In bladder cancer, a malignant tumor develops, usually in the mucous
membrane of the urinary bladder. The urinary bladders is part of the
urinary tract. It collects the urine released by the kidneys and signals
from a filling of 200 milliliters with a slight urge, from 400 with a strong
urge to urinate that it has to empty itself.
In technical jargon, the mucous membrane of the bladder and urinary
tract is called the urothelium. Doctors therefore speak of urothelial
carcinoma if a malignant growth forms there. Bladder carcinoma or urinary
bladder carcinoma are also common names. If left untreated, bladder tumors
can penetrate deeper layers of the bladder (advanced / muscle invasive bladder
cancer) and spread across the bladder (metastatic bladder cancer). In an
estimate seven out of ten cases, however, doctors diagnose bladder cancer as
long as it is limited to the mucous membrane.
Bladder cancer in men occurs more than twice as often as bladder cancer
in women. According to the Robert Koch Institute (RKI) there are around
15,000 new cases of bladder cancer each year. Age seems to play a
role. Bladder cancer is rare in children and young people.
Bladder cancer at the age of 30 or younger is an exception with less
than one percent of the cases; the disease usually occurs in patients over 45
years of age, according to the German Cancer Society (DKG), men are on average
74 and women 77 years old.
Smokers are particularly at risk; nicotine is a risk factor ,
as are certain chemical substances . This
also increases the risk of developing bladder cancer for people who deal with
such substances at work (e.g. painters, truck drivers, hairdressers, printers).
Symptoms: recognizing
bladder cancer
Bladder cancer is difficult to spot in the early stages. The
reason: there are no clear signs of bladder cancer, no specific
symptoms. The symptoms also occur with other diseases - men often think of prostate problems first, women of cystitis . The
early symptoms of bladder cancer include, for example:
- Blood
in the urine (hematuria). It can occur in such large quantities that the
urine turns red or brown in color, but it can also be present in such
small quantities that it is not visible to the naked eye. An
indication that this could be a sign of bladder cancer is that the patient
does not have a fever or
that there are clear urinary tract infections.
- Urination
to urinate without urination. Sufferers may feel the need to go to the
toilet more often than usual, but they cannot urinate.
In a later stage of the bladder cancer, symptoms develop that more
specifically indicate a tumor disease, including
- Painful
urination. This
bladder cancer symptom occurs, for example, when the tumor is so large
that the growth presses on the urinary bladder.
- Abdominal
and kidney pain. They occur when the bladder tumor blocks the ureters and the urine
can no longer drain freely. The blocked urine can then cause pain in
the kidney or back area.
- Enlarged
or swollen lymph nodes. Enlarged lymph nodes are a sign of bladder
cancer that can occur when the cancer has metastasized. If the tumor
blocks veins or lymph vessels, the lymph nodes can swell and congestion
can form.
- Bone
pain. They
arise when the tumors spread to the skeleton. The skin that surrounds
the bones is well supplied with blood - and since tumor cells usually
reach other parts of the body and organs via the blood, secondary tumors
(metastases) also form in the bones. In bladder cancer, however, less
often than in other types of cancer. Since many nerves run in the
periosteum, it is sensitive to pain.
Bladder cancer
diagnosis: These are the common examination options
In order to clarify whether it is bladder cancer, the first point of contact
is the family doctor. He or she will refer the person concerned to a
specialist in urology if there is no evidence that there is a harmless trigger
(such as an acute urinary tract infection) for the symptoms.
The urologist can then use special diagnostic methods to refute or
confirm the suspicion of cancer. This is usually finish on an outpatient
basis, without hospitalization - by means of:
- Discussion
with the patient: The
doctor asks the patient about his or her exact symptoms, especially blood
in the urine, whether the urge to urinate has increased or there are
problems with urinating. Usually, they will also want to know if
there are any other known illnesses and if the person concerned needs to
take medication on a regular basis.
- Physical
examination: The
doctor will now examine the kidney area and abdomen. In men it also
palpates the prostate, in women it checks whether the bladder can be felt
through the vagina.
- Blood
test: If
bladder cancer is suspected, checking the blood values for abnormalities
is also often part of the medical examination.
- Urine
test: The
doctor asks the patient for a urine sample, which he gives to the
laboratory. There you can find out whether there is a urinary tract
infection and whether a possible red coloration of the urine is actually
due to blood - and not, for example, to certain coloring foods (such as
beetroot). The doctor can also determine if there are tumor cells in
the urine.
