Bladder cancer (bladder cancer) – often initially asymptomatic
Smoking is the greatest Risk factor for bladder cancer. Even passive smoking increases the risk of developing it. The following applies: The longer you smoke, the higher the risk for bladder cancer.
It is believed that about every other bladder cancer disease through smoking arises.
Certain chemicals are suspected of causing bladder cancer. List includes chemical substances (So-called. Aromatic amines), which were used in the rubber industry or aniline or (e.g., beta-naphthylamine or benzidine). Bladder cancer occurs as a result of prolonged contact with these and other aromatic amines on, as it is occupational disease accepted.
Bladder infections can increase the risk of bladder cancer if they have been around for years and not be treated. Such a chronic cystitis can, for example, due to permanent urinary tract infections, caused by an indwelling catheter or bladder stones. In tropical countries include chronic bladder infections due to schistosomiasis among the most important risk factors for bladder cancer.
Exists due to blood in the urine and the medical history suspected bladder cancer (bladder cancer), the diagnosis must be secured or disproved. The doctor takes this, first the following investigations:
With a Urine test strips the doctor can determine if (hidden) blood is in the urine.
Cystoscopy is largely painless. In some cases, however, it may be uncomfortable to slightly painful. Built-in hose optical instruments the doctor can search the mucous membrane of the urinary bladder, piece by piece for suspicious spots. If necessary, he takes out a small pair of pliers tissue samples (biopsies). A fabric specialist (pathologist) then examined these samples under a microscope. In the cystoscopy, the doctor can see the openings of the two ureters into the bladder. Way to determine whether the blood may come from one of the two ureters. That would mean that the bleeding source is located elsewhere or above the bladder.
A microscopic examination of the urine on malignant cells, the so-called cytology, can contribute in bladder cancer diagnosis. It takes place when the cystoscopy gives the suspect a precursor of superficial bladder cancer.
If the cystoscopy the suspected bladder cancer, an X-ray examination of the urinary tract includes the so-called urography with contrast agent. The resulting X-ray image is excretory and represents the lower urinary tract, including.:
In addition, computed tomography (CT) or magnetic resonance imaging (MRI) are used in some cases as complementary tests. They make it possible to assess the precise spread of bladder cancer in the pelvic area.
If the bladder cancer already growing into the muscle of the bladder wall, Doctors refer to infiltrating or muscleinvasive Bladder cancer. The standard treatment of a limited to the bladder tumor looks the surgical removal of the bladder and the pelvic lymph nodes before: the so-called radical cystectomy
In men Located at the urologist also
The man is no longer capable of procreation after this operation. Depending on the surgical procedure Erectile dysfunction can (erectile dysfunction) occur, which can be successfully treated in many cases with medication, a vacuum pump or penile.
In the Mrs the doctor removes as part of the bladder cancer therapy other than the urinary bladder:
This intervention has physical and often psychological effects, as these organs are very important for the self-image of many women. After removal of the uterus, the woman can no longer have children. Since most women are diagnosed at an advanced age tend to bladder cancer, fertility is no longer important in general. In addition, lead the missing ovaries in younger patients who are not yet in menopause (menopause) were to short-term changes in hormone levels. Should complaints and questions arise, it is advisable to discuss this with a gynecologist.
The remote bladder needs to be replaced so that the urine is artificially created in a "bladder substitution" can collect or is derived directly. There are the following options, resulting in so-called continents and incontinent Urinary diversions are divided:
In the bladder substitution (Orthotopic) connects the surgeon a decoupled from the rest of the small intestine piece of intestine on the one hand to the two ureters and the other with the urethra. The ureters normally transport the urine from the kidneys to the bladder, the urethra passes the urine in men over the penis and in women over the mouth of the urethra in the region of the vulva to the outside. The thus created internal reservoir intestine allows an almost natural urination after a bladder cancer surgery. In some cases, the person concerned must intestinal substitute bladder (several times a day and at night time) emptied via a catheter. Pelvic floor exercises help to regain control of urination again or improve (incontinence) to prevent urinary incontinence.
If a replacement bladder out of the question as Harnreservoir, is a so-called Pouch another continents method. This is a reservoir that the operator of a "disused" forms loop of the small intestine or colon. He closes the urethra at this piece of intestine and creates a direct opening to the abdominal wall, called a stoma. The ostomy includes tight seal and functions as a valve so that no involuntary urine from the reservoir can escape to the outside. Using a catheter the person can empty the stored urine over the stoma.
The Implantation of the ureter into the rectum (Last part of the colon) is the third option of the continent urinary diversion after bladder cancer surgery. In the rectum, the urine mixes with the chair and the person can remove him arbitrarily through the anus (control of the sphincter).
All three alternatives are only useful if the kidneys are working well, since the long contact time of the urine with the intestinal tissue causes certain substances to return to the blood, which must then filter the kidneys again.
Is a radical bladder removal in bladder cancer (bladder cancer) is not possible or reject those affected it off, they can be treated with radiation therapy (radiotherapy). In general, the doctor combined irradiation with chemotherapy (so-called. Radiochemotherapy). Previously, the doctor bladder cancer as possible by cystoscopy (TUR) should be removed completely. An advantage of this method is that the bubble is maintained. The most accurate treatment planning sparing the surrounding healthy tissue - the risks of radiation treatment are low.
Should remain after the treatment, a residual tumor or bladder cancer recurrence, the doctor will explain how to proceed to the person concerned and propose may bladder cancer surgery.
In advanced bladder cancer that has grown over the muscle layer out and has already reached neighboring organs in some cases (so-called. T3 and T4 stage), acting on the whole body chemotherapy may be required. question are two versions - in both cases, the cancer drug access (cytostatics) that come in the chemotherapy used by infusion through the bloodstream to the malignant cells in the area of the bladder or the organs where secondary tumors (metastases) are located. There, the drugs kill off the cancer cells.
Are already Distant metastases available (for example, in bone, liver or lung), chemotherapy is often the only treatment option to the to prolong survival and the life quality the person concerned to improve. Although chemotherapy is associated with side effects, but these can nowadays be well controlled. Drugs or substances used in chemotherapy for use, include: