Papillary urothelial tumor with low malignant potential

Definition of the concept

Urothelial carcinoma is a malignant tumor that in 90% of cases grows from the tissues of the mucous membranes of the bladder. The basis of the neoplasm is transitional cell structures.

Urothelial carcinoma is divided into two types: superficial and invasive. The first tumor grows from the top layer of mucous membranes lining the inside of the bladder. This type of neoplasm occurs in the majority of patients.

The invasive form is characterized by deep germination. This type of carcinoma invades the muscles that line the walls of the bladder.

The pathogenesis of the tumor is not fully understood. It is believed that the degeneration of bladder cells begins with frequent contact with urine containing carcinogenic substances. Under the influence of this factor, processes are launched in the mucous membrane that provoke the appearance of an aggressive tumor characterized by rapid growth.

Treatment methods

Treatment for transitional cell carcinoma depends on the stage of the disease. There are the main therapeutic methods that are most often used to combat bladder cancer:

Surgical method

Surgery is always the first choice when a patient is diagnosed with cancer. Tumor removal is the only effective therapeutic method in oncology. Surgery is performed in two ways:

• Total resection.
• Segmental resection.

Total resection is performed when the tumor has grown into the organ tissue and cannot be removed independently. A cystectomy is performed, after which the surgeon creates an artificial bladder. To do this, use part of the large or small intestine. In addition, ureteroplasty is performed. This surgical intervention allows you to normalize the process of urinary passage and improve the patient’s quality of life.

Segmental resection is performed when the tumor has not yet grown deeply into the organ tissue. This operation involves removing the part of the bladder that has undergone a pathological process and nearby lymph nodes. In this case, bladder function is not impaired. There are cases when it becomes necessary to remove a section of the organ that is connected to the ureter. In this case, additional plastic surgery will be required to restore normal urine output.

Radiation therapy

Radiation therapy is prescribed to destroy cancer cells and reduce the size of the malignant tumor. This treatment method is prescribed to those patients who have been diagnosed with invasive cancer. In addition, radiation therapy is indicated after surgical removal of the tumor. The patient undergoes radiation five days a week for two months.

Chemotherapy

Chemotherapy is used both independently and in addition to radiation sessions. The method is based on the use of drugs with a cytostatic effect. In other words, these drugs kill cancer cells. To treat transitional cell cancer of the bladder, two types of chemotherapy are used, which differ in the way the drugs are administered:

• Intravesical. Cytostatic agents are injected into the bladder cavity. This method allows you to act directly on the lesion, destroying the tumor at the site of its attachment. According to statistics, intravesical administration of medications causes a lower percentage of side effects, and if they do develop, they are not accompanied by a pronounced clinical picture. Throughout the entire treatment period, the patient is diagnosed with hematuria. This symptom is not cause for concern, and, as a rule, disappears after discontinuation of the drugs.
• Systemic. Medicines are administered intravenously. The method helps to destroy cancer cells not only at the site of the tumor, but also throughout the body when metastases develop. The nature of the side effects depends on what drug is administered and how the patient responds to it. The number of courses is prescribed by the doctor based on the degree of development of the pathological process.

Biological method

Biological therapy works at the cellular level. It is not used as an independent type of treatment, but in the complex fight against cancer, the effectiveness of this method has been proven. The essence of biotherapy is to block the factors of division and growth of malignant cells, locate foci of metastasis in the body and neutralize them.

Treatment with biotherapy is not suitable for all types of cancer, and is prescribed by a doctor after the patient has undergone a complete examination. There is one type of biological method called immunotherapy. To carry it out, they use agents similar to substances produced by the human immune system. Additional stimulation of lymphocytes is created aimed at destroying tumor cells.

It is strictly forbidden to use traditional methods for the treatment of cancer, since it is possible to stimulate the growth of tumor cells if the ingredients are chosen incorrectly.

