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Informations: New researches about the surgical therapy of bladder cancer
geschrieben von : Admin am Montag, 21. Mai 2007, 20:26 Uhr
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5020 Aufrufe
(AUA 2007, Anaheim, CA, May 20, 2007) – A podium session moderated from Robert R. Bahnson and Michael A O’Donnell discussed new studies about the surgical therapy of urothelian carcinomas. one highlight of this session was the studies about the laparoscopic and robotic radical cystectomy of the bladder. Some videos in this article are available.
Video is available here
Aaron Lentz, from Chapel Hill, NC, reported in their study that in patients undergoing cystectomy for bladder cancer, married individuals appear to have improved pre-operative laboratory variables, shorter hospitalization, and improved pathological outcomes vs. unmarried patients in our case series. These findings may support the evidence (observed in other tumor types and other disease states) that married persons present earlier than unmarried individuals, and this may help explain the improved survival outcomes that have been observed in married patients with bladder cancer.
Video is available here
A nonrandomized inter-institutional comparison from Bern, Switzerland and Cleveland, OH, reported that the extended pelvic lymphnode dissection is associated with lower recurrence rates in patients after radical cystectomy. Nivedita Dhar explained that the compare and evaluate the rates of recurrence (local and/or systemic) for patients with stage pT2pN0-2 and pT3pN0-2 urothelial carcinoma of the bladder with limited pelvic lymph node dissection (PLND) at Cleveland Clinic (CCF) or with an extended PLND at University of Bern (Bern). Recognizing the inherent limitations of a retrospective two institution comparison, the results suggest that the more extended the PLND, the more likely positive nodes are found and if so, a meticulous extended PLND may reduce the probability of local and/or distant recurrence when compared to a limited PLND.
Video is available here
The researcher group of Ulm, Germany, reported from Georg Bartsch, visualized a study about prostate cancer in cystectomy speciments of patients with bladder cancer. The results of this study explained that in 23 cases the patients had a definite PCA therapy before radical cystectomy, while in 244 cases PCA was diagnosed incidentally in the cystectomy specimen. In these concurrent PCA-cases the median and medium serum-PSA level was 2.3 ng/ml and 4.6 ng/ml (Range 0.3 -77.4 ng/ml), while in those patients who had no PCA, the median and medium serum-PSA level was 1.3 ng/ml and 2.0 ng/ml (range 0.1 - 51.7 ng/ml). The detection rate of PCA increased by optimizing the histopathologic work-up from 7.7% to 33.4%. The rate of PCA with Gleason-score >6 decreased from 15.6 % to 10.4 %, while the rate of locally advanced PCA decreased from 31.3 % to 11.8 %. The rate of significant PCA changed from 40.6 % to 31.6 %. The incidence of PCA in the early series was: < 50y: 2%, 50-59y: 4%, 60-69y: 7%, 70y+: 18%. These incidences increased in the current series: <50y: 8%, 50-59y: 28%, 60-69y: 34%, 70y+: 41%. The rate of postoperative PSA-progression in the complete series was only 1%. only one patient died from progressing PCA (Gleason-Score 10). Even with intensified histopathologic work-up, the incidence of prostate cancer remains lower than expected from the literature. In contrast to radical prostatectomy the cure rate of prostate cancer by radical cystoprostatectomy is extremely high. This raises the question, whether the definition of a ,,signficant“ PCA should be limited to cases with non organ-confined or Gleason 8-10 tumors.
Video is available here
Clayton S Lau, Duarte, CA, talk about their study of the laparoscopic and robotic assisted laparoscopic cystectomy and urinary diversion: the City of Hope experience. They retrospectively reviewed the charts of 111 patients that have undergone either laparoscopic or robotic assisted laparoscopic cystectomy and urinary diversion at our institution and examine multiple clinical and pathologic variables. Between 5/2001 and 10/2006 111 total cases were done, 51 laparoscopically and 60 robotic assisted laparoscopic. Eighteen of these were salvage cystectomies. The charts of these patients were retrospectively reviewed. Preoperative characteristics including gender, clinical stage, and indications for surgery were analyzed. Postoperatively EBL, conversion rate, number of lymph nodes removed, pathologic stage, positive margin rate, port site metastasis rate, and complication rates were evaluated. Ninety men and twenty one women underwent radical cystectomy via laparoscopic or robot assisted laparoscopic approach. The most common indication was high grade urothelial bladder cancer (n=98, 88,3%). Average EBL for the laparoscopic approach was 556,6ml (100-2000ml), while it was 375 (100-1500ml) in the robotic assisted laparoscopic group. The average lymph nodes removed in the laparoscopic and robotic assisted laparoscopic group was 16,1 (2-42) and 20,7 (2-47) respectively. There were positive margins in 6 (5,4%) patients. Urinary diversions were done via a mini-laparotomy. Average hospitalization was 15,1 and 12,9 days respectively in the laparoscopic and robotic assisted laparoscopic groups. Complication rates were 31,3% and 33,3% in the laparoscopic and robotic assisted laparoscopic group respectively. No port site metastasis reported. This is the largest single institional series of laparoscopic and robotic assisted laparoscopic cystectomies. It can be done safely, while postoperative recovery and oncologic outcomes appear to be similar to open surgery. An extended lymph node dissection can be accomplished via both minimally invasive approaches. However, controlled clinical trials and comparisons from high volume centers are needed.
