Bladder cancer is a type of cancer that starts in the cells of the bladder, which is a hollow organ in the pelvis responsible for storing urine. The majority of bladder cancers are non-lethal and do not have a high potential for spreading. However, they have a tendency to recur. About 30% of bladder cancers are classified as aggressive tumors that have the potential to invade the muscle layer of the bladder and spread to other parts of the body through metastasis.

Many cancers are named based on the tissue of origin or the location in the body. Bladder cancer that is confined to the superficial layer of the bladder without invading the muscle layer is called superficial or non-muscle-invasive bladder cancer. After treatment, superficial bladder cancer can recur. Recurrence often manifests as the reappearance of a superficial tumor with similar characteristics, either at the same location or in another part of the bladder. The majority of recurrences do not spread to other parts of the body; they remain localized in the bladder. Therefore, regular follow-up visits for patients with bladder tumors are important.

Bladder cancer, also known as bladder carcinoma, predominantly occurs in the adult population, with a higher incidence in males compared to females.

What Causes Bladder Cancer?

The exact cause of bladder cancer is not known. However, there are several risk factors that may contribute to its development.

Bladder Cancer: Causes and Symptoms

Bladder cancer is often caused by several risk factors, including:

1. 1 - Smoking: The most common risk factor for bladder cancer is the use of tobacco products. Individuals who smoke or use tobacco products are 4 to 7 times more likely to develop bladder cancer compared to non-smokers. Passive smoking (exposure to secondhand smoke) also increases the risk of bladder tumors.
2. 2- Age: Bladder cancer is more frequently diagnosed in individuals over the age of 50. The majority of people diagnosed with bladder cancer are above this age threshold.
3. 3 - Gender: Men have a 3 to 4 times higher likelihood of developing bladder cancer compared to women. However, due to the increasing prevalence of smoking among women in recent years, the incidence of bladder cancer in women has been rising. Women also have a higher chance of mortality from bladder cancer compared to men.
4. 4 -Chemical Exposure: Certain industries, such as textile, leather, paint, rubber, battery, chemical, or printing industries, involve exposure to chemicals that can trigger bladder cancer.

Other risk factors for bladder cancer include:

1. 1 - Family history of bladder cancer
2. 2 - Chronic bladder infections
3. 3 - Inadequate fluid intake and holding urine for prolonged periods
4. 4 - Consuming a diet high in fats or additives

Symptoms of Bladder Cancer

Once bladder cancer develops in the body, the most noticeable symptom that prompts individuals to seek medical attention is the presence of visible red or reddish-colored urine due to the mixing of red blood cells. This symptom is known as macroscopic hematuria.

In addition to blood in the urine, other symptoms that may be observed during the course of the disease include:

1. • Pain in the lower abdomen and pelvic region
2. • Frequent urination
3. • Urgency to urinate
4. • Microscopic presence of blood in the urine
5. • Presence of blood clots in the urine
6. • Painful urination
7. • Feeling of mass or fullness in the pelvic region
8. • Back pain
9. • Fatigue
10. • Weight loss

If the disease spreads to other organs and tissues (metastasis), various symptoms may occur depending on the affected site. For example, coughing up blood or experiencing cough-related symptoms may indicate the spread of bladder cancer to the lungs. The emergence of bone pain may be a sign that bladder cancer has spread to the skeletal system.

How is bladder cancer diagnosed?

How is Bladder Cancer Diagnosed? Various tests and procedures can be used to diagnose bladder cancer:

1. 1. Physical Examination: The doctor will perform a physical examination by palpating the abdomen and pelvic area to assess the size and shape of the bladder.
2. 2. Urine Tests: A urine sample is examined for the presence of cancer cells or blood.
3. 3. Intravenous Urogram (IVU): In this test, X-ray images of the kidneys, urinary tract, and bladder are taken using a contrast agent. This test can help determine the location and size of the tumor.
4. 4. Cystoscopy: In this procedure, a camera called a cystoscope is inserted to visually examine the inside of the bladder. The doctor evaluates the images to determine the location and size of the tumor. A tissue sample near the tumor may also be taken with the cystoscope for biopsy.
5. 5. Biopsy: A sample of the tumor may be taken to determine if it contains cancer cells. This sample is examined under a microscope to confirm the diagnosis of cancer.
6. 6. Computed Tomography (CT) or Magnetic Resonance Imaging (MRI): These imaging tests can be used to evaluate the spread of bladder cancer.

These diagnostic procedures help doctors determine the presence, location, and stage of bladder cancer, which guides treatment decisions.

The cyctoscopic image of bladder cancer

How is Bladder Cancer Treated?

In the treatment of bladder cancer, the tumors detected are removed through the transurethral resection (TUR) procedure using a cystoscopic system. This procedure is performed by entering through the urinary canal without making any incisions in the body. After TUR, the excised tumor tissue is sent for pathological examination, providing detailed information about the spread and type of cancer in the bladder.

When planning the treatment of bladder cancer, factors such as the location of the tumor in the bladder, the pathological grade of the tumor, the involvement of different layers of the bladder, whether it has spread to organs outside the bladder, and the patient's age and overall health condition are taken into account.

The majority of bladder cancers, at the time of diagnosis, involve only the bladder epithelium without invading the muscle layer. This type of bladder cancer is called superficial bladder cancer, and TUR surgery is often sufficient for treatment. In cases of superficial tumors with a high pathological grade, in addition to TUR surgery, intravesical instillation of Bacillus Calmette-Guérin (BCG) vaccine or chemotherapy may be given to induce destruction of the tumor tissue by enhancing the body's immune response. Patients are regularly monitored with cystoscopy and imaging techniques to assess the likelihood of tumor recurrence.

For tumors that have invaded the muscle layer by penetrating the inner lining of the bladder, the treatment is radical cystectomy, which involves complete removal of the bladder. Radical cystectomy surgery almost always includes the removal of the prostate gland in males and the uterus in females. During the radical cystectomy procedure, different techniques can be used to create a new bladder using the patient's small intestine, either in an open or minimally invasive approach known as robotic-assisted surgery. While radical cystectomy surgery can be performed using the traditional open method, advancements in technology have enabled the use of the robotic-assisted approach.

In cases where the tumor has affected the outer layer of the bladder (serosa) or has spread to other tissues and organs, surgical methods are not preferred, and systemic chemotherapy or radiation therapy are used as treatment options.

How is Follow-up Done After Bladder Cancer Surgery?

After surgery, follow-up is conducted through cystoscopies at 3 or 6-month intervals, based on the pathological results. Even if no tumor develops, it is necessary to be followed up for at least 10 years.