Classification

Treatment tactics for carcinoma are determined depending on the type of tumor. The classification of a malignant tumor is based on several criteria. Superficial carcinomas are divided into:

• urothelial g1;
• urothelial g2;
• urothelial

The first type of neoplasm is characterized by low malignancy and is well visualized during examination of the bladder. The course of the oncological process does not cause pronounced changes in the structure of the organ, as a result of which the latter retains its basic functions.

Type g1 tumor is characterized by slow development. The prognosis for such a neoplasm is favorable, since the oncological process does not spread beyond the original focus.

With urothelial carcinoma of the second type, malignant cells are detected on almost the entire surface of the mucous membrane of the affected organ. The neoplasm in this case is characterized by moderate growth.

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Carcinoma type g3 is a poorly differentiated cancer characterized by aggressive development. A tumor of this type consists exclusively of malignant cells and metastasizes relatively early.

The histological features of the tumor determine the extent of surgical intervention. That is, depending on the type of carcinoma (g1, g2 or g3), the doctor removes part or all of the bladder and (if necessary) adjacent structures.

Neoplasms are also divided among themselves by appearance. According to this classification, papillary urothelial carcinomas of the bladder are more common. Externally, the tumor resembles wart growths that appear inside the organ. Less commonly, ulcerative urothelial carcinoma is detected in bladder tissue.

The latest cancer classification is based on the degree of tumor invasion into adjacent structures. Based on this criterion, the following forms of malignant neoplasms are distinguished:

1. Non-invasive papillary. They are localized strictly in the mucous membrane of the bladder and do not metastasize.
2. Invasive. Penetrates into the muscle tissue of the bladder.
3. Metastatic. Cancer cells spread through the lymphatic system throughout the body.

In addition to the factors listed above, the prognosis of the development of the tumor process is influenced by the structure of the tumor. Urothelial carcinomas are composed of squamous and glandular cells. If the former predominate over the latter, they speak of a negative scenario for tumor development.

What types of carcinoma are there?

Correct treatment can be prescribed only if the specialist is maximally informed about all the characteristics of the pathology in a particular patient. For details refer to the international classification. Only there all studies of the histology, morphology and clinical manifestations of cancer are collected in one place, which will significantly facilitate the choice of adequate treatment.

Externally, in most cases, a non-invasive form of carcinoma is diagnosed, which looks like a knot of villi with a brown color. Much less common is the follicular type with interspersed follicles with a brownish-red color.

Classification of carcinomas by growth into the walls of the organ

• A non-invasive form of urothelial cancer develops inside the organ on the mucous membranes. This formation is not characterized by aggressive spread, there are no sites of stasis;
• The invasive form of carcinoma is characterized by intensive germination into the muscles of the bladder organ;
• The metastatic form of urothelial cancer is distinguished by its extensive spread. Atypical cells enter the lymph flow and, together with the lymph flow, affect even the most distant organs and tissues in the patient’s body.

Histological features

1. Papillary transitional cell carcinoma. In this form, the cells practically do not change; the biopsy section is light red or pink. This tumor is soft in structure, resembles a sponge in appearance and is often located on a flexible stalk, which makes it easy to remove;
2. Transitional cell inverted papillary cancer is extremely rare; according to histology, the structure is very active, since each of the cells undergoes degeneration into a malignant form. The structure contains many nipples and is brush-like. The surface is covered with epithelium, there is a wide stalk at the base;
3. Urothelial carcinoma of the bladder, squamous cell type. The rarest and most dangerous type of tumor. When this form develops in men, the background will always be prostatitis and prostate adenoma. Women certainly experience degenerative changes in the uterus or ovaries.

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The main stages of carcinoma in the bladder

To prescribe an effective treatment regimen, a specialist needs to know the degree of development of carcinoma. This neoplasm has a peculiarity - 3 stages of development, and not 4, like others. Let's look at the stages in more detail.

