Edema on the bladder after surgery
Tumors of the bladder can be benign (papillomas) andMalignant (papillary and infiltrating cancer). Papilloma is a soft tumor on a thin stem, consisting of a set of long, branching villi. Papillomas can degenerate malignantly and are subject to surgical removal during endoscopic operations (performed without additional incisions), despite their benign nature. I must say that benign neoplasms in the bladder are relatively rare - no more than 10%. Malignant bladder damage is a fairly common oncological problem. In men, this disease is detected 4 times more often than in women. Tumors of the urinary bladder is 1.5-3% of the total number of malignant tumors and 30-50% of tumors of the genitourinary organs. Most often this form of the tumor occurs at the age of 40-60 years.
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Causes of bladder tumors
It is unambiguous to state that the causes oftumors of the bladder have not been thoroughly studied, but something about the origins of this disease we know. Thus, the association of the risk of developing bladder cancer with tobacco smoking, as well as the effect of certain chemical and biological carcinogens, has been unequivocally proven. Industrial carcinogens used in rubber, paint and varnish, paper and chemical industries are often the cause of bladder cancer. The harmful effect of aniline is widely known. Thus, workers employed in aniline production were more likely to have bladder cancer than among other population groups, and sometimes tumors occurred 10 years after stopping contact with aniline.
Mechanism of exposure to carcinogens on the wallThe bladder is obvious - standing out in the urine, they are in contact with the mucous membrane. That is why standard measures for the prevention of malignant bladder formations begin with compliance with the norms of fluid intake (about 1.5-2 liters per day) and the timely emptying of the bladder when urinating. By the way, bladder cancer is a professional disease of drivers - and the reason for this phenomenon is the inability to urinate when a urge occurs - not always on the road you can quickly find a toilet.
Symptoms of bladder tumors
The first symptom of bladder cancer is most oftenbecomes the appearance of an admixture of blood in the urine. This happens in 75% of cases. In most cases, the admixture of blood is not accompanied by any pain, may be prolonged or short-term, intense or subtle, but it should always cause anxiety and cause immediate medical attention. After some time, the admixture of blood can be repeated. Not always this symptom clearly indicates a malignant lesion and can be a consequence of infection and the development of cystitis, especially if there is a concomitant admixture of blood in the urine rapid painful urination.
If the tumor grows deep into the wall of the bladderthen possible serious complications-the compression of the ureters with the development of renal failure, the germination of the tumor into the intestine or vagina with the development of the urinary-intestinal or vaginal-vaginal fistulas, the development of acute or chronic anemia due to intravesical bleeding. At this stage, patients begin to worry about pain in the lumbar region. According to statistics, 75% of all newly diagnosed tumors are superficial and do not penetrate deep into the wall of the bladder.
Diagnosis of bladder tumors
When you go to a doctor, the examination begins withexamination and palpation, but small tumors growing inside the bladder are usually not probed. Palpable formation indicates a widespread penetrating lesion of the bladder. Ultrasound examines the majority of tumors larger than 1 cm and is a screening method in the examination of urological patients with suspected neoplasm of the urinary system. Often, a bladder X-ray is used with contrasting (excretory urography or descending cystography, as well as computed tomography).
The main research method for tumorsThe bladder is a cystoscopy (endoscopic examination of the cavity of the bladder), which allows you to examine the bladder from the inside, reveal the tumor, with a high degree of probability to determine its nature and prevalence, and perform a bladder biopsy (taking tissue samples for histological examination). If it is not possible to perform a biopsy, cytological examination of urine for atypical cells is performed, but the accuracy of this test is inferior to biopsy. Cancer of the bladder metastasizes primarily along the lymphatic pathways. The pelvic, retroperitoneal lymph nodes are affected. Remote metastases are relatively rare. To determine or exclude metastases to the lungs, chest radiography is performed. If there is a suspicion of metastases in the bone, bone radiography is performed, but it should be noted that bladder cancer does not metastasize very often.
Treatment of bladder tumors
Treatment of bladder tumors includesvarious surgical interventions, radiotherapy and drug therapy. The choice of optimal tactics depends on the stage of the disease. A fundamentally different approach to tumors with signs of tumor germination into the muscular layer of the bladder and without it. In 75% of cases, the muscle layer is not affected. Previously, such tumors were called "superficial." Now they say "muscle-invasive". The standard of treatment of such tumors in the absence of metastases is transurethral resection (endoscopic surgery, involving electrorezection of the bladder zone with tumor lesion) followed by immuno- or chemotherapy. The need for follow-up therapy dictates that about 70-80% of bladder tumors tend to recur within the next 5 years after surgery.
