diseases. The influence of human papillomavirus infections as a cause of neoplasms remains questionable. Of the parasitic infections, urogenital bilharziasis provokes active carcinogenesis.

Professional factor. This risk affects people who regularly come into contact with substances such as xylene derivatives, phenols, phthalates, anti-cancer drugs, etc. Often these are painters, health workers, workers in the chemical, oil and gas production and processing sectors.

“Household” carcinogens. This risk group includes smokers who suffer from bladder cancer two to three times more than those who do not suffer from this addiction. And also chlorinated drinking water belongs to the category of carcinogens – it increases the likelihood of disease by more than one and a half times.

In some cases, tumor formation can be genetically determined and caused by hereditary factors.

Cancer of the urinary tract: diagnosis

Detection of tumor formation in the main organ of the urinary system is a complex clinical and laboratory study with instrumental examination included. Here, hematuria is detected by urinalysis; visual microscopic analysis reveals atypical cells; culture finds or excludes infection; a test for the detection of a tumor agent is carried out; a blood test ascertains anemia, confirming blood loss. And also held:

• Transabdominal (superficial) ultrasound. This diagnosis is able to detect neoplasia larger than 5 mm, located in most cases on the side of the cystic walls. Research efficiency: neoplasia up to 5 mm — 37%; tumor with a diameter of more than 5 mm – 83%.
• Transrectal or transvaginal scanning is done to diagnose tumors in the neck of an organ. In some cases, endoluminal echography is performed. This is a study using an ultrasound device inserted into the bladder through a natural opening. Accuracy of determining pathology – 94%.
• Urethrocystoscopy – biopsy of the urethral mucosa. This is a mandatory diagnostic procedure. Reveals the number, size, growth rate, location of tumor formation.
• CT high quality x-ray images. They make it possible to obtain more detailed data and find small neoplasms that cannot be determined by echographic examination. And also tomography can reveal the depth of the introduction of malignant tumors.
• MRI – high-precision images obtained by magnetic resonance imaging. The most informative type of diagnosis of bladder cancer.
• Endoscopy allows you to visually detect the appearance of neoplasia, its size and location. In addition, this examination makes it possible to take a biopsy and carry out morphological confirmation of bladder cancer.
• There is an x-ray diagnostics: in case of tumor formation, a cystographic examination is performed, which reveals the deformation of the borders of the bladder wall. This allows you to determine the growth of the neoplasm.
• With the help of pelvic phlebography and lymphadenography, the involvement of the veins of the pelvic region and lymph nodes is revealed.
• Distant metastases are detected by ultrasound examination of the abdominal and pelvic organs; chest x-ray, skeletal scintigraphy.

Therapy

Tumor formation in the bladder can be conditionally ungrouped.

• Non-muscle invasive (superficial) cancer.
• Invasive cancer – penetration of metastases deep into the muscle layers.

Therapy at the initial stage of the course of the disease can do without surgical methods. In this case, chemotherapy is used with the use of one or a group of cytostatics; treatment with immunological drugs. The purpose of these groups of drugs depends on the size, location and progression of malignancy.

Non-muscle invasive cancer: treatment

Transurethral resection of the bladder (TUR). A surgical operation in which special equipment is inserted through the urethra. The impact on the tumor is made by resection, laser, electrocoagulation.

Intravesical (local) chemotherapy. The method consists in introducing an antitumor drug into the organ cavity. The course of local chemical therapy is from 6 to 8 weekly intravesical installations. It is an effective method for preventing the recurrence of this cancer.

Penetrating bladder cancer: methods of therapy

Cystectomy. This is a surgical operation to excise a fragment of the bladder or an entire organ. The degree of intervention is determined by the course of the cancer.

Radical cystectomy. The technique provides for a complex ectomy of organs, namely: the bladder; a fragment of the serous membrane of the abdominal cavity or tissue of the parietal space of the pelvis; prostate; paired organ of the male reproductive system. In women, a complex ectomy of the bladder is performed; uterus and its neck, appendages; anterior wall of the vagina. A mandatory procedure for cystectomy is the removal of pelvic lymph nodes.