Video is available here
Gerald J Wang from New York, NY, reported about their study of the prospective comparison of perioperative and early pathologic outcomes of the robotic versus open radical cystectomy. Their initialexperience with robotic-assisted RC suggests potential advantages compared to the standard open approach. Although operative duration was greater in the robotic group, blood loss, transfusion requirement, time to regular diet, and hospital stay were all decreased compared to the open cohort. The robotic method also demonstrated comparable early pathologic outcomes, with no difference in margin status or total number of lymph nodes removed. Long-term functional and oncologic outcomes are needed to better define the role of robotic-assisted RC in the surgical management of bladder cancer.
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Informations: New Markers for Detecting Bladder Cancer
geschrieben von : Admin am Montag, 21. Mai 2007, 18:47 Uhr
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4657 Aufrufe
(Anaheim, CA, May 20, 2007) – At an AUA – podium session physicans, researcher and urologists discussed new studies about marker for detecting bladder cancer.
One of these studies was a long term follow-up study of the prognostic utility of the BTA stat test from the University of Finland. The Finland researchers found out that BTA stat test is not only diagnostic, but seems also to have prognostic importance. Therefore in patients with negative test results, especially in those with low grade tumours, the interval between follow-up cystoscopies could be safely prolonged.
The researcher group around Hung-yi Chiou, Taipei, Taiwan, found out that cigarette smoking and alcohol drinking were significantly associated with the risk of urethelial cancer. Subjects with the hOGG1 Ser/Cys genotype have a significant increased urethelial cancer risk (OR 1.6; 95% CI: 1.5-4.5). No significant association was observed between the polymorphism XPD Lys751Gln and the risk of urethelial cancer. However, ever smokers with the XPD Lys/Lys genotype have a significant increased urethelial cancer risk (OR 2.0; 95% CI: 1.3-3.2). The highest significant urethelial cancer risk (OR 2.7; 95% CI: 1.4-5.3) was found in ever smokers with the hOGG1 Ser/Cys and Cys/Cys genotypes.
Lioudmila Sitnikov from Worcester, MA, reported about there study of the RNA-binding protein IMP3 – a novel molecular marker predicts progression of superficial (Ta and T1) urothelial carcinomas of bladder. The researchers of this group found out, that IMP3 is an independent prognostic marker that can be used at the time of initial diagnosis of superficial urothelial carcinomas to identify a group of patients with a high potential to develop progression and metastasis, and who might benefit from early therapy.
Another study from Los Angeles, CA, reported about the diagnostic, prognostic and therapeutic molecular marker of Carbonic Anhydrase IX (CAIX) in Bladder Cancer. Their conclusions are that CAIX is differentially expressed in non-invasive vs. invasive transitional cell carcinoma, low grade vs. high grade TCC, and primary tumor vs. metastasis. CAIX is an important predictor for TCC recurrence, progression, and survival. Since CAIX expression is absent in normal urothelial cells and it is highly expressed in non-invasive low grade TCC, evaluation of CAIX in urinary sediment may be a useful adjunct to diagnostic cytology, and intravesical CAIX targeted therapy might be effective in these high CAIX-expressing tumors. Likewise, since metastatic tumors express high CAIX, evaluation of systemic CAIX targeted therapy as a therapeutic approach is warranted.
Kerstin Junker from the german group of researchers around Prof. Schubert, Jena, visualized their study about a new tumour marker for diagnosis of bladder cancer in urine – oncofetal Fibronectin. They found out that FFN is a highly sensitive and specific quantitative biomarker and shows a higher sensitivity than cytology, BTAstat and NMP22. All invasive tumours were detected. In conclusion, their results have shown that oncofetal Fibronectin represents a new promising marker for the detection of bladder cancer in urine.
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Informations: AUA – 2007 is now starting in Anaheim, Ca
geschrieben von : Admin am Sonntag, 20. Mai 2007, 01:23 Uhr
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4333 Aufrufe
(Anaheim, CA, May 19) The greatest urological congress in the world, the 102nd Annual Meeting & Exhibts of the American Urological Association (AUA) is running today. Thousands of physicans and urologists worldwide discusses from May 19 to 24 about new treatment and diagnosis in urological medicine.
Founded in 1902 and headquartered near Baltimore, Maryland, the American Urological Association is the pre-eminent professional organization for urologists, with more than 15,000 members throughout the world. An educational nonprofit organization, the AUA pursues its mission of fostering the highest standards of urologic care by carrying out a wide variety of programs members and their patients, including UrologyHealth.org, an award-winning on-line patient education resource, and the American Urological Association Foundation, Inc.
