Bladder Cancer Treatment: Symptoms, Stages and Artificial Bladder Surgery
Bladder cancer is the fourth most common cancer in men worldwide. Although it is generally considered a disease of older age, the age of onset is gradually decreasing due to heavy smoking and chemical exposure.
The most characteristic feature of bladder cancer is its high risk of recurrence. This means that the disease must be monitored for life, as if it were a chronic disease. However, the good news is that 70-75% of cases are detected at a ‘superficial’ stage, i.e. before it has spread to the muscle layer. In cancers detected at this stage, complete treatment is possible without removing the bladder, using minimally invasive techniques and drugs administered into the bladder.
In this comprehensive guide, you will find information on everything from the importance of blood in the urine to transurethral resection of the bladder (TUR-M) and the ‘artificial bladder from the intestine’ technology used in cases where the bladder must be removed.
What is Bladder Cancer and How Does it Develop?
The bladder is a flexible, muscular organ that stores urine from the kidneys. The inner surface of the bladder is lined with a special mucous membrane called the ‘urothelium’. Over 90% of bladder cancers begin with the deterioration of cells in this inner layer, which is in constant contact with urine (Transitional Cell Carcinoma).
Cancer cells multiply uncontrollably, first forming cauliflower-like structures. If left untreated, they can take root in the bladder’s muscle wall, then spread to the lymph nodes and other organs.
Risk Factors: Why Me?
Bladder cancer is one of the cancer types with the most clearly understood causes. The culprit is largely evident: tobacco products.
- Smoking: Smoking is the cause in more than half of bladder cancer cases. Carcinogenic substances in cigarette smoke enter the bloodstream, are filtered by the kidneys, and reach the bladder via urine. These toxic substances come into contact with the bladder wall for hours, triggering cancer. The risk is four times higher in smokers.
- Chemical Exposure (Occupational Disease): Workers in the paint, rubber, leather, textile and printing industries face an increased risk due to the chemicals used (aromatic amines).
- Chronic Infections: Long-term catheterisation, untreated bladder stones and chronic irritation.
- Insufficient Fluid Intake: Drinking too little water causes carcinogenic substances to become concentrated in the urine and remain in the bladder for longer periods of time.
- Being a Man: It is 3-4 times more common in men than in women.
Bladder Cancer Symptoms: The Danger of Painless Bleeding
The most important and most common symptom of the disease is haematuria, or blood in the urine.
- Painless Bleeding: The biggest misconception among patients is the thought that ‘I have no pain, so it’s not important.’ Bleeding in bladder cancer is usually PAINLESS. Urine may be tea-coloured, cola-coloured, or bright red. Bleeding may sometimes be clotted.
- Intermittent Bleeding: Bleeding may occur one day and then stop for a month. This does not mean that you have recovered. The cancer continues to grow inside.
- Frequent Urination and Burning: If the cancer is near the bladder neck or mimics an infection (carcinoma in situ), frequent urination and a burning sensation may occur.
- Back and Bone Pain: This occurs if the disease has progressed to an advanced stage (metastasis).
Critical Warning: If an individual over the age of 40 experiences even a single instance of visible blood in their urine, this should be considered a suspected case of bladder cancer until proven otherwise, and they should consult a urologist immediately.
Diagnostic Methods: Is Cystoscopy Something to Fear?
Ultrasound or tomography may show the mass, but visualisation of the inside of the bladder is essential for a definitive diagnosis and treatment plan.
Cystoscopy (Camera Examination)
Many patients are apprehensive about this procedure, but it has become very comfortable nowadays.
- Procedure: A thin, flexible device with a light and camera at the end is inserted through the urinary tract.
- Duration: It takes approximately 5-10 minutes.
- Anaesthesia: It is performed under local anaesthesia (gel) or mild sedation (sleep state), and no pain is felt.
- Importance: The location, number and shape of the tumour can be clearly seen. If a tumour is detected, a decision is made to remove it during the same session or during a planned surgery.
Treatment Methods: The Depth of Cancer Determines the Outcome
Bladder cancer treatment is divided into two types depending on how deep the cancer has spread:
A. Uninstaged (Superficial) Bladder Cancer Treatment
The tumour is confined to the inner membrane and has not invaded the main muscle layer. Seventy-five per cent of patients fall into this group.
1. TUR-M (Transurethral Resection of Bladder Tumours)
It is the gold standard treatment.
- How is it performed? It is inserted through the urinary tract, so there are no incisions in the body. The tumour is shaved off and cleaned using a scraper with electrical energy at its tip, and then sent for pathology.
- Objective: To both diagnose and remove the visible tumour.
2. Intravesical Drug Therapies (BCG and Chemotherapy)
After TUR-M, medication is administered into the bladder via a catheter to prevent cancer recurrence.
- BCG Treatment: This is actually a tuberculosis vaccine. When administered into the bladder, it stimulates the immune system and enables the body’s own soldiers to attack the cancer cells. It is administered once a week for 6 weeks. It is quite effective.
B. Advanced (Deep) Bladder Cancer Treatment
The tumour roots have invaded the muscle wall of the bladder. Simply scraping it away is no longer sufficient, as the cancer has the potential to spread throughout the body via the blood and lymphatic systems.
1. Radical Cystectomy (Removal of the Bladder)
It is one of the largest and most comprehensive surgeries in urology.
- Procedure: The bladder, surrounding lymph nodes, prostate and seminal vesicles in men; and part of the uterus and ovaries in women are removed.
- Method: It can be performed using open, laparoscopic or robotic surgery (Da Vinci). Robotic surgery offers the advantages of less bleeding and faster recovery.
2. What will the new urinary tract be like?
After the bladder is removed, there are three ways to expel urine:
Artificial Bladder (Intestinal Bladder / Orthotopic Bladder): A section of approximately 40-50 cm is taken from the patient’s own small intestine, shaped into a sphere to form a new bladder, and connected to the natural urinary tract.
Advantage: The patient does not need to carry a bag and can urinate normally. Social life and body image are preserved.
Ileal Conduit (Bag System): A small section of intestine is removed, one end is connected to the renal ducts and the other end is brought out through the abdominal skin. Urine fills a bag attached to the skin.
Who is it performed on? It is performed on elderly patients, those with additional illnesses, or those who cannot use an artificial bladder.
3. Chemotherapy and Immunotherapy
In cases of metastatic disease, systemic chemotherapy may be administered before surgery (to shrink the tumour) or after surgery (to kill any remaining cells). In recent years, targeted therapies (immunotherapy) have also achieved significant success in advanced bladder cancer.
Post-Treatment Follow-Up: A Lifetime of Friendship
It is important to remember that bladder cancer is a ‘stubborn’ cancer. Even with superficial tumours, there is a 50-70% risk of recurrence. Therefore:
- Cystoscopy Follow-ups: For the first 2 years, cystoscopy to examine the inside of the bladder is required every 3 months, and thereafter at longer intervals for life.
- Smoking Must Be Stopped: Continuing to smoke significantly increases the risk of recurrence and the likelihood of treatment failure.
Living with an Artificial Bladder
Living with a new bladder made from the intestine requires a learning process.
- Urge to Urinate: As the new bladder has no nerves, there is no normal urge to urinate. The patient feels fullness in the abdomen.
- How to Urinate: The patient empties their bladder by contracting their abdominal muscles (using the straining method).
- Timed Urination: Patients should set an alarm and go to the toilet every 3-4 hours to empty their bladder, otherwise the bladder may become too full and leak urine or damage the kidneys.
- Mucus (Slimy Substance): It is normal for there to be sediment in the urine because the intestinal tissue continues to produce secretions. Drinking plenty of water resolves this.