The removed organ is replaced by ureterocutaneostomy – implantation of the ureters into the skin; urine diversion according to the Bricker method; orthopedic bubble from the tissue of the small intestine or stomach.

If necessary, the ectomy is enhanced by remote or contact laser treatment, chemotherapy, general or intravesical immunological therapy. If the patient refuses surgery, radical treatment with ionized radiation is prescribed.

Cancer of the bladder: preventive measures

Prevention of bladder cancer includes a wide range of measures. These are: complete exclusion of alcoholic beverages and cigarettes; increased physical activity – increased walking; a healthy diet with the inclusion of the required amount of vegetables and fruits; exclusion from the diet of chlorinated water and other carcinogens; maximum limitation of UV radiation.

At the slightest hint of signs of the disease, for example: increased urination, you should immediately contact a qualified specialist and undergo a diagnostic examination. A malignant neoplasm must be detected at an early stage – the effectiveness and success of treatment directly depends on this. Early diagnosis in some cases helps to avoid surgical intervention. Remember: cancer is a complex disease that needs to be detected in a timely manner.

symptoms and causes of development, types, stages, diagnosis and treatment of BC, prognosis

Bladder cancer (BC) is a malignant neoplasm that develops in the mucosa and submucosa or wall of the organ. The disease accounts for 4-5% of all malignant neoplasms. Among all tumors of the urinary system, pathology occupies 70% Source:
Dolgikh D.V. Bladder cancer (issues of etiology and pathogenesis) / D.V. Dolgikh [et al. ] // Siberian Medical Journal (Irkutsk). – 2015. – № 7. – S. 26-30. In men, the tumor is diagnosed at a younger age, it is more aggressive. However, in women, when an invasive form of a neoplasm is detected in the later stages, the chances of surviving are less.

According to the Federal State Statistics Service in Russia in 2017, 16.5 thousand people were diagnosed with a malignant neoplasm of the bladder, established for the first time in their lives. Among them, 12.7 thousand are men, and 3.8 thousand are women. The primary incidence of malignant neoplasms of the bladder in Russia in 2017 was 11.2 per 100,000 of the population, while among men the primary incidence was 18.6 per 100,000 of the population, and among women 4.9per 100,000. Thus, the incidence of malignant neoplasms of the bladder among men is more than 3 times higher than among women. Source:
Kulesh P.A. The study of clinical and morphological features of bladder cancer / P.A. Kulesh, A.A. Bagaeva // Eurasian Union of Scientists. – 2019.0183 Kulesh P.A. The study of clinical and morphological features of bladder cancer / P.A. Kulesh, A.A. Bagaeva // Eurasian Union of Scientists. – 2019.. The disease is more often diagnosed in residents of industrialized countries, large cities.

RMP is one of the most difficult to treat, primarily due to late diagnosis. About 1 out of 10 detected cases of neoplasms is cancer with metastases.

Causes of bladder cancer

There is no single proven cause of a tumor. Many risk factors contribute to the development of bladder cancer. Among them:

