The bladder (urinary bladder, urinary bladder) is the organ located in the lower part of our abdomen and in which the urine (urine) coming from both kidneys accumulates. Its capacity is roughly around 400-450 ml. When enough urine accumulates, there is a sensation of urination and it is voluntarily emptied. The bladder continues with the prostate in men, and urine is excreted from the body through the urinary tract in the penis called “urethra”. In women, the bladder continues with a short urethra and the urinary tract thus ends.
Bladder cancer develops from the covering called mucosa that lines the inner surface of the bladder. We can compare this part to the slippery tissue on the inner surface of our cheek. Bladder cancer appears as cauliflower-shaped masses associated with this tissue (Figure 1).
Apart from this, as the bladder tumor progresses, it tends to grow towards the bladder wall. Thus, it can pass into the connective tissue just below the mucosa or into the deeper muscle layer that forms the actual wall of the bladder.
The most common and well-known symptom of bladder cancer is blood in the urine (hematuria) without pain. Some other symptoms, in order of frequency, are as follows: Burning while urinating, frequent trips to the toilet, sudden feeling of urgency, waking up to urinate at night, burning sensation in the bladder area. However, since these complaints can be seen in many urological diseases, patients with these complaints should not think that they have bladder cancer and should not panic. Because the diagnosis of the disease is basically made by ultrasonography and similar imaging methods. When necessary, the patient’s bladder is examined through a camera, a process called “cystoscopy”, and a definitive diagnosis is made (Figure 2).
After the diagnosis of bladder cancer is made, what needs to be done is to scrape the bladder cancer from the bladder wall. This procedure is performed with a surgical instrument called “resectoscope”, which allows tissue to be cut with the electric current passing through it. The name of this surgery is “transurethral bladder tumor resection” (TUR-T). During this surgery, the tumor, which originates from the bladder wall and generally grows into the bladder, is separated piece by piece from the solid underlying tissue and taken out of the bladder. All samples taken are examined in the Pathology department to reveal the depth (stage) of the disease.
We can compare the bladder wall, where bladder cancer originates, to the wall of a room in real life. The layers of the room wall can be classified as paint, plaster and brick parts. A similar classification applies to bladder cancer. In a bladder tumor, these parts correspond to the mucosa, submucosa and bladder muscle layers, respectively. Following the operation to remove the bladder cancer from the bladder wall mentioned above, the pathologist informs you in which layer the disease is located. As a result, if the tumor invades the mucosa and submucosa layers (paint and plaster layers on the wall), it is called “bladder cancer that has not involved the muscle layer or superficial bladder cancer. On the other hand, if the muscle layer of the bladder is involved, this is called “bladder cancer involving the muscle layer” or deep bladder cancer. The treatment of these two subtypes of bladder cancer is completely different from each other.
In the first case, the bladder is protected and drugs are administered into the bladder to prevent the cancer from recurring and spreading to the deep layers, while in the second case, the bladder is surgically removed and chemotherapy is given before or after, depending on the patient’s condition. Recently, bladder-preserving approaches based on radiation therapy and combining it with chemotherapy have also come to the fore in a limited group of patients with low tumor burden in bladder cancer involving the muscle layer. Please contact Uropark physicians to get information on this subject and to be evaluated in this regard.
