Bladder cancer

Description:

Kliniko-morfologichesky classification of cancer of bladder. On a morphological structure malignant tumors of a bladder with an overwhelming frequency have an epithelial origin. Transitional cell cancer meets frequency of 80-90%, an adenocarcinoma - 3%, planocellular cancer - 3%, papilloma - 1%, sarcomas of various origin - 3%.

Bladder Cancer symptoms:

The clinical picture of cancer of bladder depends on a tumor stage. New growths of Ta-T1 usually proceed asymptomatically. The gross hematuria or a microhematuria which can once appear, and then long time happens one of the first clinical manifestations not to disturb the patient.

Massive or it is long the proceeding gross hematuria can cause a bladder tamponade - a state at which clots almost completely fill a bladder.

Other danger of the proceeding hamaturia is decrease in level of hemoglobin and the patient's anemization. This life-threatening state is frequent forces to undertake the emergency operative measure.

In process of growth of a tumor also other symptoms which are often connected with accession of an infection begin to join. Various frustration of an urination - a dysuria can be shown.

Emergence of pain over a bosom can be a sign of germination of a tumor in a muscular layer. At first it is connected with the act of an urination, and then, in process of germination of a muscular wall of a bladder and infiltration of the next bodies, pain becomes a constant.

Growth of a tumor of a bladder quite often leads to a prelum of mouths of ureters that breaks an urine passage from kidneys. Such patients have a nagging pain in lumbar area, is frequent as renal colic. Often on this background there is an attack of acute pyelonephritis.

Diagnosis. Quite often at widespread cancer it is possible to define a tumor at women at conjoined manipulation through a vagina and a front abdominal wall, at men - through a rectum. In analyses of urine at cancer of a bladder increase in quantity of erythrocytes, in blood tests - the decrease in level of hemoglobin indicating the proceeding bleeding is noted.

One of ways of diagnosis of cancer of bladder is the cytologic research of urine which is conducted usually several times. Identification in urine of atypical cells is pathognomonic for a bladder new growth. In recent years there was one more laboratory diagnostic method, so-called VTA (bladder tumor antigen) the test. By means of a special test strip the urine research on existence of a specific antigen of a tumor of a bladder is conducted. This technique is usually applied as a method screening diagnosis.

In diagnosis of cancer of bladder ultrasonic diagnosis is of great importance. Transabdominal study allows to reveal tumors more than 0,5 cm with probability of 82%. The educations located on sidewalls are most often visualized. At localization of a tumor in a bladder neck use of a transrectal research can be informative. It is better to diagnose new growths of the small sizes by means of the transurethral scanning which is carried out by the special sensor entered on an urethra into a bladder cavity. A lack of this research is its invasiveness. It is necessary to remember that ultrasonography of the patient with suspicion of a tumor of a bladder has to include surely a research of kidneys and upper uric ways for the purpose of identification of dilatation of pyelocaliceal system as prelum sign a tumor of the mouth of an ureter.

Tumors of the big sizes come to light by means of excretory urography or a retrograde tsistografiya. The sedimentary tsistografiya according to Knayze-Shober helps to increase informational content of a research. The spiral and multispiral computer tomography with contrasting is of great importance in diagnosis of cancer of bladder. By means of these techniques it is possible to establish the size and localization of education, its relation to mouths of ureters, germination in the next bodies, and also a condition of kidneys and upper uric ways. However this method can be applied if the patient is able to save up a full bladder and to hold urine during research time. Other lack of KT is insufficient informational content in identification of depth of germination of a tumor in a muscular layer in connection with a small possibility of visualization of layers of a wall of a bladder.

The magnetic and resonant tomography is also applied in diagnosis of new growths of a bladder. Unlike KT, with much bigger accuracy it is possible to estimate a tumor invasion at a muscular layer of a bladder or the next bodies.

Despite informational content of hi-tech methods, the main and final way of diagnosis of cancer of bladder is the tsistoskopiya with a biopsy. Visualization of a tumor, the conclusion of the morphologist about the malignant nature, a structure and degree of a differentiation of a new growth of a bladder are leaders in the choice of a method of treatment.

The fluorescent tsistoskopiya can increase informational content of a tsistoskopiya. Feature of this technique is that after processing of a mucous membrane of a bladder solution of 5-aminolevulinic acid at a tsistoskopiya with use of a light flow of a blue-violet part of a range tumoral fabric begins to fluoresce. It is connected with the increased accumulation by cells of a new growth of the fluorescent agent. Use of this technique allows to reveal formations of the small sizes which often cannot be found by any other method.

Bladder Cancer reasons:

Finally the etiology and links of a pathogeny of cancer of bladder are not established. The separate risk factors with a high probability causing developing of cancer are revealed. So, for example, more than 100 years it is known that the people working with aniline dyes have bladder cancer much more often. It is caused by the fact that the decomposition products of aniline dyes removed with urine have the expressed cancerogenic effect on a mucous membrane of a bladder. Thus, in risk group there are artists, painters, interior designers.

In risk group there are drivers. It is connected with cancerogenic action of products of combustion of gasoline, and also with a habit to use not enough liquid and to detain long urine. By 2-5 times the risk is increased to develop bladder cancer at smokers. At the same time the probability increases with a smoking experience.

Close connection of the malignancies and chronic diseases of a bladder, and also a disease causing an urinary stasis is traced: prostate hyperplasia, urethra stricture, etc.

Cancer therapy of a bladder:

The main way of cancer therapy of a bladder is surgical. During removal of a bladder the issue of removal (derivation) of urine is resolved. Now all options of operations can be divided into the following groups:

  1. Operation after which urine is emitted constantly and patients need an urinal, - an ureterocutaneostomy.
  2. Operations at which internal removal of urine is used - mouths of ureters open in intestines.
  3. Operations with creation of a tank from which urine is emitted at the request of the patient.

Conservative methods of cancer therapy of a bladder include: radiation therapy - remote and contact irradiation system or local intravesical chemotherapy and a local immunotherapy vaccine BTsZh. All these techniques can be applied as adjuvant or neoadyyuvantny therapy, or as palliative treatment at patients whose general condition does not allow to resort to an operative measure.