To honor sound reporting and outstanding news coverage of urologic disease topics, the American Urological Association has announced the establishment of its Annual Excellence in Urology Health Reporting Award. Presentation of the awards will take place during a special press reception on Saturday, May 19, 2007 in Anaheim in conjunction with the AUA Annual Scientific Meeting.
The award is designed to honor journalists in both trade and consumer media outlets for responsible, informative reporting on health topics in urology. Awards will be given annually in the following categories: Consumer Print Publications, Consumer Electronic Publications and Trade Publications. Applicants may submit their own work, or be nominated. Awardees will receive a stipend and award.
“Over the past decade, media interest in urologic topics has increased significantly, and there is an abundance of information available to the public as a result,” said Ira D. Sharlip, M.D., chair of the AUA Public Media Committee. “We feel that it is very important to honor journalists who have excelled in presenting urology in a thorough, balanced and effective manner.”
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Informations: Bladder Cancer Awareness Week
geschrieben von : Admin am Dienstag, 24. Oktober 2006, 11:35 Uhr
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Bladder Cancer Awareness Week
November 13 - 17, 2006 The Bladder Cancer Support Team reminds you that November 13th - 17th is Bladder Cancer Awareness Week. If you are visiting M. D. Anderson Cancer Center on November 16th, please stop by our booth between 10:00 a.m. and 1:00 p.m., located on the Rotary House crosswalk, next to the Great American Smokeout exhibit. Download the Flier (pdf) Tobacco use is a major risk factor for bladder cancer. Cigarette smokers are two to three times more likely than nonsmokers to develop bladder cancer and both pipe and cigarette smokers are at increased risk. In conjunction with the Great American Smokeout on November 16th, the Support Team invites you to attend the following seminar: "Take Your Health in a New Direction: M. D. Anderson's Tobacco Treatment Program"
Danielle Devine, PhD
Research Psychologist
Department of Behavioral Science Thursday, November 16, 2006, 12:00 p.m. - 1:00 p.m.
Place...of wellness
Ambulatory Clinic Building, ACB2.1041
1220 Holcombe Blvd., Houston TX 77030 Download the Flier (pdf)
Autor:
The University of Texas M. D. Anderson Cancer Center
1515 Holcombe Boulevard
Houston, TX 77030
For more informations about the bladder cancer support team please visit:
http://www.mdanderson.org/departments/bladdercansup/
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Informations: German-based Federation of bladder cancer Patients driving home the message
geschrieben von : Admin am Dienstag, 23. Mai 2006, 18:22 Uhr
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5538 Aufrufe
Bladder Cancer Screening and Support Groups Are Needet Worldwide
(Atlanta, GA, May 22, 2006) The Federation of bladder cancer Patients (FbcP) at www.bladder-cancer.net based in Berlin, Germany is a global internet organization for patients with bladder cancer. The FbcP is also driving home its message for worldwide awareness of bladder cancer, literally via a "Bladder Cancermobile". Detlef Höwing, a German journalist, was diagnosed with bladder cancer in 2002. He now drives his Bladder Cancermobile throughout Germany to encourage education and the development of self-help groups for this cancer.
"Through the website, Bladder Cancermobile and other activities, we hope to encourage more support groups where cancer patients help cancer patients through the exchange of current health reports and therapeutic updates relevant to this disease," said Detlef Höwing, FbcP encourages the exchange of communication on a worldwide basis that includes patients and clinicians.
 Now Höwing is taking his message global to the more than 13.000 urologists attending the 2006 annual meeting of the American Urological Association, held in Atlanta, GA.
"As a reporter, I am interested in learning about worldwide bladder cancer research developments and treatments; as an advocate, I hope to encourage more awareness of bladder cancer education worldwide."
"After I was diagnosed with bladder cancer in 2002, I wanted to exchange views personally with other patients and search for self-help groups in Germany," said Höwing.
By 2004 Höwing had created the "online-journal human & cancer" at www.mensch-und-krebs.de , as a project of the Selbsthilfe Harnblasenkrebs e.V. (Support federation of bladder cancer), www.selbsthilfe-harnblasenkrebs.de in Germany. He published various articles in German and English about cancer. The idea for the www.bladder-cancer.net website and the organization originated at the 57th urologic cangress, held in Düsseldorf, Germany in September 2005.
 Höwing reports that more and more individuals are using the worldwide web for information. Visits to www.bladder-cancer.net (the offical site of FbcP) and the other sites of the organization and its projects total approximately 100.000 visits each mounth. "That's good news," says Höwing, "but there is much work to be done to drive home the message that more adults need to be aware of the bladder cancer risk factors, namely smoking and occupation exposure to chemical and dyes, and the key symptom, blood in the urine."
"My dream is that all people (bladder cancer patients) in the United States, United Kingdom, Germany, Sweden, Netherlands, and other Countries can have opportunity to publish articles about their experiences, activities and meetings, and would be able to receive and exchange information about the newest research in the field, both in English and their own language."