• Carcinoma grade 1. Found more often than others. The cells resemble healthy ones in their structure. Papillary formations grow slowly, sometimes up to 6 years. Do not grow into neighboring tissues and organs;
• Carcinoma grade 2 – bladder carcinoma g2. Papillary neoplasm is rarely detected at this stage. The histology shows significant changes. The number of nuclei in cells is actively growing, and transformation into a malignant form occurs. Abnormal cells can germinate, but can only affect regional lymph nodes;
• Grade 3 carcinoma is the rarest cancer of the bladder. It develops exclusively in cases of lack of treatment. It is distinguished by hematogenous metastasis, that is, it reaches the most distant places in the patient’s body through the bloodstream. It can be discovered after death, during an autopsy.

Both the stage and the degree of carcinoma are needed not only to determine adequate treatment, but also to make prognoses for the development of a person’s condition and the dynamics of disease progression. This indicator is determined based on the lesion, and the specialist determines the degree of tumor development and possible areas of spread of its metastases.

Stages

The development of urothelial carcinoma, regardless of the degree of aggressiveness, goes through several stages, each of which is characterized by its own symptoms.

Stage 1

At the first stage, cancer cells located on the surface of the mucous membrane degenerate. At this stage, muscle fibers retain the same structure, and metastases are not detected during examination of the body, including in regional lymph nodes.

Diagnosing urothelial carcinoma at the first stage is difficult. But if the tumor is detected early, treatment is quick and with virtually no consequences.

Stage 2

The second stage is characterized by tumor growth into the muscle layer of the bladder. This stage is characterized by more pronounced symptoms than the previous one, since the development of a neoplasm provokes dysfunction of the organ.

It is not uncommon for carcinoma to metastasize to regional lymph nodes at the second stage. At the same time, neighboring tissues and organs remain undamaged. In this case, the presence of cancer in the bladder is indicated by blood clots contained in urine.

Stage 3

Stage 3 carcinoma is diagnosed when cancer cells have spread beyond the bladder and affected regional lymph nodes and adjacent organs.

The prognosis for the development of the oncological process at this stage is unfavorable. But in some cases, a complete cure of the patient is possible.

Stage 4

At the fourth stage of development, urothelial carcinoma cannot be treated. Therapy for such a tumor is aimed at extending the patient’s life expectancy and improving the patient’s condition.

This is explained by the fact that fourth-degree carcinomas give distant and multiple metastases, which are almost impossible to detect. In addition, the body at this stage is weakened and is not always able to withstand aggressive treatment.

Papillary bladder cancer - what is it?

Despite the lack of aggressiveness from a malignant tumor in the bladder, carcinoma grows for a very long time. Its atypical cells have a favorable prognosis. The papillary nature of the name arose due to the peculiarity of its appearance. Externally, the tumor resembles cauliflower or coral, consisting of outgrowths in the form of bunches of papillae on a fairly wide stalk.

Oncology of the papillary type in the bladder has its own characteristics that distinguish it from other tumors. In addition to the low degree of aggressiveness and slow growth in the cervix of the organ, metastases during the development of the disease affect only the lymph nodes in the organ, passing into the tissues of the adjacent ureters and uterus only in the absence of treatment.

When cancer reaches maturity, necrosis develops in the tumor and it begins to disintegrate. As a rule, localization usually occurs at the bottom of the organ or at the neck; the ureters are also often affected.

In the absence of aggression, carcinoma can transform into a malignant pathological process. For urothelial bladder cancer with a favorable prognosis, patients are advised to strictly follow the doctor's instructions. In this case, there is a chance to avoid the degeneration of the tumor into its aggressive form.

Causes

Although the causes of urothelial carcinoma remain unknown, researchers have identified a relationship between tumor development and exposure of bladder cells to carcinogens.

In approximately 50% of cases, malignant neoplasms are diagnosed in smokers. Moreover, the greatest risk of development is observed in those patients in whom the mechanisms responsible for detoxifying the body do not fully perform their functions.