In
the course of early detection, there are also some non-invasive procedures such as the
NMP22 BladderChek (searches for a substance in the urine that increase tumor
cells in the bladder) or the UBC rapid (searches for certain proteins,
so-called cytokeratins, as tumor signals in the urine). Such rapid bladder
cancer tests can be carried out by the doctor in the practice; the result is
there within ten to 30 minutes. However, such bladder cancer tests are
only suitable to a limited extent as the sole basis for making a
diagnosis. Further examinations should definitely be carried out in order
to confirm the findings if bladder cancer is suspected.
- Ultrasound : Using what is known
as sonography , the doctor can view the kidneys,
renal pelvis and bladder. In this way, he can tell whether there are
other causes than bladder cancer that are triggering the symptoms - for
example kidney or bladder stones. If there is still no complete
certainty after this examination, the doctor can recommend or perform a
cystoscopy.
- Cystoscopy: The examinations of
the urethra and bladder, also known as cystoscopy, provides important
information for diagnosing bladder cancer. It allows the doctor to
assess the mucous membrane of the bladder wall and, if necessary, to take
tissue samples from suspicious areas. In this examination, which is
usually carried out on an outpatient basis, the doctor inserts a tubular
instrument into the urethra and into the urinary bladder. This method
is almost painless for women, men are usually anesthetized locally.
- Other
examinations: In
the case of muscle invasive bladder cancer, i.e. cancer that has already
penetrated deeper layers, the doctors must check whether the bladder
cancer or the tumors have already spread beyond the bladder. This is
done using so-called imaging processes that generate images of the inside
of the body. In addition to ultrasound, this also includes computed tomography (CT), magnetic resonance
tomography ( MRT ) and x-rays .
Treat bladder cancer
and cystectomy
If the doctor has all the results of the examination, he can assess
whether it really is bladder cancer, what stage he is at and at least roughly
assess how the disease could progress and should be treated. There are two
classification systems to classify bladder cancer.
TNM
classification: It describes whether and how the tumor has spread. T stands
for the sizes of the tumor and its local spread, N indicates whether the lymph
nodes (Latin: nodus) are affected and M whether the bladder cancer has
metastasized. With the help of the TNM classification, the doctor can
divide bladder cancer into stages and determine the current tumor stage
(staging).
Grading: This
classification describes how much the cancer cells
differ from normal cells . The greater the deviation, the more
aggressively the cancer is likely to grow.
The World Health Organization (WHO) differentiates between low-grade and
high-grade bladder cancer. If deeper structures are already involved, the
WHO classification divides bladder cancer into G3, G2 and G1, with G1-G2 cancer
standing for less aggressively growing cancer, G2-G3 for aggressively growing
cancer. The indication "Low Grade" or "High Grade"
always complements the grading, e. B. "Low Grade (G1)".
How aggressive the tumor is and hows far it has already spread
determines which treatment method is possible or useful. Those affected
should have their doctor explain exactly which forms of therapy are
possible. It often also helps to exchange ideas with other affected people
in order to be able to weigh up the advantages and disadvantages.
Transurethral
resection : The majority of bladder cancer tumors are discovered when they
are still growing superficially (non-muscle invasively). Here it is
usually enough just to remove the cancer and preserve the bladder. This is
done by means of transurethral resection (TUR-B). The procedure is similar
to a cystoscopy, which means that the doctor inserts special instruments
through a shaft pushed over the bladder and urethra to remove the tumor.
During the transurethral resection of the prostate or urinary bladder,
the doctor should also remove diseased / changed tissue and have it assessed in
the laboratory. In this way it can be said whether the bladder cancer is
limited to the bladder mucosa or has already spread. The TUR-B takes approximately
20 to 60 minutes. However, the patient is under anesthesia and has to stay
in the hospital for one to several days.
To prevents the cancer from coming back, many doctors recommend another
bladder cancer operation after two to six weeks and / or in addition to
long-term removal of the bladder cancer, chemotherapy in the bladder
(local chemotherapy ) or so-called instillation
therapy. The weakened form of the live vaccine Bacillus Calmette-Guérin
enters the bladder via a catheter. This can reduce the risk that the
tumors will recur, but is not useful or possible in all bladder cancer stages.
Cystectomy: If the bladder
cancer has already grown into the muscles, but is still localized, the usual
bladder cancer therapy consists in removing the bladder and, according to the
recommendation, also the surrounding lymph nodes and, in women, the uterus, ovaries,
fallopian tubes and parts of the vaginal wall Man prostate and seminal
vesicles. In technical jargon, this procedure is called cystectomy.