Bladder Cancer Statistics from Germany
- In Germany, 400.000 people sicken anually from cancer
- According to the newest values reported from the Robert Koch Institute, the number of newly diagnosed bladder cancer patients is on rise in Germany:
- 16.000 cases reported in 2000
- 24.700 cases reported in 2004
- The share of the invasive and palliative tumors remains unchanged during a 40-year period, 33 percent.
- Cancer-mortality can be reduced by up to 50% with provision-measures and can be reduced by up to 10% with early diagnosis-measures.
Comments about self-help groups in Germany
Althouth the innovative treatment of bladder cancer progresses, the work of cancer-support groups will increasingly gain importance in the next years.
"Without life-courage and psychological support and care, the best tumor-therapy cannot work successfully. The cancer-self-help madde itself to the task, to help, to provide courage, and to achieve practical help," said Ulla Schmidt, the federal minister for health of Germany. "The self-help is an essential part of our public health... the people in the support groups fulfill tasks, which supplement the proffessional offers of the medical supply in deverse and effective age, where people, which shar their experiences with others, commit here."
Mission of the FbcP
The Selbsthilfe Harnblasenkrebs e.V. faced the task along with the Federation of bladder cancer Patients (FbcP) through the enlightenment of the population and the support of meaningful early diagnosis measures, to lower the number of the people, with which an advanced bladder cancer is diagnosed and of the people, that will often die of this disease. For the concerned people, also their families, we offer a forum to share information and experiences. Furthermore, we take part in clinical research projects, where we work together with leding German clinics, like the Charite, Berlin.
The FbcP has supported initiatives, like those from Dr. Gerson Lüdecke, expert for urine-tumor marker studies from the University clinic in Giessen. Dr. Lüdecke spoke recently at the German cancer congress and EAU about the necessity of a provision for care of the bladder carcinoma, especially under consideration of inclusive screenings of risk groups of bladder cancer. Dr. Lüdecke said:
"We can improve the diagostics of the bladder carcinoma through a structure reorientation. Risk adapted screening is one of the most important points in the cancer provision surely in order to get costs and usefulness effectiveness."
For more information, contact:
FbcP c/o Detlef Höwing,
Quickborner Str.71,
13439 Berlin, GERMANY
email: info@bladder-cancer.net
www.bladder-cancer.net
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Informations: BCAN - New National Bladder Cancer Awareness Organization
geschrieben von : Admin am Dienstag, 23. Mai 2006, 18:18 Uhr
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5123 Aufrufe
Atlanta, May 22, 2006 - The Amarican Urological Association Foundation and the Bladder Cancer Advocacy Network (BCAN), www.bcan.org the first national patient-based organization for bladder cancer, announced today that they have formed a partnership to help promote awareness of bladder cancer, the 5th most prevalent cancer in the U.S.
As Part of the agreement, the two organizations will work together to help spread awareness among patients and the general public in USA. As a first step, the Foundation and BCAN plan to hold patient symposia across the country, with the first scheduled for the fall of this year. And in the future, BCAN and the AUA Foundation will work together with the global Orgaization: Federaion of bladder cancer Patients - FbcP, find at www.bladder-cancer.net .
"Given the importance of making people aware of this serious disiease, the AUA Foundation is pleased to join with BCAN in helping the public learn more about bladder cancer," said John Huber, executive director of the AUA Foundation. " We are proud to join BCAN in this mission to help educate people about the latest research, symptoms and treatments of this disease. Together we can help raise awareness and hopefully help save lives in the process."
In addition to the AUA Foundation, BCAN has received the support of the medical community. More than 20 prominent academic urologists, oncologists and radiologists, representing many of the major cancer centers in the United States, serve on BCAN's Scientific Advisory Board.
"Despite the fact that there are more than 63.000 new patients diagnosed with bladder cancer and 13.000 deaths annually, it has been treated like the "elephant in the room," the disease no one wants to talk about in public," said Diane Quale, president of BCAN. "With the help of the AUA Foundation and others, we hope to address the issue at all levels - so that bladder cancer is no longer the silent disease."
BCAN also recently announced that the actor Tate Donovan will join the organization as both a national spokesperson and member of the BCAN Board of Directors. Donovan will attend the AUA conference to express the importance of raising awareness about the disease.
Donovan and his family have been profoundly affected by bladder cancer. His father, Dr. Timothy Donovan, at the time a retired urologist, died of bladder cancer in 2000. His mother also was diagnosed with superficial bladder cancer in October 2005.
As spokesperson for BCAN, Donovan will appear in educational materials, as well as tell his family's story to the medical community and to the public to help spread awareness about the disease and its symptoms.
"We believe Tate can help us bring a national voice to bladder cancer in much the same way that Katie Couric increased public awareness of colorectal cancer," said Diane Quale. " His family's experience is a very real example that the need for awareness is mandatory - even among doctors - and that the disease can affect anyone at any time."
