The vast majority of bladder tumors are superficial at the time of diagnosis, that is, they have not spread to the muscle tissue of the bladder. The incidence of bladder cancer, which is thought to occur as a result of the genotoxic effects of smoking or environmental pollution factors or as a result of spontaneous genetic changes, increases with age. Along with complaints such as bleeding in the urine, inability to completely empty the urine, frequent urination, it is likely that the patient should consult a doctor with symptoms such as weight loss, weakness, cough, bone pain, especially in advanced cases. Although complete urinalysis, urinary system ultrasonography, intravenous pyelography and computed tomography are the methods we frequently use in the diagnosis of bladder tumor, diagnostic cystoscopy and biopsy allow definitive diagnosis. Both the size and number of the tumor and the location of the tumor in the bladder are very important.
The first step in treatment is transurethral resection of the tumor (TUR-mt), both to remove the tumor and to show whether the bladder cancer is superficial or muscle-invasive. It is often necessary to perform a second resection (re-TUR) to determine which group the tumor belongs to and which treatment scheme should be followed. In treatment planning, the age of the patient, the stage and grade of the tumor (behavior), the number and size of the tumor are very important. In superficial bladder tumors, we usually apply intracavitary treatment (BCG immunotherapy and chemotherapy) into the bladder once a week to prevent recurrence and progression of the tumor.
Unless the tumor recurs, patients should be followed up 4 times a year in the first year, twice in the second year, and annually thereafter. However, this approach is adjusted according to the course of the disease. In some patients, maintenance therapy is also applied along with induction (initial) therapy. Intracavitary treatment has no place in muscle-invasive tumors, and a radical treatment is required in these patients. Radical cystectomy, in which prostate, seminal vesicle and iliac lymph nodes of the bladder are removed in male patients and a part of the bladder, uterus, ovaries and vagina in female patients, is the first treatment option. Radiotherapy and radiotherapy and chemotherapy can be applied in suitable patients. Along with these treatments, the patient should completely abstain from smoking. Chemotherapy is the only treatment option for metastatic bladder tumors.