• Smoking . It is considered the main factor provoking RMP. Approximately half of the detected cases of cancer are associated with smoking, in smokers it is diagnosed 3 times more often than in non-smokers.
• Poor water quality and unfavorable environmental conditions . The chance of getting sick is increased by an excess of chlorine and fluorine in drinking water, pollution by waste from industrial production of water and air.
• Abuse of alcohol, fried and fatty foods .
• Harmful working conditions – work with substances containing aromatic amines, phenols, phthalates. At risk are workers in the chemical, paint and varnish, rubber, oil, aluminum, leather and textile industries, artists, designers, hairdressers. RMP often occurs among drivers of long-distance flights, due to prolonged driving in a sitting position, frequent hypothermia, inability to urinate in a timely manner. Source:
  Kulesh P.A. The study of clinical and morphological features of bladder cancer / P.A. Kulesh, A.A. Bagaeva // Eurasian Union of Scientists. – 2019..
• Non-infectious urogenital pathologies – chronic cystitis, urolithiasis, diverticulitis; genitourinary infections – chlamydia, mycoplasmosis, ureaplasmosis, trichomoniasis; parasitic diseases – schistosomiasis.
• Urinary stasis or infrequent urination for various reasons – prostate adenoma, narrowing of the urethra, insufficient fluid intake.
• Radiation therapy for tumors of the cervix and ovaries, prostate, chemotherapy with the use of “Cyclophosphamide” (increases the risk by 4.5 times), long-term use of phenacytin-containing analgesics (increases the risk of occurrence by 2-6.5 times) Source:
  Kulesh P.A. The study of clinical and morphological features of bladder cancer / P.A. Kulesh, A.A. Bagaeva // Eurasian Union of Scientists. – 2019..
• In addition, the risk is significantly increased in people exposed to ionizing radiation Source:
  Kulesh P.A. The study of clinical and morphological features of bladder cancer / P.A. Kulesh, A.A. Bagaeva // Eurasian Union of Scientists. – 2019..

Symptoms of bladder cancer

The main symptom of bladder cancer is hematuria (blood in the urine), which is often transient, its severity does not depend on the stage of the disease Source:
Kulesh P.A. The study of clinical and morphological features of bladder cancer / P. A. Kulesh, A.A. Bagaeva // Eurasian Union of Scientists. – 2019.. Possible microhematuria, when the blood is not visible visually and is detected only during the analysis, and macrohematuria – the urine turns dark orange, pink, red, brown.

Early symptoms also include dysuric disorders: frequent or infrequent urination, accompanied by pain, cutting or burning, weak, intermittent urine stream.

All the first signs of bladder cancer are non-specific, characteristic of other diseases of the urogenital area. It is important to seek medical help as early as possible in order to conduct a differential diagnosis, identify a neoplasm in time and begin treatment.

Pain in bladder cancer may have different characteristics depending on the nature of the spread of the tumor. With a locally advanced tumor process, initially most often there is pain over the bosom, provoked by the act of urination, subsequently the pain becomes constant, pain appears in the perineum and in the sacrum. With obstruction by a tumor of the mouths of the ureter, hydronephrosis develops, pain in the lumbar region appears, a positive symptom of tapping of the lumbar region, an enlarged kidney is palpated. Bone pain is usually indicative of skeletal metastases Source:
Kulesh P.A. The study of clinical and morphological features of bladder cancer / P.A. Kulesh, A.A. Bagaeva // Eurasian Union of Scientists. – 2019..

In the later stages of cancer, general weakness, pain in the lumbar and inguinal regions, lower abdomen, lack of appetite and weight loss, fever, swelling in the legs, swollen lymph nodes join. Fistulas may appear between the bladder and rectum.

Types of bladder cancer

By prevalence in the muscle layer:

• non-muscle invasive – located only on the mucosa and submucosa;
• muscle invasive – Invades the thickness of the bladder wall.

Localization:

• on the dome – the upper wall of the bladder;
• on side, front or rear walls ;
• in Lieto’s triangle – a space in the form of a triangle with vertices at the mouths of the ureters and the outlet of the urethra;
• on the bladder neck ;
• in the region of the orifices of the ureters ;
• in the area of ​​the urachus – normally closed rudimentary primary duct located above the bladder;
• Tumor involves several areas .

By type of growth:

• exophytic (papillary) – the formation grows upward from the mucous membrane, initially looks like a polyp;
• endophytic (infiltrative) – grows inside the wall of the organ with the transition to the muscle layer, has no clear boundaries;
• mixed form – neoplasm grows inward and outward simultaneously;
• flat ;
• nodular ;
• intraepithelial .