BCAN was founded by Diane Zipursky Quale and her husband, John Quale. John is a Bladder cancer survivor who was initially diagnosed in July 2000. Since they began dealing with the disease, they have discovered that there is little knowledge about bladder cancer and that there is only a limited amount of information avaiable to those suffering from it. Diane and John thought it was time to give a voice to bladder cancer and the hundreds of thousands of survivors of this disase.
Additional information about BCAN and bladder cancer can be found on the organization's web site:
www.bca.org
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Informations: Bladder cancer, bladder carcinoma
geschrieben von : Admin am Samstag, 29. Oktober 2005, 17:45 Uhr
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3024 Aufrufe
Bladder cancer, bladder carcinoma
Summary With 2-3 per cent of the cancer-diseases, the cancer (carcinoma) of the bladder is rather rare, but stands on place two in the smoker-conditional cancer-diseases after the lung-cancer, however.
The bladder-carcinoma stands as well over 24.000 new-diseases per year on place 5 of the frequency-scale of cancer-diseases in Germany. 230.000 people in Germany are circa or were affected by bladder-cancer once. Approximately 7.000 people die of the bladder-carcinoma per year in Germany. This is to big extent because the concerned go to late to the doctor although symptoms of the disease make themselves noticeable already in an early stage. It often is prevented a successful therapy and a complete cure by it. Men as frequently as women are well 3-once involved, although emerged in the last years, that also women more frequently sicken.
Concerned men therefore are more frequent than women and the disease-frequency rises with the 60.-year of life. Already often sicken member from risk-groups earlier, however. Risk factors are: The occupation-encumbrance had an influence on chemicals, tobacco-consumption, excessive alcohol-consumption, hair-stain, and in tropical regions the bilharziasis. Symptoms like bloody urine and pains only late rarely occur. With the lowest indications of problems at the urination or pains with it or in the lower abdomen, an urologist immediately should be consulted. The diagnosis becomes this, through sonography (ultrasound), the microscopic urine-examination (cytology), the urine-examination of the tumour marker NMP22 and the cystoscopy (bladder-reflection), executes. All excrescences in the bladder are cancer that subdivides itself into many stages. The successful therapy improves an early diagnosis and treatment considerably! For that reason, a preventive examination is after cancer, especially with risk-groups very important. - Below more of it.
A micro-hematuria (not with free eye visible blood in the urine) is determined at routine-examinations, should take place further examination.
The method of the election with existence of a bladder-carcinoma is the transurethral resection (TUR) with which the tumor is removed by means of an endoscope through the urethra and the withdrawal of tissue-tests to the histological examination.
Through the histological (microscopic) examination, the penetration-depth can and is determined the tumor-stage with it. Superficial tumors can be taken away over the urethra, so-called TUR. Whether the cancer encroached already on adjacent organs, is determined with CT or MRT. With advanced stages, there are two therapy-approaches: The radical operation with bladder-distance or a TUR (transurethral resection) with subsequent irradiation and chemotherapy. A follow-up treatment is meaningful in every case by means of an instillation-therapy with mitomycin or BCG, because bladder-cancer has a Reside - inclination of approximately 70 per cent. Definition The bladder is a concave-organ, in which the urine transports from the kidney over the ureters and is stored until the secretion. The bladder-cancer takes its origin of the so-called passage-epithelia (urothelium) of the bladder - this is the mucous membrane that lines the bladder.
One distinguishes two types from bladder-cancer: The superficial bladder-cancer: this form is more or less limited the mucous membrane and a relatively benign type. It represents 80 percent of the bladder-cancers.
The aggressive type, that grows into the bladder-wall and into the muscular system.
The first is marked in that it can perform again (relapse-inclination) after the therapy. The second, aggressive type frequently shows, if is not operated radically, a firm growth.
One understands a vicious tumor that is created in the bladder, by a bladder-carcinoma (bladder-cancer). This tumor is created in the urothelium. The urothelium is the lining of the bladder of interior, to some extent the inner-skin of the bladder.
Division (1)
Approximately 70 per cent of all bladder-tumors, so-called superficial tumors are at the time of the diagnosis-position that is called limited on the mucous membrane and the Lamina propria situated directly under it, the connective tissue-work period between mucous membrane and bladder-muscular system. The remaining is already in the deep work periods of the bladder (bladder-muscular system) as well as outgrown over it. one calls it locally advanced bladder-carcinomas. The symptoms are even still advanced if already metastases appeared. Consequently, one can subdivide the simpler survey the bladder-carcinoma half in three main-groups: the superficial carcinomas, the locally progressed carcinomas and the metastasis carcinomas. In accordance with leaves itself divide also the coarse direction of the therapy, namely into transurethral resection plus adjuvant therapy, radical cystectomy (bladder-distance) and systemic chemotherapy.
Division (2)
The division of the tumor-expansion happens after the TNM-System, with what T for tumor, N for lymph nodes ("node") and M for metastases stands. The expansion of the primarily-tumor with the corresponding uppercase letters becomes on that occasion plus addition and the Grading with the uppercase letter "G" and the figures 1 - 3 marked. The small senior letter of "p" then means that the stage was determined by the pathologist. All pTaG1-3 and pT1G1-3 tumors and the carcinoma in situ (Cis) belong to the superficial bladder-tumors.