The following factors can also trigger the degeneration of bladder cells:

• chronic inflammatory process in the tissues of the bladder;
• frequent or regular urinary retention
• prolonged use of medications ;
• irradiation of the pelvic organs;
• defects (congenital or acquired) in the structure of the bladder;
• prolonged contact with chemicals .

People who frequently drink alcoholic beverages are at increased risk of developing urothelial carcinoma.

Causes

At present, the exact causes of the development of transitional cell cancer of the bladder have not been identified; there are only risk factors that can trigger the development of the disease.

It is also worth noting that people who are exposed to aromatic amines, as well as those suffering from chronic cystitis, are at risk.

It should not be excluded that in men the risk of developing transitional cell carcinoma is 3 times higher than in women. This fact is justified by the fact that there is a direct connection between nicotine addiction and the risk of getting sick. Smoking stops, risk decreases.

Provoke the occurrence of transitional cell carcinoma:

• industrial carcinogens;
• chronic diseases of the urinary system;
• parasitic infection;
• congenital bladder defects;
• people who have undergone radiation therapy for the treatment of other diseases in the pelvic area are susceptible to the disease;
• urinary retention;
• medications (for example, cyclophosphamide).

Symptoms

The first stages of development of urothelial carcinoma of the bladder are characterized by a predominantly asymptomatic course. This is the main danger of the tumor: treatment gives a positive result mainly in cases where the oncological process does not extend beyond the organ.

The first signs indicating damage to the bladder become noticeable when carcinoma grows into the muscle layer. At this stage, blood clots appear in the urine (hematuria).

As the tumor grows, problems with urination arise: patients face frequent (especially at night) urges to empty the organ. Cases of involuntary (uncontrolled) urine release cannot be excluded.

The burning sensation in the perineum, characteristic of a urothelial tumor, is episodic (occurs during urination) or constant. In later stages of development, patients experience pain in the lower back. At the same time, discomfort occurs when urinating. In addition, unexpected spasms of the affected organ are possible.

The nature of the clinical picture at the third and fourth stages of development varies depending on the area of ​​spread of metastases.

Due to their proximity, cancer cells spread into the liver and/or kidney tissue, leading to jaundice, nausea and other complications. When the lungs are damaged, frequent coughing with sputum containing blood impurities occurs. Metastasis to bone tissue causes pain of varying degrees of intensity, which is localized in different parts of the body.

Urothelial carcinoma of the bladder: types, symptoms and prognosis – No tumor

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Any malignant epithelial tumor of the bladder containing wholly, partially, or focally anaplastic urothelium.

The main components of the diagnosis of urothelial carcinoma are the following: the form of tumor growth, the degree of cell differentiation (G, grade of anaplasia) and the stage of the process.

The growth pattern includes the presence of papillary structures, infiltrative growth, carcinoma in situ structures, and various combinations thereof. Determination of the degree of differentiation is appropriate for papillary and infiltrating carcinomas.

It should be noted that it does not apply to carcinoma in situ. To avoid diagnostic errors, the WHO classification strictly recommends not to classify non-invasive papillary tumors as carcinoma in situ.

Malignant neoplasm of the urothelium of the papillary structure. Unlike papillomas and papillary tumors with a low risk of malignancy, these neoplasms are characterized by structural and nuclear atypia of varying degrees of severity, which is graded on a scale of 1 to 3, since the degree of progression differs significantly for each of the three grades.

The degree of differentiation of tumors of heterogeneous structure is determined by the least differentiated areas, i.e., the highest degree of anaplasia.

The first degree of anaplasia (G1) is a highly differentiated cancer characterized by mild structural and cellular atypia (Fig. 2.7). Unlike urothelial papillary tumors with a low risk of malignancy, in this case there is a slight violation of the polarity of the nuclei, their size, shape, and chromatin structure. Rice. 2.7. Papillary urothelial carcinoma, G1.

