Urology

Bladder and Urine Tracts Cancer

What is the disease, whom may it affect, how it can be treated and where? All the answers to these questions - in the following article.

Bladder and urine tracts cancer is considered the fourth most common tumor among men and the tenth most common among women.
This is a tumor which grows from the cells coating the urine system, mostly in the bladder, but such a tumor can also appear in the ureters and the kidneys. This tumor is mostly diagnosed in 70 year old men, although it can be found in younger men as well

What are the causes for bladder and urine tracts cancer?

The major risk factor is smoking, and the diseases can occur in individuals who stopped smoking years ago, although there is a much greater risk with those who are still smoking. There are also risk factors relating to dealing with certain chemicals and former exposure to radiation.

The main expression of the urine tract cancer is painless blood in urine. Mostly, the patient is surprised to find blood in the toilet, and therefore this situation requires immediate clarification, to locate the place in the urine system which causes the bleed and the reason for it.

How to diagnose bladder and urine tracts cancer?

The clarification must include a special CT scan, called CTU, and also a cystoscopy - during which we insert a thin camera to the bladder through your genitals. The camera is inserted under local anesthesia, gently, and makes it possible to see tumors in the lower urinary system, should they exist.

How to treat bladder and urine tracts cancer?

Treatment of the bladder tumors are TURBT surgery, to remove the entire tumor through the ureter. The surgery is conducted under general or regional anesthesia. The surgery consists an immediate treatment to the disease and also allows exact diagnosis that this is indeed cancer, and the determination of its nature. There are various levels of malignancy in bladder cancer. The level of malignancy is determined by a pathological exam under a microscope, and by the level of penetration to the bladder wall, the ureter or the kidney. Tumors of low malignancy which do not penetrate the wall but are limited to the mucosal layer are usually not life threatening. However, these tumors have a recurrence tendency of about 80%, and sometimes they recur in a more severe, aggressive way.

Tumors which are highly malignant may also recur, however the probability of their progression and penetration to the muscle layer is much higher. When a tumor penetrates the muscle of the bladder or the ureter it becomes life threatening. Without treatment, most patients will develop metastases which threaten their lives.

Such situations require significant surgery that removes the entire bladder, the prostate and the seminal vesicles in men, while in women, we remove the entire bladder, the womb, the ovaries and a part of the vagina. The surgery concludes in creating an artificial opening in your abdominal wall to drain the urine (stoma) or in creating a new bladder (reconstruction), depending upon the personal data of the patient. Often, there is also a need for chemotherapy before or after the surgery.

When the disease does not penetrate the muscle but it is recurrent or it has other, more dangerous characteristics, mostly there is need of preventative treatment using substances inserted to the bladder. The most efficient treatment is BCG. This is a solution of a live, weakened bacteria of bovine tuberculosis, inducing the awakening of the immune system to generate a severe reaction to the tumor. This treatment is given to the bladder using a catheter once a week, for 6 time, and then in 3 weekly therapies, every three months, for two years.

A more innovative way to provide the medication is called synergo. This method uses a catheter equipped with a microwave system, to heat the bladder wall while providing chemotherapy. This method, implemented in the Kaplan medical Center Urology Unit significantly improves the efficiency of the therapy.

Another alternative is injecting chemotherapy using a catheter, in a similar way. This treatment has less side effects, but it is also less efficient in comparison with BCG, and is mostly designated for low risk patients.

There are middle situations in which the cancerous tumor is close to the muscle but did not reach it. In such situations it is obligatory to perform a repetitive abscission in the area of the tumor, to examine whether any tumor is left and has it reached the muscle layer.

In situations that the tumor exists in the upper urinary tracts (kidney or ureter) the risk of progression to metastasis is high. The treatment of these situations is by surgery to remove the kidney and the ureter along with a small portion of the bladder. Sometimes, in a small and low malignancy level tumor, we may consider other actions in order to preserve the kidney.

A patient who suffered from this type of cancer is at risk for recurrence, and therefore must hold a medical followup and quit smoking, for the rest of his life.