Risk factorsNumerous elements are held responsible for the emergence of the bladder-cancer:
Occupational hazards
Altogether, over 50 differently chemical substances are known for an emergence of this disease. Among them also chemicals that are used in the rubber or magenta-industry, like the b-Naphthalin and diaminodiphenyl. Step with employed persons, with whom a more professionally chronic contact with these chemicals is proved, a bladder-carcinoma on, so this is recognized as occupation-disease.
Avoidable risks
The smoking is regarded as a risk factor for bladder-cancer, however not so influential for the lung-cancer or the vicious tumors in the oral cavity or the pharynx. However, bladder-cancer is the second-most frequent smoker-cancer after the bronchial-cancer. This is also the reason that the disease-numbers increase with the women since the share of the smokers increased strongly since the World War II in the population.
Newest studies showed, this also an excessive alcohol-consumption and here especially the periodic consumption of high-percent alcohol (schnapps) of the bladder-cancer can lead, since the urothelium (bladder-inner-wall) is attacked here.
Since newest, also content-materials are brought causally with the emergence of bladder-cancer in hair-stains in context what can also be proclaimed an increase of involved women.
Also more regularly frequent use of Phenacitin (an analgesic) can have to do causally with the emergence of a bladder-carcinoma.
Bilharziasis (schistosomiasis)
An infection is one of the most important risk factors world-wide with single-educational, the Schistosoma. These bacteria live in tropical countries in water-cochleae and penetrate through contact with the water in the human being one, in which these water-cochleae live. In some regions of Africa, all inhabitants virtually sickened because they swim in infested fluxions or seas, as well as use the infested water as drinking water. Approximately 300 million people are from this disease, the schistosomiasis as well as Bilharziasis involved. The bladder-carcinoma often is a rare late consequence if no therapy against these causes takes place. Since very poor countries, that an inclusive medical care, enlightenment and provision often lack, usually are about yielding a return at the concerned countries, no treatment often is carried out and the concerned find the red urine and blood normal in the chair.
Through the tourism in these countries, the schistosomiasis is one frequent also in Europe in the vacation of acquired disease. In failure-disease, bloody chair, red urine, pains and problems at the urination after a tropics-residence, one later should think also months and years of this disease.
Because of the completeness, viruses are called here, the human papilloma-viruses, that participation is also repeated with the emergence of vicious tumors in principle.
Symptoms and diagnostics As there are not any unequivocally specific trouble, that points out this disease with high likelihood, with most vicious tumors also with the bladder-carcinoma. For that reason, every abnormal symptoms should, like pains, bloody or unusually dark urine, undefinable woolly pieces in the urine (often with pains with the urination) excessive urine-urge problems at the urination, by a doctor is clarified. A low blood-addition in the urine (a red-coloring) already frequently exists early. However, this blood-addition (micro-hematuria) occurs in the bladders and kidney-system in almost all disease. First clearly bloody urine (macrohematuria) worries the patients. A farther progressed carcinoma however often consists of this case. Pains also very late originate first in far advanced stages or if an ureter (from the kidney to the bladder) or the urethra are transferred by the tumor. The pains can be in this case also in the edges or in the back, because of the congestion or inflammation in the concerned kidney. Symptoms can be also frequent or painful urination.
In principle, it is applicable to the urologist that every unclear micro-hematuria, that bloody urine is called, without fevers or clear urine-way-infection - until as evidence (from the German broad outlines to the bladder-carcinoma) the opposite on a bladder-carcinoma can remind.
A microscopic examination of the urine (urine-cytology) often is little helpful because the tumor-cells are to rarely be found in the urine. only with particular bladder-carcinomas (low differentiated), the marksmanship is higher. If no tumor-cells are therefore found in the urine, this is no evidence against the existence of a bladder-carcinoma.
For that reason, a Tumor-marker provision with NMP22 should take place additionally before the urine-cytology, that under consideration of the exclusion-criterions, a present bladder-cancer more certainly can prove.
The most important examination at the first visit with the urologist is the sonography (ultrasound-examination) of the bladder and the prostate gland where the first results can be put fast gentle for the patient on the existence of a bladder-carcinoma.
The additional examination is the reflection of the bladder (cystoscopy), that is performed in an urological clinic or with the urologist. Under local anaesthesia or anaesthesia, a flexible tube is put forward by the urethra into the bladder. Over optics, the inside of the bladder can be looked at. If the urologist sees a tumor in the bladder-wall, he can appraise which wall-work periods the tumor penetrates and also tests take, that then are examined microscopically. The doctor can see also the orifices of the two ureters and can recognize, whether blood comes from one of the two ureters. Over a cystoscopy, also a tumor-operation can take place if the tumor still is sufficiently small as well as is. The tumor with an electric loop is taken away on that occasion, shreds and later rinses, or by means of laser-ray becomes desolate. This operation is called (TUR) transurethral resection.