Papillary structures with mild cellular atypia. Hematoxylin and eosin staining. x200 Mitoses are rare, but can occur throughout the entire thickness of the epithelial layer. G1 corresponds to grade I in the 1973 WHO classification or low grade urothelial carcinoma and grade IIA in most European centers.

The risk of disease progression is about 13%. The second degree of anaplasia (G2) - moderately differentiated cancer - is considered intermediate. It differs from G1 mainly in the increase in structural atypia with the preservation of some elements of organization, i.e. polarity and monomorphism, which is absent in G3 tumors (Fig. 2.8). Rice. 2.8.

Papillary urothelial carcinoma, G2. Papillary structures with moderate atypia. Hematoxylin and eosin staining. x200 These signs have not changed compared to the 1973 WHO classification and are assessed as grade IIB in most European centers.

The third degree of anaplasia (G3) - poorly differentiated cancer - is characterized by pronounced cellular polymorphism with a lack of polarity. loss of surface cells (impaired ripening), variability of nuclear parameters, numerous pathological mitoses (Fig. 2.9 and 2.10). According to the 1973 WHO classification

corresponds to grade III, the same as in Europe, and high-grade tumors in other centers. Late stages of cancer are observed in more than 65% of patients. Rice.
2.9. Papillary urothelial carcinoma, G3. Pronounced cellular polymorphism in the tumor. Hematoxylin and eosin staining. x200 Fig.
2.10. Papillary urothelial carcinoma, G3. Pronounced cellular polymorphism in the tumor. Hematoxylin and eosin staining. x400 In the 2004 WHO classification, non-invasive papillary urothelial carcinoma of low-grade anaplasia (low-grade) and high-grade anaplasia (high-grade) was allocated to a separate category.

Low-grade papillary non-invasive carcinoma is detected in 5 cases per 100,000 people annually. In 70% of cases, the tumor is localized on the posterior or lateral wall of the bladder. Cystoscopy reveals an exophytic papillary tumor: single - in 78% of cases, multiple - in 22%.

If foci of poorly differentiated carcinoma are found in the tumor, it should be classified as high grade papillary carcinoma. Cytokeratin (CK) expression

20, CD44, p53, and p63 are intermediate between those in low-risk papillary tumors and high-grade anaplasia papillary carcinomas.

Tumor cells have a predominantly diploid set of chromosomes. High-grade papillary non-invasive carcinoma is a tumor with a predominance of moderately expressed structural and cellular atypia.

Cystoscopy may reveal lesions ranging from papillary to solid nodular. The lesion can be either single or multiple. The expression of CK20, p53 and p63 is more pronounced than in low-grade carcinoma.

Tumor cells are usually aneuploid.

Urothelial tumor extending beyond the basement membrane. Like papillary tumors, they are differentiated on a G1-G3 scale depending on the degree of nuclear anaplasia, but some centers divide them into “low-grade” and “high-grade” categories.

The macroscopic picture is very diverse: tumors can be papillary. polypoid, nodular, solid, ulcerated and endophytic. Most pT1 tumors are papillary, low-grade or high-grade anaplasia.

pT2-4 carcinomas are usually nonpapillary and have a high degree of anaplasia.

Multifocal tumors and formations larger than 3 cm have a less favorable prognosis. The presence of background changes in the form of carcinoma in situ increases the risk of relapse and progression.

Metastatic lesions of lymph nodes and systemic dissemination are always associated with a poor prognosis of the disease. Morphological prognostic factors include the degree of anaplasia, stage and some other specific features.

Thus, the presence of vascular invasion in pT1 tumors reduces 5-year survival to 44%.

The depth of invasion should be assessed in all biopsies. The TNM classification recommends the inclusion of specific anatomical information to determine the stage of the tumor process (Table 2.2).

Table 2.2. TNM classification of bladder cancer

The presence of invasion of the lamina propria should be noted in the pathological report, although this can be extremely difficult when making tangential sections through the integumentary urothelium or von Brunn's nests. In non-invasive papillary lesions, the basement membrane maintains a smooth, clear contour, in contrast to the discontinuous contours in invasive complexes.

