Etiology

Above all, occupational exposure to chemical compounds (among others from the group of aromatic amines) is considered to be the factor leading to falling ill with cancer of the urinary bladder. Smoking tobacco is also mentioned (cancerogenic substances found in tobacco smoke such as nitrosamines, as well as tryptophane metabolites excreted in the urine). An additional risk factor, which may contribute to the development of more aggressive forms of cancer of the urinary bladder is a long exposure to foreign bodies and infections (mainly Schistosoma haematobium, it concerns African and Small Asia countries, as well as medicines – cyclofosphamide) and small pelvis irradiation due to another tumors in that area.

Genetic disturbances observed in the case of cancers of the urinary bladder are mainly the mutations within suppressor gene p53, oncogene erbB-2, p21, c-myc.

Symptoms

One of the most frequent symptoms of cancer of the urinary bladder, which forces the patient to visit a doctor is haematuria, sometimes with clots. With the advance of the tumor process disuric symptoms may take place, namely pain, bladder tenesmus, burning sensation during miction, sometimes temporary retention of urine. Pain in the lumbar area as well as features of urinary tracts infection may appear during a stasis of urine in the upper urinary tracts. The pain in pelvis and around groin as well as swelling of the lower extremities usually accompany further symptoms of the disease. The first ‘signaling’ symptoms are the pains caused by metastatic changes in bones.

Diagnosis

Even one haematuria or earlier mentioned pain symptoms are an absolute indication for a patient to be examined in order to exclude the possibility of cancer of the bladder. Ultrasonography should be the first examination in the diagnosis of cancer of the urinary bladder, when the tumor change may be depicted, provided that it is big enough, the bladder is full and the place on the wall accessible during examination.

In contrast examination unevenness of bladder contour, filling defects and rigidity of infiltrated wall may be observed depending on the value and the degree of infiltration.

When a suspicious change is detected in bladder, the character of the change should be explained as soon as possible by the means of histopathologic examination. Having done bimanual examination (in order to find any out of bladder changes) cystoscopy is done. During the examination, segments are taken for histopathologic examination.

The urine cytology examination seems proper, nonetheless the negative result does not exclude the presence of a tumor process.

Apart from the above-mentioned examination, morphology, general urine examination, urography (the evaluation of urethers and kidneys) as well as small pelvis computer tomography (the evaluation of local infiltration and the invading stage of lymph nodes) are done. In the case of pain disorders, radiological examination and bone system scinigraphy seem advisable. Similarly to other tumors, chest RTG, gynecological examination in women and an evaluation of prostate’s state in men are recommended. From the prognosis perspective, determining the degree of histological tumor malignancy (basic prognostic factor apart from the state of primeval tumor determined according to TNM classification) seems vital. The following degrees of differentiation are distinguished: well-differentiated cancer (G1) – about 45% of detected cancers, moderately differentiated (G2), poorly differentiated (G3) and undifferentiated cancer (G4). The diagnostic value of BTA and NMP-22 markers is being checked and their determination does not constitute a norm as far as diagnostic methods are concerned.

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