Cancer of the bladder
Cancer of the bladder. It is 3% cancer of all localizations. The risk of the disease is higher for people working with aromatic amines, as well as those suffering from chronic cystitis. The most common is transitional cell carcinoma, less often squamous cell and adenocarcinoma. The disease can manifest as papillary growth with malignancy or a solid, ulcerated, invasive tumor. There are in situ bladder cancer, superficial cancer (T1-2) and cancer, invading the muscular layer and surrounding tissues (TZ-4). In the papillary form of bladder cancer, multicentric growth is often observed. Superficial bladder cancer rarely forms metastases. With further development of the tumor, pelvic (N1-2), retroperitoneal lymph nodes (N3-4), as well as lungs, liver, bones are affected.
The first symptom of the disease in 75% of cases is hematuria, the cause of which must be established in each case. Other symptoms of the disease are frequent urination, hydronephrosis, inflammatory complications (cystitis, pieponephritis).
Diagnosis. The main value among diagnostic methods is cystoscopy with biopsy. Additional diagnostic methods are excretory urography, computed tomography, ultrasound, etc.
Treatment includes various surgical interventions, radiation and drug therapy. In case of bladder cancer in situ and superficial cancer of stage T1, transurethral resection of the bladder is used, and in stage T2 - partial resection of the bladder. When an invasive tumor of significant size (TK) is recommended, cystectomy with or without pelvic lymphadenectomy. Sometimes, such an operation is preferred chemotherapy and radiation therapy, and then, if necessary, perform an operation. With cancer of the bladder of stage T4, involvement of retroperitoneal lymph nodes (MZ), distant metastases, chemotherapy is of primary importance.
Quite often intravesical chemotherapy is also suitable for early stages of the disease in cases of multicentric cancer, and it is advisable to perform chemotherapy after operations.
Chemotherapy includes intravesical or systemic administration of cytotoxic drugs. Intravesical (in 100 ml isotonic sodium chloride solution for a period of 1 h) one of the following drugs is administered (cisplatin 60 mg or adriamycin 80 mg once a month, thiophosphamide 60 mg once a week, 3 doses, mitomycin C 40 mg 1 time per 2 months). The therapeutic effect is achieved in 50-70% of patients. For systemic treatment, cispatin is recommended (60-100 mg / m2 every 3 weeks) or a combination of cisplatin, adriamycin and 5-fluorouracil (cyclophosphamide). Five-year survival at stages T 1-2 is 50-80%, stages TZ-4-20-30%.
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