In the zone of invasion, the character of the stroma often differs from other areas, i.e., there is fibrosis, sclerosis and inflammatory infiltration. It is necessary to indicate whether extensive or focal invasion of the lamina propria is present in the biopsy specimen, but the term “superficial cancer” should not be used, since two stages are confused: pTa and pT1.

Special attention should be paid to the muscular plate of the mucous membrane. These thin, scattered muscle bundles are located in the middle of the lamina propria of the mucous membrane parallel to the surface, partly next to thin-walled vessels (Fig. 2.11). Rice. 2.11. Infiltrative urothelial carcinoma.

Tumor invasion into the muscular plate of the mucous membrane, the muscular layer of the bladder wall is intact. Hematoxylin and eosin staining. x100 Infiltrative growth in this zone cannot be interpreted as muscle invasion.

The term “muscle invasion” is not entirely correct, since it does not distinguish between the muscular plate of the mucous membrane (muscularis mucosae) and the muscle layer itself (muscularis propria) or between superficial and deep muscle invasion. It is recommended to indicate the presence of the muscle layer itself so that urologists are informed about the depth of material sampling.

In our experience, the muscular layer of the mucous membrane is extremely rarely visualized in biopsy material, especially with papillary lesions, and the muscular layer itself is more often present in material after transurethral resections, since during biopsy the material is usually taken superficially.

When assessing invasive carcinomas, a number of guidelines recommend specifying the mode of stromal invasion. It is believed that a tumor infiltrating the stroma in a “broad front” (Fig. 2.12) is less aggressive than “tentacle-like” growth (Fig. 2.13 and 2.14). There are also three other types of invasive tumor growth: micropapillary, microcystic and nested. Rice. 2.12.

Infiltrative urothelial carcinoma. Invasion on a “broad front”. Hematoxylin and eosin staining. x200 Fig.
2.13. Infiltrative urothelial carcinoma. The tumor invades the stroma in separate wide strands. Hematoxylin and eosin staining. x200 Fig. 2.14. Infiltrative urothelial carcinoma. "Tentacular Infestation". Hematoxylin and eosin staining. x200

Source:

Classification of urothelial bladder cancer, stages, symptoms, treatment

• Urothelial bladder cancer is a disease that occurs more often after 50 years of age.
• The first signs of this malignant disease of the genitourinary system appear in the form of blood in the urine and periodic pain in the lower abdomen.

Diagnostics

Urothelial carcinoma is characterized by symptoms similar to those of other pathologies of the genitourinary system: cystitis, prostatitis, urethritis. Therefore, if you detect blood clots in your urine or other unpleasant sensations that constantly bother you, you should consult a doctor.

If transitional cell carcinoma is suspected, several procedures are prescribed to both identify the tumor and exclude concomitant diseases.

Diagnosis of neoplasms begins with a urine test to detect atypical cells and an increased concentration of red blood cells (hematuria). At the same time, a biochemical blood test is performed to determine the presence of specific tumor markers and anemia.

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A tumor in the bladder is detected using ultrasound and radiography. Both methods help to detect areas in the pelvic organs where malignant cells are localized.

CT and MRI provide additional information. These methods make it possible to diagnose benign and malignant neoplasms of any size, the localization of atypical cells and the area of ​​metastases.

The final diagnosis is made based on the results of cystoscopy. The method involves collecting a small amount of tissue from the bladder mucosa, which is then examined under a microscope to detect large cell structures.

Why does papillary bladder cancer occur?

It is impossible to unambiguously determine the cause of the development of pathology in the body, even taking into account the development of medicine at the present time. But as a result of many years of research, oncologists have identified a whole group of factors that affect the condition of the organ and its predisposition to cancer, as well as pathologies of the urinary system in this direction.

The main causes of papillary cancer lie in HPV. According to statistics, papillovirus in almost all cases transforms into cancer, therefore, if surgeons unscrupulously remove a benign growth, it can turn into a malignant one.

