First and foremost, it is believed that occupational exposure to chemical compounds, including those belonging to the aromatic amines group, is the primary contributor to the development of cancer of the urinary bladder. It is also said that smoking tobacco can cause cancer since it contains compounds that are known to cause cancer of the urinary bladder, such as nitrosamines and tryptophane metabolites that are discharged in the urine while smoking tobacco.
There is an additional risk factor that might lead to the emergence of more severe cancer of the urinary bladder types. This risk factor is a prolonged exposure to foreign bodies and infections (primarily Schistosoma haematobium, which affects countries in Africa and Small Asia, as well as medicines – cyclofosphamide), as well as a small pelvis irradiation due to another tumor in that region.
Mutations within the suppressor gene p53, the oncogene erbB-2, the p21 gene, and the c-myc gene are the most prevalent forms of hereditary disorders that might be identified in cases of cancer of the urinary bladder.
SIGNS AND SYMPTOMS
One of the most common signs of cancer of the urinary bladder, which compels the patient to seek medical attention, is the presence of blood in the urine, which can occasionally be accompanied by blood clots. As the tumor continues to progress, it is possible that disuric symptoms will manifest themselves. These symptoms include discomfort, tenesmus of the bladder, a burning sensation during urination, and occasionally, temporary retention of urine. While the urinary tracts are at a standstill, patient may have pain in the lumbar region in addition to symptoms that are characteristic of an infection in the urinary tract. Further symptoms of the condition typically accompany the pain that is felt in the pelvis and in the groin area, in addition to edema that occurs in the lower limbs. Pains that are brought on by metastatic alterations in bones are the initial symptoms that are considered to be “signaling.”
THE DIAGNOSIS
At the very least, a single instance of haematuria or the pain symptoms that were stated before is an unquestionable indicator that a patient should undergo examination in order to rule out the likelihood of cancer of the urinary bladder. The first test that should be performed in the process of diagnosing cancer of the urinary bladder is ultrasonography. This is because the tumor change may be portrayed during this examination, given that the tumor is large enough, the bladder is full, and the location on the wall is accessible during the examination.
On the other hand, depending on the value and the degree of infiltration, it is possible to see unevenness in the shape of the bladder, filling faults, and stiffness of the wall that has been infiltrated.
It is imperative that a histopathologic examination be performed as soon as feasible in order to provide an explanation for the nature of the alteration that has been found in the bladder when it is deemed to be worrisome. Cystoscopy is performed after a bimanual examination has been performed (with the purpose of identifying any abnormalities in the bladder). In the course of the examination, sections are extracted for the purpose of histopathological analysis.
Although it appears that the urine cytology screening was performed correctly, the fact that the result was negative does not rule out the possibility of a malignant development.
In addition to the examinations that have already been stated, morphology, general urine examination, urography (the assessment of kidneys and urinary tracts), and small pelvis computer tomography (assess the extent of local infiltration and lymph node invasion) are also performed. Diagnostic procedures such as radiographic examination and bone system scintigraphy appear to be recommended in the case of pain issues. In a manner comparable to those of other malignancies, it is advised that a chest RTG, a gynecological examination in women, and an evaluation of the status of the prostate in males be performed.
When considering the prognosis, it appears to be of utmost importance to ascertain the level of histological tumor malignancy, which is a fundamental prognostic feature that sets it apart from the condition of the primordial tumor, which is assessed according to the TNM classification. Approximately forty-five percent of cancers that are diagnosed are classified as well-differentiated cancer (G1), moderately differentiated cancer (G2), poorly differentiated cancer (G3), and undifferentiated cancer (G4). These are the different degrees of differentiation that are separated. Although the diagnostic significance of BTA and NMP-22 markers is currently being evaluated, it should be noted that the determination of these markers does not represent a standard in terms of diagnostic procedures.
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CLASSIFICATION OF HISTOLOGICAL FEATURES
• Tumors of the epithelium:
- papilloma of the intermediate cell type
- planoepithelial papilloma
- transitional cell papilloma that has infiltrated the wall of the bladder
- carcinoma of the transitional cell type
- Different types of transitional cell carcinoma include:
- “in conjunction with planoepithelial transformation”
- “in conjunction with adenous transformation”
- “alongside both planoepithelial and adenous transformation”
- carcinoma of the basal colon
- cancer of the adenocarcinoma
- a tumor that is anaplastic
• Tumors that are not epithelial:
- a large tumor fibroma (plural)
- a myxoma
- a lymphoma
- pheochromocytoma is the term.
