Synonyms
Bladder tumour, bladder cancerThe bladder carcinoma is a malignant tumour of the bladder. Due to its very insidious and late symptoms, it is often only discovered in a late stage. Depending on the extent and differentiation of the bladder carcinoma, it is treated surgically or with chemotherapy.
If the bladder carcinoma is discovered early, the chances of recovery are very good. This is not least due to the very extensive surgical possibilities. The bladder carcinoma accounts for about 3% of all malignant tumours and is therefore a rather rare tumour.
Men are affected about 3 times more often than women. The age peak of the bladder carcinoma lies between the 50th and 60th year of life. The symptoms often appear late.
The first symptom of bladder carcinoma is a bloody urine (macrohaematuria), whereby urination is painless. Urinary retention, urge symptoms or irritative micturition symptoms can also occur. Late symptoms of bladder cancer are, as with most tumour diseases, weight loss, anaemia and flank pain.
These occur as a result of urinary flow disturbances, which cause the urine to back up into the renal pelvis, leading to stretching pain in the renal capsule. First of all, blood and urine should be examined chemically in the laboratory. However, there are no tumour markers for bladder carcinoma, which is why, with regard to the blood values, mainly the kidney values such as creatinine and uric acid are determined in order to be able to assess the kidney function.
In the urine, both the red blood cells (micro/macrohaematuria) can be determined exactly, as well as a cytological diagnosis, which can give further indications of a bladder carcinoma. In addition, an ultrasound of the kidneys should always be performed. This is a non-invasive but very meaningful way of assessing whether or not there is a mass or an enlargement of the kidneys.
After a mass has been detected, a urogram should always be connected. In this way a tumour of the urinary tract can be excluded. In addition, a computed tomography of the abdomen and an X-ray thorax should be performed to assess metastases in the lungs and the spread of the tumor in the abdomen and pelvis.
The bladder carcinoma is classified according to the TNM classification and the grading of the WHO. Depending on the stage, both the prognosis and the therapy are different. Tis: Carcinoma in situ, i.e. the tumour cells are only located in the outermost layer of the bladder wall.
Ta: Non-invasive tumour of the outermost wall layer, which grows papillarily into the bladder cavity. T1: The subepithelial connective tissue is affected. T2: the tumour infiltrates the musclesT2a: the superficial muscle layers are affectedT2b: the deep muscle layers are infiltratedT3: the tumour infiltrates the surrounding fatty tissueT3a: only microscopically can tumour cells be detected in the fatty tissueT3b: the fatty tissue is also infiltrated by tumour tissue with the naked eyeT4: the tumour infiltrates surrounding organsT4a: prostate, uterus or vagina are affectedT4b: pelvic wall or abdominal wall are affected by tumour tissueAccording to the WHO, the tumour is divided into different degrees of mailigness (grades 1- 3).
Grade 1: a highly differentiated papillary tumour with low malignant potentialGrade 2: low grade malignancy grade The tumor no longer corresponds completely to the urothelial tissue, but this is still recognizable. Grade 3: all other stratification disorders are assigned a high malignancy. –>The radical removal of the bladder has a 5-year survival rate of about 75% in the muscle infiltrative stage.
If the tumour infiltrates the fatty tissue, the 5-year survival rate after complete removal is 40%, the tumour has only affected the neighbouring organs to about 25%. The most important preventive measure to avoid bladder cancer is not to smoke. The other risk factors are mostly occupational and can hardly be avoided.
On the other hand these risk factors are by far not as important as nicotine abuse. Bladder carcinoma is one of the less frequent malignant tumour diseases. Due to the late symptomatology, many bladder carcinomas are discovered as chance findings during urine diagnostics.
Since both the extent of the intervention and the probability of survival vary considerably depending on the stage, rapid intervention is necessary. Due to the very advanced surgical options available today, good and, above all, acceptable results for the patient can be achieved even if the bladder is completely removed. However, metastasized bladder carcinomas are no longer well treatable, but are then, depending on the extent of the metastases, only treated palliatively with chemotherapy or radiation. Due to the proven high risk of bladder carcinoma in smokers, the most important preventive factor is non-smoking.