In the bladder, carcinoma can occur due to the following factors:

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Men are 10 times more likely to be considered at risk than women. There is also a high risk in people over 50 years of age and in patients with reduced immune defenses.

Treatment

Treatment tactics are developed taking into account a complex of factors: the age and individual characteristics of the patient, type of tumor, stage of development of the oncological process, and others.

For superficial forms of carcinoma, when cancer cells do not spread beyond the affected organ, partial excision of the bladder is indicated.

The procedure is performed using a resectoscope, the cutting part of which is inserted through the urethral canal. The volume of excision is determined depending on the area of ​​tumor growth.

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In some cases, instead of resection, therapy uses electrocoagulation, laser ablation or cryodestruction, which involves exposing the tumor to liquid nitrogen.

Regardless of the stage of development of the oncological process (with the exception of the fourth), treatment of urothelial carcinoma is supplemented by the administration of the BCG vaccine directly into the bladder. The latter has a detrimental effect on malignant cells.

If a cancerous tumor grows into neighboring organs or tissues, a radical cystectomy is used, during which the bladder and damaged structures are completely removed. This procedure is often combined with radiation and/or chemotherapy. Moreover, the last two methods are used both before and after surgery.

In addition to the bladder, nearby organs are removed during a cystectomy. In men, these are the prostate and testes. In women, removal of the urethral canal, uterus, appendages of the last and anterior vaginal wall is indicated. If necessary, the doctor excises regional lymph nodes.

Urotherial carcinomas that have metastasized are treated with radiation and systemic chemotherapy. The first is used in the presence of contraindications to radical intervention and in cases where the cancer cells have not spread far beyond the pathological focus. Chemotherapy is indicated for distant metastases.

After cystectomy, measures are taken to organize urine diversion. To do this, a catheter is inserted, new channels are formed using the rectum, or other actions are performed according to indications.

Treatment of carcinoma in the bladder

Therapy is prescribed immediately after diagnosis based on information about the stage of the tumor. For early lesions, microsurgical surgery can be performed to remove cancer cells. This intervention is minimally invasive, but requires chemotherapy after it is performed. Most often, this is quite enough to cure the patient.

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Treatment of papillary carcinoma as it grows in size requires the use of the following techniques:

1. Chemotherapy and radiation therapy will shrink the tumor before surgery;
2. Cystectomy or transvesical electroresection will remove cancerous tissue from the organ. Experts make artificial ureteral tubes from intestinal tissue;
3. After the operation, radiation treatment or medication is prescribed, aimed at destroying the changed cells in the lymph flow.

As soon as the therapy ends, the patient must begin treatment against inflammation, adjust the menu, guided by the advice of the attending physician. All products with carcinogens are excluded to prevent relapse.

Metastases

Metastasis, during which cancer cells break away from the tumor and spread throughout the body, occurs at different times.

The likelihood of the development of this process is determined by the degree of malignancy of the neoplasm. In low-grade tumors, cancer cells spread at the initial stages of the cancer process.

Urothelial carcinomas that grow on the surface of the bladder usually metastasize within 1-2 years after discovery of the tumor. Abnormal cells spread throughout the body primarily through the lymphatic system.

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In advanced cases, metastases penetrate into new areas through tumor growth or through the circulatory system. The last option is the most dangerous, as it leads to damage to distant organs.

The likelihood of metastasis formation directly determines the risk of cancer recurrence. In most patients, malignant tumors reappear within the first year after radical surgery. However, the possibility of carcinoma formation cannot be ruled out after a few years.

Disease prevention

Timely consultation with a doctor and carrying out various types of tests and ultrasound for preventive purposes allows you to identify a tumor in the early stages, thanks to which there is the possibility of a complete recovery. To date, the main cause of the emergence and development of cancer cells has not yet been identified. Doctors recommend drinking purified drinking water, it is advisable to stop smoking and drinking alcohol, and avoid direct contact with radioactive and chemical substances.