With the diagnostic action is a phase among other things - division of the bladder-carcinoma important, because the further therapy depends on the stage. Also here, the best examination is the cystoscopy and sampling (TUR).
A computerized tomography (CT) or magnet-resonance-tomography (MRT) are carried out with each patient afterwards. Regarding the stages - division however clearly was defeated the bladder-reflection (cystoscopy) she/it, because both examinations cannot represent the different work periods of the bladder-wall satisfactorily. From the participation the deceased work periods the bladder-wall is the stages namely - division decisively dependent. By the MRT and CT, a participation of adjacent organs (intestine, uterus, prostate gland, seminal vesicles, pelvic floor-muscular system or lymph nodes - attacks) can be determined. In this situation, however, already a far progressed carcinoma is metastases (daughter-lumps in liver or lung) before and with high likelihood. This participation of the adjacent organs is not recognized with a bladder-reflection. TherapyAll superficial bladder-carcinomas should with the basis-therapy, namely the transurethral resection is treated. An endoscope is introduced in it by the urethra in anaesthesia into the bladder and the tumor with an electro-loop is "planed" down there. The planed down tissue then is given to the pathological examination and the pathologist certain both the expansion-degree of the tumor (the stage) in the TNM-System and the size of the maliciousness (Grading).
The superficial bladder-carcinomas have a high relapse-quote that is called in up to 70 per cent of all cases appears tumor again sooner or later after the operation. For that reason, a so-called adjuvant therapy is recommended broadly today. This happens through in-flushes of medications into the bladder. After placing a disposable catheter, the medication is injected into the bladder. There, it can then effect the mucous membrane and the tumor-endangered areas. The therapy of the bladder-carcinoma depends however decisively on the stage, in which he/it was recognized.
The superficial bladder-carcinomas
Most bladder-carcinomas (approximately 80 per cent) are discovered in a very early phase (in the tumor-stage T1 or Tis). This means in this case that the tumor restricts itself to the most internal work periods of the bladder-wall and the muscular wall of the bladder doesn't involve. In these cases, a relatively small operation suffices over the bladder-reflection (cystoscopy and TUR). It becomes to this, how above described, executed a reflection of the bladder over the urethra. one can introduce operation-instruments additionally and can take away the tumor under view. The urologist even can partially take away the bladder over this way if that is necessary because of the expansion. It can be meaningful in certain situations, one, to execute therapy additionally. For example a local chemotherapy or local immune-therapy can be applied in that the corresponding medication is given into the bladder and works only in the bladder-inside.
After this therapy, however, a renewed bladder-carcinoma occurs in more than half of the cases (50-70 per cent) within 5 years. For that reason, a periodic control is necessary by means of the cystoscopy. In 60-70 per cent of the cases, the originally superficial bladder-carcinoma can be had command of by the repeated TUR long-term.
The deeply infiltrating bladder-carcinomas
Only approximately 20 per cent of the bladder-carcinomas is at the time of the first diagnosis of the advanced phase that is called with participation of the muscle-work period of the bladder-wall. These are named - deeply infiltrating bladder-carcinomas. In these cases, the above described TUR doesn't suffice. Several therapy-possibilities of the disposal stand:
The cystectomy
That is a complete operative distance of the bladder and the prostate gland, with subsequent or synchronized bladder-substitute. This is to be marked as the best method, with which achieving the highest absolute cure-chances is and that has the highest survival rate (approximately 70-80 per cent after 5 years) for the concerned. Often, one can a "Neo - bladder" from one piece of small bowel, that then takes over the function of the bladder, produces. If the urethra is not concerned, it can often be gotten also as natural urine-excretory-organ so that no artificial exit must be put what the quality of life influences positively in the future. With this operation, also parts of the lymph nodes of the surrounded area are taken. These become, how supplied also the other taken out tissue of a histological examination in order to finally be able to determine, whether metastases are likely, and a subsequent chemotherapy is advised.
A TUR (operative distance of the tumor over a bladder-reflection like above described) with subsequently irradiation and chemotherapy will only rarely be effective and comprises the danger of later metastases.
An exclusive one high-measured chemotherapy with several medications, possibly combined with an immune-therapy is executed only with patients, with whom a cystectomy is not possible from medical view.
One would recommend more final possibility however only when the tumor is available in the highest stage, if it therefore grew in adjacent organs and the likelihood of metastases is very high with it.
The TUR and radiotherapy
The exclusive radiotherapy is one in form shrink with the bladder-carcinoma through the danger of the side effect - bladder or a chronic bladder-inflammation restricts. For that reason, the radiotherapy is applied normally in combination with another law case. In principle, it can be appointed also before or after an operation. The most, an irradiation proved itself in combination with a relatively mild chemotherapy (Cisplatin) against a TUR. It becomes on that occasion, how above described, over a bladder-reflection the tumor or a part of the bladder removes. This should happen as in a way as possible that no microscopic tumor-remains are to be seen at the cut-fringes. The irradiation becomes subsequent over approximately daily 5-6 weeks executed. In the first and last week of the irradiation, chemotherapy takes place under stationary conditions.