According to histological structure:

• Epithelial cancer . In 98% of cases, bladder tumors develop from epithelial cells Source:
  Kulesh P.A. The study of clinical and morphological features of bladder cancer / P.A. Kulesh, A.A. Bagaeva // Eurasian Union of Scientists. – 2019.. In 90-95% of cases, bladder tumors are morphologically transitional cell carcinoma Source:
  Dolgikh D.V. Diagnosis of bladder cancer / D. V. Dolgikh [et al.] // Siberian Medical Journal. – 2015. – No. 6. – S. 141-147 .. It can be low- and highly differentiated, on which the degree of malignancy of the formation depends. Verrucous carcinoma, adenocarcinoma and clear cell adenocarcinoma, urachus cancer, small cell carcinoma are diagnosed much less frequently.
• Non-epithelial cancer . Tumors from muscle, fibrous vascular and other tissues: rhabdomyosarcoma, fibrous histiocytoma, leiomyoma, hemangioma, melanoma, germ cell tumors.

Histological picture of a low-grade superficial bladder urothelial tumor. Source: cureus.com

Stages of bladder cancer

In the first stage bladder cancer, tumor cells are located only in the epithelial layer. The process does not affect the wall of the bladder, nearby and distant organs.

second stage is characterized by invasion of the neoplasm into the muscle layer. Adjacent organs are not affected, there are no distant metastases.

At the third stage , in addition to the germination of cancer in the muscular layer of the bladder, there is an increase in regional lymph nodes.

The fourth stage is characterized by any size of the tumor, while regional lymph nodes are affected, metastases are observed in distant organs.

9 is used for international classification0071 TNM system :

• T – indicates the extent of the tumor, indicated by numbers from 1 to 4.
• N – the presence of metastases in the lymph nodes. The number 0 indicates the absence of metastases in the lymph nodes, 1 – a single affected node, 2 – metastases in 2-5 lymph nodes.
• M – (x, 0 or 1) – the inability to detect, the absence or presence of distant metastases.

Bladder cancer staging

Diagnosis of bladder cancer

The first stage in the diagnosis of bladder cancer is examination of the patient, taking an anamnesis of life and illness, laboratory and instrumental studies. The doctor will ask the patient in detail about the symptoms, the time of their occurrence, the frequency of occurrence, the presence of bad habits, and other factors that provoke the disease.

During a urological examination, the doctor will determine Pasternatsky’s symptom – the presence or absence of pain when tapping on the lower back, and also check the condition of the prostate gland using a digital examination through the rectum.

In addition to general and biochemical blood and urine tests, which are not informative in the diagnosis of oncological diseases, the patient may be assigned to study the urine sediment for the presence of pathological cells and to determine tumor markers of bladder cancer .

Ultrasound for bladder cancer allows to visualize the tumor if its size exceeds 4 mm, determine the form of tumor growth (exophytic, endophytic or mixed) and the depth of its invasion into the wall Source:
Long D. V. Diagnosis of bladder cancer / D.V. Dolgikh [et al.] // Siberian Medical Journal. – 2015. – No. 6. – P. 141-147. During a cold cystoscopy, the bladder is examined and a section of the affected tissue is excised for analysis. Another treatment and diagnostic method is TUR-biopsy , when the neoplasm is completely excised, with the capture of healthy tissue. During transurectal resection with photodynamic diagnosis, a doctor can see even the smallest areas of a tumor lesion in blue illumination.

Papillary bladder tumor (cystoscopy). Source: cureus.com

To determine the involvement of the lymph nodes, metastasis to other organs, use:

• CT and MRI,
• scintigraphy,
• lymph node biopsy,
• chest x-ray,
• abdominal ultrasound;
• tests for tumor markers.

Three markers, UBC, TPS and VEGF, have the highest sensitivity and specificity in staging bladder cancer. An increase in the level of UBC in the urine characterizes the initial stages of bladder cancer and the possible non-invasive recurrence of the tumor with organ-preserving treatment. In patients with non-muscle-invasive bladder cancer, an elevated level of VEGF can serve as an additional criterion not only for disease recurrence, but also for its progression. The simultaneous rise in the content of UBC in the urine and TPS, VEGF in the blood serum is associated with the progression of tumor growth and characterizes the initial stage of bladder cancer invasion into the muscle layer. A high level of VEGF is characteristic of a tumor growing outside the organ, as well as with a high activity of tumor growth and a low degree of its differentiation, which is a poor prognostic factor Source:
Long D.V. Diagnosis of bladder cancer / D.V. Dolgikh [et al.] // Siberian Medical Journal. – 2015. – № 6. – S. 141-147. The study allows to assess the patency of the ureters, to identify neoplasms both in the upper urinary tract and in the bladder Source:
Kulesh P. A. The study of clinical and morphological features of bladder cancer / P.A. Kulesh, A.A. Bagaeva // Eurasian Union of Scientists. – 2019..

Multislice computed tomography Source:
DV Dolgikh. Diagnosis of bladder cancer / D.V. Dolgikh [et al.] // Siberian Medical Journal. – 2015. – № 6. – P. 141-147. Source radiopaedia.org

Bladder cancer treatment methods

0181 transurethral resection followed by intravesical chemotherapy or immunotherapy – injection of drugs into the bladder cavity. The advantage of intravesical administration is the absence of side effects of systemic chemotherapy, such as nausea, vomiting, hair loss.

BCG vaccine is used for intravesical immunotherapy. Weakened Koch’s sticks activate cells of the immune system, which begin to attack the tumor.

A more modern method of immunotherapy is the use of checkpoint inhibitor drugs. Checkpoints are molecules that suppress the immune response, including to prevent the occurrence of autoimmune diseases. Inhibitors block these points and stimulate the immune system to fight cancer cells.

Another low-traumatic method of treatment is laser en-bloc resection , which allows you to remove the neoplasm in the mucous and submucosal membranes, the muscle layer as a single block. This method is not suitable for large formations without clear boundaries.

In the advanced stages of bladder cancer, if the above methods have not helped, resort to complete removal of the organ – cystectomy , followed by radiation or chemotherapy.

Isolated cystectomy (bladder removal only) is rarely performed for invasive cancer. More often it is combined with the removal of neighboring organs: the prostate and seminal vesicles in men, the appendages and uterus in women. At the same time, the entire urethra or part of it, pelvic lymph nodes are excised.

After cystectomy, it is possible to perform a reconstructive operation – neocystoplasty, when the removed bladder is replaced with an isolated section of the intestine, to which the ureters and urethra are connected.

Prognosis for the disease

The prognosis of survival depends on the stage at which the tumor is diagnosed, how timely and complete the treatment is. If a single epithelial lesion is detected and TUR is performed in conjunction with chemotherapy or immunotherapy, the chances of recovery are about 91 %. In the second stage, without the spread of cancer to other organs, timely transurethral resection and chemotherapy (rarely radiation therapy) allow us to hope for recovery without recurrence in 73-75% of patients. In the third stage and the transition of the process to nearby organs, even after removal of the bladder and chemotherapy, there is a possibility of relapse, a five-year survival rate is observed in 50% of patients. At the fourth stage, the process is considered inoperable, palliative methods are used, the five-year survival rate is less than 7%.

Prevention of bladder cancer

Stopping smoking and alcohol, eating a lot of fresh fruits and vegetables, which contain antioxidants that prevent cell regeneration, will help reduce the likelihood of developing a tumor. Bladder cancer is less likely to occur in those who drink enough water per day. It is believed that the risk of neoplasm is reduced by 7% for every 240 ml of added liquid.

It is necessary to be attentive to your health and consult a doctor when the first, even minor, signs of illness appear. It is important to monitor the regularity of urination, to protect yourself from genitourinary infections, to diagnose and treat inflammatory processes of the urinary tract in time. Workers in hazardous industries should not neglect professional examinations. People over the age of 40 are recommended to undergo an annual medical examination.

Sources

1. Dolgikh D.V. Diagnosis of bladder cancer / D.V. Dolgikh [et al.] // Siberian Medical Journal. – 2015. – No. 6. – S. 141-147.
2. Dolgikh D.V. Bladder cancer (issues of etiology and pathogenesis) / D.V. Dolgikh [et al.] // Siberian Medical Journal (Irkutsk). – 2015. – No. 7. – S. 26-30.
3. Dunaev M.