Be healthy!

Author: Ivanov Alexander Andreevich, general practitioner (therapist), medical observer.

Lifespan

The development of urothelial carcinomas of the bladder ends in the death of the patient, usually in cases where the growth of the tumor is accompanied by metastasis of the latter. Moreover, life expectancy also depends on the location of cancer cells.

According to medical statistics, the 5-year survival threshold is reached by 25% of patients in whom metastases are found in regional lymph nodes. When internal organs are damaged by cancer cells, this number of cancer patients die within the first two years after diagnosis of carcinoma. If metastases penetrate the bone structure, patients die within 6 months.

With timely detection of the tumor and successful treatment, 5-year survival is observed in 90% of patients. This figure drops to 60% when the tumor process is diagnosed at the second stage of development.

Advanced forms of bladder cancer are often not treated due to the fact that radical intervention can shorten the patient’s life. In such circumstances, palliative therapy is used. This method involves taking medications that slow down the development of the tumor process and suppress the main symptoms.

Pathological anatomy

Bladder carcinomas differ from papillomas, with which they often have external similarities, in that in them the epithelium and connective tissue are not in the correct ratio, but there is an atypical arrangement of the epithelium growing into the connective tissue stroma, located in groups in the form of strands or nests. The starting point of carcinoma, as well as benign papillomas, is the epithelium of the bladder.

In appearance, bladder cancer appears as:

1) papillary tumor protruding into the lumen of the bladder, roundish angular in shape;

2) a neoplasm infiltrating the wall of the bladder, penetrating mainly the mucous membrane of the bladder.

Papillary carcinoma (villous cancer) is very often no different in appearance from benign papilloma. Often, upon careful palpation, the high density of the leg and the wall of the bladder surrounding it indicates its carcinomatous nature. The cancerous nature of the neoplasm is more pronounced in widely seated papillary tumors, when at the site of implantation the tumor and the mucous membrane of the bladder are not sharply demarcated from each other.

Cancer, protruding into the lumen of the bladder in the form of a roundish tumor, does not have villi, but is lumpy, knotty, uneven, in places ulceratively disintegrating, sometimes encrusted with salts.

With infiltration cancer, there is no tumor, the mucosa and submucosa are denser than normal, and there are scattered ulcerations on the mucosa.

The mucous membrane of the parts of the bladder adjacent to the malignant tumor is never completely normal, and polypous and cystic formations appear on it next to the cancerous tumor as an expression of irritation. It is very easy for the bladder to become infected, especially with ulceration or necrotic decay of the tumor. Inflammation from the bladder often spreads to the upper urinary tract. When a neoplasm grows over the mouth of the ureter, blockage may occur with urinary retention and expansion of the ureter and renal pelvis.

The transition of a cancerous tumor from the bladder to other organs or perforation into the peritoneal cavity is rarely observed. Metastases in the lymphatic pelvic glands are observed more often with infiltrating cancer (about 85%) than with papillary forms. This is explained by the fact that lymphatic vessels are located only in the submucosal and muscular layers, and in order to damage the glands, the tumor must spread to these layers. Distant metastases are observed late; they can be in the pleura, lungs, liver, kidneys, peritoneum, brain, etc.

Like benign papillomas, bladder carcinomas can be multiple, and there are also combinations of papillomatous with other forms of cancer. Often, relapse after removal of the papillomatous or nodular form is in the form of infiltrating cancer.

Consequences

If the tumor is diagnosed at an early stage, the prognosis for the outcome of the disease is considered favorable. Timely treatment reduces the risk of developing metastases, and removal of the tumor in most cases leads to a complete recovery. The patient is registered at the oncology clinic, where he is observed every 2-3 months.

If the cancer was diagnosed at a late stage, when metastases had time to develop, then even after a total resection of the bladder and a course of systemic chemotherapy, the patient is not predicted to live more than 3-5 years.