Bladder cancer is a malignancy that begins in the epithelial cells of the bladder. This cancer varies in its aggressiveness, but the main concern is its recurrence and the potential for progression to invasive disease. The most common form is Transitional Cell Carcinoma (TCC), which begins in the transitional cells that line the inside of the bladder. Bladder cancer can present with a variety of symptoms, including gross hematuria, dysuria, and painful urination. It is important to note that many aspects of diagnosis and treatment of this disease are aimed at preventing invasive growth, which is key to maintaining bladder function and the patient's quality of life.
History of the disease and interesting historical facts
The history of bladder cancer research goes back to ancient civilizations, when descriptions of urinary tract diseases are found in clinical records of ancient Egyptians and Greeks. Archaeological finds contain references to “bladder cancer,” indicating that humanity has been observing this disease for thousands of years. In the Middle Ages, the number of described cases increased due to the development of medical science and the concept of malignant diseases. In the 18th century, surgery became the first effective treatment. However, improvements in diagnostics and therapy began to be observed only in the 20th century, thanks to various studies and the introduction of innovative technologies.
Epidemiology
According to the World Health Organization, bladder cancer is the eighth most common cancer among all cancers. It is estimated that in 2020, more than 573,000 new cases were registered, as well as about 200,000 deaths due to this disease. The epidemiology of bladder cancer has its own peculiarities: in most cases, the disease is diagnosed in men over 65 years old, while in women this type of cancer is less common, however, the corresponding incidence rates are increasing. It is important to note that risk factors such as smoking and exposure to certain chemicals in the workplace lead to higher rates of disease in certain population groups.
Genetic predisposition to this disease
Genetic predisposition to bladder cancer is considered as a combination of hereditary and acquired factors. Studies have identified several genes that may be involved in oncogenesis: TP53, FGFR3, KMT2C and others. For example, mutations in the TP53 gene are associated with malignant forms of the disease and its aggressive course. Genetic markers such as loss of homozygosity in the 9p and 17p region have also been associated with the risk of developing bladder tumors. Active research is currently ongoing to identify new markers that can help in early diagnosis and risk stratification.
Risk factors for the development of this disease
Risk factors for developing bladder cancer include:
- Smoking: Smoking has been proven to increase the risk of bladder cancer by 2-3 times.
- Exposure to chemicals: Work in industries involving gasoline, aniline dyes and other carcinogens increases the risk of developing the disease.
- Presence of chronic diseases: Chronic urinary tract infections and cystitis can contribute to the development of tumors.
- Age: Old age is a significant risk factor, especially after 65 years.
- Floor: Men are more susceptible to the disease than women.
Diagnosis of this disease
Diagnosis of bladder cancer includes a range of measures:
- Main symptoms: Macrohematuria, painful urination, frequent urge to urinate.
- Laboratory tests: Urine analysis for tumor markers (UroVysion).
- Radiological examinations: Ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI) to assess the extent of the process.
- Other types of diagnostics: Cystoscopy with biopsy is the "gold standard" for diagnosis.
- Differential diagnosis: Other causative factors such as infections and stones must be excluded.
Treatment
Treatment for bladder cancer varies depending on the stage and degree of invasiveness of the tumor:
- General treatment: For early forms of the disease, cystoscopic removal of tumors may be sufficient.
- Pharmacological treatment: Immunotherapy using Bacillus Calmette-Guérin (BCG) or drugs such as mifepridin and combinations of chemotherapy drugs.
- Surgical treatment: In cases of invasive cancer, partial or total cystectomy may be required.
- Other types of treatment: Supportive therapy such as physiotherapy and anxiolytics.
List of medications used to treat this disease
Drugs used in the treatment of bladder cancer include:
- Immunotherapy (BCG vaccine)
- Pembrolizumab
- Atezolizumab
- Gemcitabine
- Cisplatin
Disease monitoring
Monitoring the condition of patients who have had bladder cancer consists of the following stages:
- Control stages: Regular cystoscopies and urine tests to detect recurrence.
- Forecast: The prognosis depends on the stage of the disease, but with timely diagnosis, survival is more than 90% in the early stages.
- Complications: Relapses and invasive growth are possible, requiring additional intervention.
Age-related features of the disease
Different age groups exhibit different characteristics of the course of bladder cancer:
- Young patients: Cancer is often aggressive and requires a more proactive approach to treatment.
- Elderly patients: Often a more favorable prognosis is observed, but concomitant diseases occur.
- Teenagers: Cases of bladder cancer are extremely rare and require an individual approach.
Questions and Answers
- What are the main symptoms of bladder cancer? The main symptoms are macrohematuria, frequent urge to urinate and painful urination.
- Who is at risk for developing bladder cancer? Those at risk include smokers, chemical industry workers and people over 65 years of age.
- How is the disease diagnosed? Diagnosis includes cystoscopy, urine tests, and imaging studies such as CT scan and MRI.
- What are the main treatments for bladder cancer? The main treatment methods include immunotherapy, chemotherapy and surgical removal of the tumor.
- What is the prognosis if the disease is detected early? When bladder cancer is detected early, survival rates can be greater than 90%.
