Bladder Cancer

Cystic (superficial) cancer

The diagnosis of bladder cancer is the most prevalent worldwide, with 330,000 cases of this cancer occurring annually, and the incidence of men compared to women is (3.8: 1.0), and bladder cancer is one of the most malignant tumors that affect the urinary system in humans and is the seventh among the most common cancers in Men and seventeenth among the most common cancers in women.

The incidence of this cancer varies according to the geographical location in the world, and a recent decrease in the incidence of this cancer is noted due to primary prevention leading to a decrease in the main risk factors, especially smoking and environmental pollution in industrialized countries and exposure to environmental and industrial carcinogens.

As for the risk of death from this cancer, it has decreased in the past ten years, due to the improvement in the means of diagnosis and treatment for this cancer. The incidence of superficial bladder cancer is 75% and it is non-invasive in the bladder muscle (NMIBC), and because it has not penetrated the bladder muscle, where clinical studies have proven its slow penetration and spread to the muscle of the bladder wall (NMIBC), and therefore the cure rate is high in the case of superficial cancer and in Any stage before it has invaded the muscle compared to invasive bladder cancer (NMIBC), which is considered to be of high risk and may lead to early death.

Bladder cancer risk factors: :

Clinical studies have shown that the cause of bladder cancer is closely related to the genetic and personal predisposition of the patient, especially after exposure to the following risk factors:

1- Tobacco smoking: Smoking is one of the most common causes of bladder cancer and causes (50%-65%) of men and 7%-20% of women, and this incidence of cancer is related to the smoking period and the number of cigarettes smoked daily before. Person, and the incidence of this cancer is high among those people who started smoking early in their lives, especially after reaching adulthood, as well as those who are exposed in their childhood days to an environmental environment in which there is tobacco smoking

 

As for the cause of infection, it is as a result of tobacco containing carcinogens to the bladder, especially aromatic amines and polycyclic aromatic hydrocarbons.

 

2- Occupational exposure to chemicals: Occupational and environmental exposure through work in dye factories, oil drilling and minerals, and environmental and occupational exposure to chemicals is the second cause of bladder cancer, knowing that recent clinical studies have shown that the occupational incidence of this cancer ranges between (20-25%). As for the chemicals that have proven dangerous, they are petroleum derivatives(Benzenederivatives) and aryl amines such as aniline, as well as due to occupational exposure to dye products, rubber products, and industrial materials for textiles, as well as dyes, leather and chemicals used in these factories to prepare and manufacture these materials, and the period of infection is after exposure For these factors, ten years, and the latency period until the emergence of cancer is about 30 years. As for chlorinated amines, they are the most dangerous for bladder cancer with 10% of all other risk factors leading to this cancer.

 

3- Eating large amounts of chlorinated water. This chlorinated water is considered a carcinogen for cells in the body in general and the bladder in particular, as well as the content of drinking water on arsenic, which increases the incidence of this cancer.

4- Exposure to ionizing radiation, especially after radiotherapy for female cancers as well as male cancers such as prostate cancer.

Clinical studies have proven a strong relationship between bilharzia infection and the formation of squamous bladder cancer, as this infection leads to chronic inflammation of the bladder causing the emergence of this type of cancer in the bladder.


5- Exposure to therapeutic chemicals in the case of treatment of lymphatic cancers, especially the chemical antagonist cyclophosphamide (Cyclophosphamide), and this may lead to bladder cancer after a latency period of (6 – 13) years.

Symptoms:

The medical history of the patient with this cancer and its relationship to the risk factors leading to bladder cancer, especially smoking, occupational chemical exposure.

Photography:

  1. 1- Imaging the upper and lower urinary tract by using colored x-rays to determine the presence or absence of bladder cancer in the ureter or in the renal pelvis, where the upper urinary tract (renal pelvis and ureter) are affected by (1.8%) and the bladder triangle is affected by (7.5%).
    Computed tomography (CT), where it is possible to detect the spread of bladder cancer to the renal pelvis or ureter at a higher rate than imaging by colored X-rays, as well as detecting whether or not the lymph nodes are affected by this cancer.
  2. 2- Computed tomography (MRI): or color magnetic resonance tomography to detect the involvement of other organs in the abdomen and behind the peritoneum with this cancer, especially the lymph nodes.
    Ultrasound This diagnostic mechanism is used as an initial method for diagnosing a tumor in the bladder at a high rate due to the imaging and diagnostic effectiveness of the transducer of modern devices. This is done by ultrasound through imaging by this transducer from above the bladder, and at the same time any Expansion or absence of the renal pelvis as a result of its spread in the upper urinary tract (ureter and renal pelvis) or due to its narrowing of the ureter opening in the bladder.
  3. 3- Urine cytological examination This is done by examining the urine to search for cancer cells and it is possible to diagnose 28-100% of superficial vesical cancer, knowing that this diagnostic method lies in its high diagnostic sensitivity for cancer cells in the urinary bladder, ureter or in the renal pelvis.
    4- Partial markers in urine.
    5- Cystic endoscopy: This diagnostic examination is performed only in the event that cystic tumor is not confirmed by the aforementioned imaging diagnostic methods, because the patient with bladder cancer will sooner or later undergo endoscopic extraction after previously diagnosed by the aforementioned diagnostic methods.

treatment :

There are two types of treatments for this superficial cancer (NMIBC): 1) Adjuvant therapy: This modern and successful treatment in the first and second stages of this disease is the extraction of the tumor by endoscopy and at the same time the immunotherapy two weeks after the tumor extraction, where the infusion of the immune substance (BCG) is done weekly in the The bladder for two hours and for six consecutive weeks and then for a full year every three weeks, where clinical studies have proven that this treatment has led to a high cure rate in recent years compared to other traditional treatments. But if a new growth of this cancer occurs in the bladder after its endoscopic extraction and treatment after three months, then this indicates that this cancer has not been radically removed or that it has not been treated properly and adequately. Therefore, it is necessary to perform a second laparoscopic resection and then adjuvant therapy for all patients with primary noninvasive bladder cancer (NMIBC), without exception.

Prof. Dr. Samir Al-Samarrai

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