Conducting a specific treatment, consistingin the periodic administration of drugs in the bladder according to a certain scheme, reduce the risk of recurrence to 20-35%. If the diagnosis of a malignant lesion is not confirmed or the tumor penetrates the muscular layer, then intravesical therapy is not prescribed. In this case, the implementation of a course of radiation therapy or a more radical surgical intervention aimed at complete removal of the organ affected by the tumor can be discussed, followed by the creation of a bladder from the segment of the small or large intestine.
Radical cystectomy is the method of choice in treatmentdeeply infiltrating tumors. It includes the removal of the bladder and prostate in men; removal of the bladder, urethra, anterior wall of the vagina and uterus in women. In the case of a common lesion (urethra, uterus, prostate, urethra), the possibility of using endoscopic surgery is virtually excluded. Sometimes the last stage of the operation (the creation of the intestinal bladder) is postponed for a while (this allows to minimize the volume of operation in weakened patients at advanced stages of cancer), and then the technique of excretion of ureters on the skin is used.
With advanced cancer, the involvement of retroperitoneallymph nodes, distant metastases, chemotherapy is of primary importance. Tumor relapses can occur both after radiation treatment, and after surgical interventions and are subject to palliative radiation or symptomatic therapy. The prognosis depends on the stage of the process and the nature of the treatment. After a radical surgery, the 5-year survival rate is about 50%. The best results are observed with combined treatment (resection of the bladder with radiotherapy). Five-year survival at stages T 1-2 is 50-80%, stages TZ-4-20-30%. With a superficial bladder lesion in stage Ta, a 10-year survival rate reaches 87%.
Questions and answers on "Tumor bladder tumor"
Question:Hello! My wife, on ultrasound results, concluded: education in the bladder. Urologist consultation. Cystoscopy. The image clearly shows the formation of a circular shape. Does this mean that this education is malignant?
Answer: Very often, tumor formations of the mucosaThe bladder has a malignant nature, especially in people who smoke. Your husband needs to undergo a transurethral resection of the bladder tumor with the introduction of the mitomycin-c in the bladder within the next few hours. Histological examination of the operating material will allow to determine the degree of malignancy of the tumor and the stage of the disease that will be required for further treatment.
Question:Hello. Whether the introduction of BCG into the bladder is harmful to the treatment of a tumor in the bladder of T1 and how it will affect my health, I am 76 years old, have 2 operations, 1 was in 2010, the second in September 2012, was constantly observed in the urologist. I was prescribed this procedure 6 times. Thank you.
Answer: If you have not previously received this treatment, then it can be performed. Your health does not hurt, but will reduce the risk of a tumor recurrence.
Question:My beetroot found a clear new growthaverage echogenicity in the bladder, tumor size 20-25 mm. Urine goes with blood painlessly. He is 75 years old, a month ago he had a stroke. In the operation, we were denied because of a stroke. What can we do in this situation?
Answer: It is necessary to try, that blood loss,associated with a tumor in the bladder was minimal, in this situation, if there is an admixture of blood in the urine, it is necessary to take hemostatic drugs (decoction of nettle, dicinone, etc.), consult with your doctor how to take them correctly. In the future, as soon as anesthesiologists consider it possible to take your beetroot for surgery, it is necessary (if possible and conveniently placed) to be removed through the urethra by transurethral resection. This operation is not very traumatic, it is done under spinal anesthesia (which is also beneficial in the patient after a stroke). In addition, an additional examination may be necessary to clarify the spread of the tumor.
Question:My father is 74 years old. A year ago, he had an infarct and at the same time he had cancer of the bladder. Three months after the infarction, an operation was performed to resect the bladder. the operation was very difficult, during the operation, a second heart attack, a very large loss of blood, a pulmonary edema, a cerebral edema and many more were transferred. 43 days of resuscitation, but Dad survived and recovered, went to work. The histology of the removed tumor is T3NxM0, and ureteral plastic has also been performed. At the moment, ultrasound is diagnosed with recurrence of bladder cancer. With invasion of the muscular layer, the tumor occupies most of the neck of the bladder. Oncologists in chemotherapy and radiation therapy refused. Have suggested to address on necessity for installation of a cystostomy. Something can be done in such a situation, taking into account two heart attacks and an aneurysm?
Answer: Cystostom with an unsuccessful tumor of the urinary bladder is contraindicated. Another operation is needed - cystectomy.