- cancer of the sarcoma
CLASSIFICATION
It is necessary to apply either the TNM classification or a modified approach developed by Jewett and Marshall in order to arrive at an estimate of the degree of development.
• Classification of the TNM
The clinical categorization of T and N relates to the pathological classification method of pT and pN.
T – primary tumor
- Tx – The primary tumor cannot be evaluated at this time
- T0 – There is no indication of a primary tumor
- Carcinoma in situ, a preinvasive tumor that is located inside the epithelium and has focal anaplasy (G1, G2, G3) on its surface
- Noninvasive papillary carcinoma is denoted by tac.
- T1: The tumor has invaded the connective tissue underneath the epithelium
- Muscle is invaded by the tumor in T2
- There is a deep infiltration of the tumor into a portion of the muscular coat that does not surpass it (T3a).
- The tumor also infiltrates the whole muscular coat (T3b).
- Perivesical tissue is invaded by the tumor.
- Extracapsular expansions (unilateral) are referred to as T3a.
- Extracapsular extensions (bilateral) are referred to as T3b.
- “T3c” stands for “seminal vesicles infiltration.”
- (T4) The tumor has spread to other organs.
- T4a: The tumor has spread to the vagina, the uterus, and the prostate
- Invasion of the pelvic wall and abdominal wall is referred to as T4b.
N – regional lymph nodes
- It is not possible to evaluate the lymph nodes in the region.
- N0 indicates that there is no regional lymph node metastasis
- N1 indicates that there is metastasis in the lymph nodes
- N2 indicates that there is metastasis in a single lymph node that is greater than 2 centimeters but less than 5 centimeters in greatest dimension, or in several lymph nodes that are greater than 5 centimeters in greatest dimension.
- N3: Metastasis in a lymph node with a maximum size of more than five centimeters
M – distant metastases
- On the other hand, distant metastases cannot be evaluated.
- M0 – There are no metastases in the distant organs
- M1: Metastases that are located far away
- M1a refers to lymph nodes that are not regional, while M1b refers to bone(s).
- Organs other than the M1c
According to Whitmor-Catalon’s categorization, degrees A, B, C, and D correspond to T1, T2, T3, and T4 in the TNM classification, respectively.
• As determined by Jewett and Marshall’s classification
- Stage 0: There was no evidence of a malignancy in the specimen
- tumor that is superficial and does not invade the submucosa carcinoma in situ disease
- At this stage, the tumor is superficial and has invaded the submucosa.
- The muscle-invasive tumor is in stage B.
- In the first stage, B1, the invasion is shallow (less than halfway).
- A deep invasion (more than halfway) is the stage B2 invasion.
- The invasion of the perivesical fat occurs during stage C.
- Extra vesical illness is referred to as Stage D, and it is further subdivided into:
- Stage D1: invasion of neighboring organs or metastases in regional lymph nodes, respectively.
- At this stage, extrametastases have spread to distant organs.
MEDICAL CARE
The choice of treatment for people who are suffering from cancer of the urinary bladder is determined by the degree of advancement according to the TNM classification, the level of histological malignancy of the tumor, and how the patient is doing generally.
• An operation for therapy
(TURT) stands for “transurethral resection of tumor.”
This procedure is utilized in situations when surface modifications (Ta, T1, T2, as well as the numerous ones) are present, as well as when treating preinvasive tumor Tis, provided that the number of focuses is modest and the atypy is not considerable. If the diameter of the base of the tumor does not exceed 2 centimeters, TURT can also be performed on tumors that are classified as T3a. It is occasionally used as a palliative therapy in cases when the cancer of the urinary bladder has progressed to an advanced stage (T3, T4).
• Section of the urinary bladder surgically removed
It is utilized in situations where a three centimeter margin of healthy tissue can be observed in large, individual foci of T2 tumors and in the early stages of T3 tumors.
• Cystectomy, also known as a complete resection of the urinary bladder
A surgical procedure that is performed in two stages and involves the removal of a bladder along with lymph nodes and the reconstruction of the ability to drain urine from the upper urinary tracts.
