Bladder cancer and its treatment

Bladder cancer is the most common cancer of the urogenital system. Although its incidence varies according to countries and geographical regions, it is seen 4 times in men and 8th in women. It is most common in the 60-70’s. It is seen 3-4 times more in men than in women. Many risk factors such as social, environmental, occupational and genetic factors and dietary habits play an important role in the development of bladder cancer. The most important risk factor is the use of cigarettes and other tobacco products. People working in the chemical industry, petroleum, paint, rubber industry, aluminum and iron business have a higher risk of developing bladder cancer due to their occupational exposure to chemical carcinogens. Smoked meat and fatty diet, obesity also increase the risk of developing bladder cancer. In addition, the incidence of bladder cancer increases in the presence of family history, exposure to radiation and chronic urinary tract infection.

The most typical symptom of the disease is painless, bloody-clot urination. Burning in urination, straining, pain in the kidney area, weakness, weight loss can also be seen. Sometimes, it can be detected incidentally in ultrasonography performed for other reasons without giving any symptoms. Ultrasonography is the first imaging method used in diagnosis. Thorax and Abdomen Computed Tomography (CT), Magnetic Resonance Imaging (MR) and Bone Scintigraphy are used to determine the stage of the tumor. Definitive diagnosis is made by imaging the lesion with cystoscopy and pathological evaluation of the parts obtained by resected (TUR-B). The first TUR-B operation is the most important stage that affects the treatment success of the disease and the survival of the patient. In high-risk patients, a second TUR-B operation can be performed to confirm the diagnosis. After the operation, drugs such as Epirubicin or Mitomycin can be given into the bladder to reduce recurrence. As a result of the pathology, the type of tumor, the depth and degree it reached in the bladder layers are revealed. Depending on the type, grade and stage of the tumor, the need for and type of additional treatment varies. In non-muscle invasive tumors, if there is lamina propria involvement and/or carcinoma in situ, intravesical BCG (tuberculosis vaccine for the bladder) treatment and control cystoscopies are considered sufficient.

The gold standard treatment for bladder cancers that have reached the muscle tissue is Radical Cystectomy + Urinary Diversion (removal of the bladder, making a new bladder from the intestine). Chemotherapy and radiotherapy may also be a treatment option for patients who are too old to undergo surgery or who have additional diseases. Chemotherapy is primarily preferred in the disease that has passed all layers of the bladder and spread to other organs.
Bladder cancer is a disease with the potential to recur. Bladder cancer patients are patients who should be followed closely by a urologist at all stages. Follow-up is usually with cystoscopy. Imaging methods can also be used at certain times.

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