Bladder cancer is a urinary bladder cancer that mostly develops from the bladder mucosa (inner lining of the bladder).

What causes bladder cancer?

As in the case of all other cancers, it is hard to give an exact reason for bladder cancer. However, it is proven that some factors increase the risk of developing bladder cancer.

In history, bladder cancer is known as “chimney sweeps’ disease”. Inhaling chemicals in the chimneys has increased the occurrence of the bladder cancer.

The most important factor causing bladder cancer is smoking cigarettes and other tobacco products. This includes hookah, which is frequently smoked in our country.

Also, various chemicals such as some chemical substances used in paint and chemical industries, some painkillers, and artificial sweeteners are blamed for causing bladder cancer.

Of course, people who do not smoke or are not exposed to any unfavorable substances may also develop bladder cancer. However, the risk is quite lower for these people compared to those who were exposed to the agents mentioned above.

In some types of bladder tumors, the irritating effects of chronic infections and bladder stones may play a role.

Is there a difference between men and women in getting bladder cancer?

Although the reason is not known clearly, bladder cancer is more common in men.

Bladder cancers are seen in three female patients versus five male patients. That men smoke more or are exposed to chemicals may be the underlying reason for this difference. But, this is only an assumption. The reason of this difference is not clearly known.

What are the symptoms of bladder cancer?

The most common and important complaint of patients is blood in the urine. This complaint is observed in more than 90% of the patients. The most typical symptom of bladder cancer is intermittent and painless blood in the urine, containing clots.

Other possible complaints are burning during urination, need for urinating frequently, blood clots in the urine, and sometimes getting unable to urinate due to the accumulation of the clots in the bladder as a result of excessive bleeding.

In advanced and spread tumors, there may be complaints such as malaise, fatigue, loss of appetite, nausea, and vomiting.

How is bladder cancer diagnosed?

It is very important to listen to the patients’ complaints and evaluate them well.

During the physical examination of the patient, sometimes no symptom appears. In some patients, especially in cases where the tumor is on the anterior surface of the bladder and is large, the tumor may be palpable on the examination. Again, if the bladder is full of blood clots and the patient is unable to urinate, the tumor becomes palpable on the examination.

Some patients should be examined with both hands under anesthesia and the extent of the tumor in the bladder should be determined. While one hand examines the abdomen, the other tries to reach the tumor through the anus.
Apart from physical examination, laboratory or imaging methods are used for diagnosis.

In the urine analysis, blood is seen. Although seen less, some patients may not have visible bleeding. With the aim of both examining these patients and evaluating the colored urine, urine analysis is required.

The tumors can be seen in the ultrasonography. Imaging methods such as intravenous urography, computerized tomography (CT), and magnetic resonance (MR) can also be used as required.

However, the most significant diagnostic method is looking into the bladder with eyes. This procedure is called “cystoscopy”. With this procedure, we see whether there is a tumor in the bladder, and if there is, we evaluate its size, number, and relationship with the structure of the bladder wall.

All these reasons make cystoscopy the most important diagnostic method for bladder cancer.

What are the treatment options for bladder cancer?

The first option is the transurethral resection of the bladder tumor (TURBT), popularly known as minimally invasive surgery.

In these surgeries, after entering the bladder through the urinary tract, the cancer is removed with special electronic blades. Tissues taken during this procedure are sent for pathological examination. The result of the examination guides the path to be followed for the treatment.

The treatment method for cancers that have not exceeded the bladder mucosa (inner lining) and have not reached the bladder muscles is transurethral resection of bladder tumor (TURBT).

Then, the patient is followed up with a cystoscopy once every few months. This process takes at least five years because bladder cancer bears the risk of reappearing.

If the result of the examination performed after this procedure shows that cancer has reached the bladder muscles, the pathway of the treatment will totally change.

The treatment method for cancers that have reached and invaded the bladder muscle is to remove the bladder. This procedure is called “radical cystectomy”. With this operation, the urinary bladder, prostate, and if necessary the urethra is removed. All lymph nodes in the region are completely removed.

In muscle-invasive bladder cancer, radiotherapy (radiation therapy) may be another treatment option. However, this treatment is generally used for patients that could not go under surgical operation.

Although chemotherapy treatment is used in some patients before surgical operation or radiotherapy to increase the success of the treatment, its main application is in patients where the disease has spread throughout the body.

What is the success of the treatments applied to bladder cancer?

Especially in non-muscle invasive bladder tumors, the treatment is both easier and more successful. However, because of the reappearing risk of the tumor, strict cystoscopic follow-up is required.

The success of the treatment used for muscle-invasive bladder cancer is closely related to the progression of cancer. If the bladder is removed without leaving any cancerous tissue and there is also no spread in the removed lymph nodes, the success rate is quite high. Many of our patients who got this treatment by meeting the necessary conditions have been living healthily for more than 20 years.

What should be done to prevent bladder cancer?

The most important thing in preventing bladder cancer is to stay away from all kinds of tobacco products. That is because the most significant cause of bladder cancer which is known and can be prevented is tobacco use.”

Drinking a lot increases the urine volume and helps secrete the substances in it without getting condensed.

Use of unnecessary medicine should be avoided.

Our patients should immediately consult a urologist for their complaints about the urinary tract or if they see blood in the urine.

Prof. Dr. Gürhan Günaydın

Graduated from Ankara University Faculty of Medicine in 1980, Dr. Gürhan Günaydın received the titles of Specialist Doctor in 1984, Associate Professor of Urology in 1994, and Professor of Urology in 2000 in Ege University Urology Department.