The procedure is intended for people who are suffering from:
G3 cancer, which is weakly differentiated, is characterized by an early recurrence following therapy with other modalities. – tumors that invade the neck of the urinary bladder, the prostate urethra, and the bladder triangle when the flow of urine from the kidneys is compromised – pre-invasive tumors that are prolonged and multifocal in nature. It is impossible to stop the bleeding that is coming from the bladder.
Additionally, cystectomy is performed on patients who have undergone failed partial resection as well as patients who have seen recurrences following radiation.
There are three modes of urine flow that may be utilized. One of these, which is referred to as the Bricker’s method, involves the creation of an ileal conduit that allows urine to flow to a bag that is adhered to the skin. The second choice is to create an intestinal cistern, which, once it is full, can be emptied by the patient themselves through the use of a skin fistula and self-catheterization. The creation of a surrogate urinary bladder that is connected to the urethra is the method that is the most comfortable for the patient (the patient urinates by moving the muscles in his or her stomach).
• Radiation therapy
Patients who do not give their consent to the treatment or patients whose cases make it impossible to perform a radical cystectomy are the ones who are candidates for this particular procedure. The administration of radiotherapy to patients who are in the T2 to T4 progression stage increases the likelihood of achieving a five-year survival without a recurrence of the cancer of the urinary bladder in 35 to 45 percent of patients, and a five-year complete survival in 23-40 percent of patients.
A 45 Gy dosage is administered for the pelvis and subsequently a boost for bladder tumor is done up to 65 Gy dose. Urinary bladder cancer patients have had better success with radiotherapy’s radical treatment options with the introduction of conformal radiation, a 3-dimensional planning method (3D CRT), into clinical practice in the last several years.
• Chemotherapy
Generally speaking, it is utilized as a palliative treatment for patients who have been diagnosed with cancer of the urinary bladder, or in conjunction with surgical procedures or radiotherapy.
In most cases, Inductive chemotherapy is used to shrink the tumor in preparation for radiation therapy.
The treatment strategies that are most frequently used are:
The M-VAC Intravenous administration of metotreksat 30 mg/m2 Doksorubicine 30 mg/m2 Cisplatine 70 mg/m2 Vinblastine 3 mg/m2 intravenous The interval of 28 days that exists between cycles
The M-VC I.V. administration of metotreksat 30 mg/m2 Cisplatine 70 mg/m2 Vinblastine 3 mg/m2 intravenously The interval of 28 days that exists between cycles
CISCA Cyklofosfamide 650 mg/m2 iv Doksorubicine 50 mg/m2 iv Cisplatine 100mg/m2 iv 21 to 28 days is the interval that occurs between cycles.
monotherapy with paclitaxel dosage
One day of intravenous paclitaxel at a dose of 250 mg/m2, with cycles repeated every 21 days
• Treatment of the bladder directly
Such a strategy is indicated in the instances of:
- tumors of T1 degree (many) – multifocal alterations of Ta type – lesions of Tis character
Most commonly used medications are: thipotepa, BCG vaccination, mitomycine, doksorubicine.
When compared to direct bladder chemotherapy, BCG therapy for surface tumors has shown better efficacy thus far due to its ability to reduce the likelihood of regional recurrence and, more importantly, the likelihood of sustaining the disease process at an invasive cancer stage.
• Prognosis
The prognosis for people with urinary bladder cancer depends on the stage of the disease, the type of treatment chosen, and the patient’s overall health. A percentage of cure after five years often ranges between fifty and seventy percent for the first and second degrees, and twenty to thirty percent for the third degree. It is quite uncommon for longer survival durations to be documented in the IV degree.
MEDICAL CARE
The choice of treatment for people who are suffering from cancer of the urinary bladder is determined by the degree of advancement according to the TNM classification, the level of histological malignancy of the tumor, and how the patient is doing generally.
• An operation for therapy
(TURT) stands for “transurethral resection of tumor.”
This procedure is utilized in situations when surface modifications (Ta, T1, T2, as well as the numerous ones) are present, as well as when treating preinvasive tumor Tis, provided that the number of focuses is modest and the atypy is not considerable. If the diameter of the base of the tumor does not exceed 2 centimeters, TURT can also be performed on tumors that are classified as T3a. It is occasionally used as a palliative therapy in cases when the cancer of the urinary bladder has progressed to an advanced stage (T3, T4).