The results regarding the cure and the 5-yearly-survival rate are at least just as good opposite the radical distance of the bladder. As advantage of this approach would be to be named that in 1st the bladder can be gotten. 2. In the case of a whereabouts of rest-tumor or a radical bladder-distance can still be carried out then a return of the carcinoma with good results.
Chemotherapy
The exclusive chemotherapy-approaches with several Chemo - medications is very side-effect-rich, therefore the usage-possibilities are left only younger patients for exception clauses because of their better constitution.
However, milder approaches stand by the relief with very far advanced stages to the disposal. Then, it becomes usually only one Chemo - medication started, or it is executed a local chemotherapy or immune-therapy. The medication is given directly into the bladder on that occasion.PrognosisMost bladder-carcinomas (approximately 80 per cent) are discovered in very early stages (in the tumor-stage T1 or an initial stage of T1 like the Tis or Ta).
After a TUR, therefore the operative tumor-distance between the bladder-reflection, steps in more than half of the cases (50-70 per cent) within 5 years a bladder-carcinoma renews on. For that reason, a periodic control is necessary by means of the cystoscopy. In 60-70 per cent, the originally superficial bladder-carcinoma can be had command of by the repeated TUR long-term.
With 20 per cent of these patients steps within 5 years a bladder-carcinoma renews, then however in a higher stage on. These patients then must be supplied equally a radical blister-distance or a combined radiation-chemotherapy like the patients, who had from start at a deeply infiltrating carcinoma, in the connection with a TUR. With both, the 5-yearly-survival rate is proceeding between 60 and 70 per cent.
If a radical distance of the bladder is carried out, the bladder must usually be replaced with turned off small bowel*-loops. In 80 per cent, this bladder-substitute works well. The patient is in 10 per cent durably incontinent (urine flows into the washing), the patient is incontinent in wider 20 per cent only at night. In 10-20 per cent, another operation must come after the bladder-substitute because of complications.
If radiotherapy is carried out after TUR, a long-term bladder-receipt can be achieved in 70-80 per cent. In approximately 10 per cent of the cases, the patients have side effects that impair the bladder-function. Low side effects would be a slight bladder, for example, - shrinkage with the consequence, frequent waters', to have to leave, (pollakiuria) respectively frequent nightly urine-urge (nycturia). Heavy side effects are chronic bloody bladder-inflammations or a massive shrinks - bladder that then leads to a cystectomy in the extreme-case, however. In approximately 10-15 per cent, a radical bladder-distance (cystectomy) must take place because of a renewed bladder-carcinoma within 5 years. In these unfavourable cases, one can still 5-yearly-survive, according to tumor-stage, between 30 and 60 per cent is reached.
With the existence of distant metastases (far away-housing projects, daughter-lumps), however, the forecast is bad. Distant metastases usually are found in the lung or in the liver. The medium survival-time then amounts usually less than one year.
Also the proof of lymph node-metastases, therefore daughter-lumps in the lymph nodes of the basin, is a sign bad prognostic because the likelihood of distant metastases is very high. This 5-yearly-survive-in the time of then lies with approximately altogether 20%. It must be roofed that the likelihood of a lymph node-affection rises in the basin with the stage of the tumor. As soon as a deeply infiltrating carcinoma is diagnosed, the likelihood of a lymph node-affection is between 10 and 20 per cent even if this cannot be diagnosed with the MRT or CT. As soon as adjacent organs are concerned, it even is up to 45 per cent; therefore almost half of all patients.
PreventionAs there is also this connection with the avoidable toxicants with the lung-cancer, with which the smoking is an avoidable risk factor, with the bladder-carcinoma.
With a professionally conditional contact with magenta or naphthalene over longer time, both urologist and patient should think of red discoloured urine at bladder-carcinoma at the appearance early.
The smoking and the uncritical use of analgesics should be avoided, as well the periodic consumption of a high-percent liquor and an excessive use of hair-stains. To this please read also the corresponding articles about these topics.
Another article occupies itself with newest examinations in the USA after Coffee-and tea-enjoyment decreases the bladder-cancer-risk.
In tropical and subtropical countries, swimming in seas and fluxions should be avoided. In many places, the bilharziasis is also pointed out publicly expressly to it. After a vacation-residence in these countries must think at the bilharziasis at the appearance of bloody urine or blood in the chair and a corresponding therapy is introduced.
In principle, it is applicable to the urologist that every unclear micro-hematuria, that bloody urine is called without fevers or clear urine-way-infection, until can remind the opposite on a bladder-carcinoma as evidence. In this case belong the cytology, the Tumor-marker - provision with NMP22, the sonography and bladder-reflection to the absolute routine of the diagnostics.
Author: Detlef Höwing - © 2005
On Basis of the German article 2002 in www.selbsthilfe-harnblasenkrebs.de
3524 _WORDSMORE
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