• Section of the urinary bladder surgically removed
It is utilized in situations where a three centimeter margin of healthy tissue can be observed in large, individual foci of T2 tumors and in the early stages of T3 tumors.
• Cystectomy, also known as a complete resection of the urinary bladder
A surgical procedure that is performed in two stages and involves the removal of a bladder along with lymph nodes and the reconstruction of the ability to drain urine from the upper urinary tracts.
The procedure is intended for people who are suffering from:
G3 cancer, which is weakly differentiated, is characterized by an early recurrence following therapy with other modalities. – tumors that invade the neck of the urinary bladder, the prostate urethra, and the bladder triangle when the flow of urine from the kidneys is compromised – pre-invasive tumors that are prolonged and multifocal in nature. It is impossible to stop the bleeding that is coming from the bladder.
Additionally, cystectomy is performed on patients who have undergone failed partial resection as well as patients who have seen recurrences following radiation.
There are three modes of urine flow that may be utilized. One of these, which is referred to as the Bricker’s method, involves the creation of an ileal conduit that allows urine to flow to a bag that is adhered to the skin. The second choice is to create an intestinal cistern, which, once it is full, can be emptied by the patient themselves through the use of a skin fistula and self-catheterization. The creation of a surrogate urinary bladder that is connected to the urethra is the method that is the most comfortable for the patient (the patient urinates by moving the muscles in his or her stomach).
• Radiation therapy
Patients who do not give their consent to the treatment or patients whose cases make it impossible to perform a radical cystectomy are the ones who are candidates for this particular procedure. The administration of radiotherapy to patients who are in the T2 to T4 progression stage increases the likelihood of achieving a five-year survival without a recurrence of the cancer of the urinary bladder in 35 to 45 percent of patients, and a five-year complete survival in 23-40 percent of patients.
A 45 Gy dosage is administered for the pelvis and subsequently a boost for bladder tumor is done up to 65 Gy dose. Urinary bladder cancer patients have had better success with radiotherapy’s radical treatment options with the introduction of conformal radiation, a 3-dimensional planning method (3D CRT), into clinical practice in the last several years.
• Chemotherapy
Generally speaking, it is utilized as a palliative treatment for patients who have been diagnosed with cancer of the urinary bladder, or in conjunction with surgical procedures or radiotherapy.
In most cases, Inductive chemotherapy is used to shrink the tumor in preparation for radiation therapy.
The treatment strategies that are most frequently used are:
The M-VAC Intravenous administration of metotreksat 30 mg/m2 Doksorubicine 30 mg/m2 Cisplatine 70 mg/m2 Vinblastine 3 mg/m2 intravenous The interval of 28 days that exists between cycles
The M-VC I.V. administration of metotreksat 30 mg/m2 Cisplatine 70 mg/m2 Vinblastine 3 mg/m2 intravenously The interval of 28 days that exists between cycles
CISCA Cyklofosfamide 650 mg/m2 iv Doksorubicine 50 mg/m2 iv Cisplatine 100mg/m2 iv 21 to 28 days is the interval that occurs between cycles.
monotherapy with paclitaxel dosage
One day of intravenous paclitaxel at a dose of 250 mg/m2, with cycles repeated every 21 days
• Treatment of the bladder directly
Such a strategy is indicated in the instances of:
- tumors of T1 degree (many) – multifocal alterations of Ta type – lesions of Tis character
Most commonly used medications are: thipotepa, BCG vaccination, mitomycine, doksorubicine.
When compared to direct bladder chemotherapy, BCG therapy for surface tumors has shown better efficacy thus far due to its ability to reduce the likelihood of regional recurrence and, more importantly, the likelihood of sustaining the disease process at an invasive cancer stage.
• Prognosis
The prognosis for people with urinary bladder cancer depends on the stage of the disease, the type of treatment chosen, and the patient’s overall health. A percentage of cure after five years often ranges between fifty and seventy percent for the first and second degrees, and twenty to thirty percent for the third degree. It is quite uncommon for longer survival durations to be documented in the IV degree.