Cancer of the genitourinary system in men. Symptoms and treatment of bladder cancer in men Palliative care for malignant tumors of the genitourinary system

The genitourinary system is one of the most important systems for human life. This system includes the most important organs, as well as other structures that are directly involved in the process of blood filtration, in the process of urination, as well as in the subsequent processes of accumulation and excretion of these waste products. The most important organs that can be identified in this system are the bladder and kidneys.

The appearance of malignant and benign tumors in the organs of the genitourinary system

The appearance of benign tumors in the body, fortunately, is not a death sentence, and such formations can be successfully dealt with, saving a person's life. Benign tumors do not metastasize, do not affect surrounding tissues, and do not reappear after their surgical removal. Recently, it is quite common to observe the development of benign tumors in the kidneys. The most striking example of a tumor of this kind is an adenoma. It appears predominantly in males after forty-five years. The adenoma can be removed, the postoperative recovery period also does not last long, and the chances of continuing a normal full life in most cases are 100%.

Another tumor-like formation that affects the kidneys is angiomyolipoma. This disease affects women more often than men. The reason for the development of angiomyolipomas is a hereditary predisposition. Patients who are diagnosed with this disease, in addition, suffer from epilepsy, are mentally retarded, and suffer from other tumor formations (brain tumor, skin tumor, etc.).

A number of diseases that are malignant tumors are kidney cancer, ureter cancer, bladder cancer, renal pelvis cancer.

Malignant formation - kidney cancer: causes, symptoms and treatment

The danger of malignant tumors, including kidney cancer, is that the disease can progress, cancer cells can form again after treatment and surgery, and can also metastasize to nearby organs and tissues. Cancer cells that affect the kidney quickly spread throughout the lymphatic system, causing it to become damaged. Thus, kidney cancer often spreads to the bones, lungs, and also to the liver or other kidney.

Kidney cancer affects people over the age of forty. Men are more likely to suffer from this disease than women, but doctors cannot explain such statistics. They only highlight the main reasons why kidney cancer develops: these are bad habits, smoking and alcohol abuse. In addition, changes in blood pressure also do not pass without a trace, they affect the functioning of the kidneys and lead to malignant formations in these tissues. Overweight people are also more likely to develop kidney cancer than others. And those who, due to their professional activities, are forced to work with hazardous chemicals are three times more likely to be diagnosed with cancer of the genitourinary system.

Symptoms of kidney cancer may include:

With such symptoms, it is not necessary to conclude that kidney cancer is developing, however, it is necessary to contact specialized specialists for a comprehensive diagnosis. Such diagnostics will be carried out by the doctors of our clinic, which has all the necessary high-tech medical equipment. In particular, the patient is prescribed magnetic resonance imaging of the kidneys and the whole body, computer diagnostics, X-ray examination, scanning of all bones to detect their damage by cancer cells. It will also require a number of laboratory tests, namely urine and blood tests, ultrasound.

Treatment of kidney cancer depends on the timely detection of the disease, as well as on the stage of its development and the size of the progressing tumor. Most patients are forced to agree to the surgical removal of the entire affected kidney, after which a course of chemotherapy and radiation is performed. Most patients gain a chance for a full life if the treatment is carried out on time.

Bladder cancer: symptoms, causes and treatment

The most common tumor of the bladder is papilloma. It is a collection of numerous villi branching on a thin stalk. Papillomas are a relatively benign formation that often develops into a malignant one, so they must be removed surgically.

Tumors of the bladder often affect the male body, especially men after the age of 50 are susceptible to it. Bladder cancer develops due to prolonged exposure to carcinogens and chemicals (associated with professional activities), due to the abuse of analgesics, after a long use of a catheter, due to the formation of stones in the bladder.

Bladder cancer can be recognized by the following symptoms: urine acquires a bloody hue, and it is the richer, the more neglected the disease is. The patient feels pain not only during urination, but also in other periods.

To diagnose bladder cancer, a laboratory analysis of urine and blood is carried out, which will be offered by the specialists of our clinic. In addition, the doctor will palpate the area of ​​the kidneys, bladder and abdomen, prescribe an ultrasound examination, endoscopy of the urea.

Comprehensive therapy for bladder cancer involves both surgery and drug treatment. The qualified doctors of our clinic choose different approaches to the treatment of bladder tumors, based on the results of the studies and the stage of progression of the disease. As practice shows, muscle tissue in most cases remains unaffected, so patients have every chance to continue a normal full life after treatment.

To remove benign formations, modern endoscopic devices are used, but if the patient's condition requires it, a suprapubic incision is made, through which the affected tissue is removed with surgical instruments.

To improve the results of surgical intervention allows the use of radiation therapy and chemotherapy.

Uncommon types of tumors of the genitourinary system

One of the rare types of tumors of the genitourinary system is cancer of the renal pelvis. It is preceded by tumors that appear in the renal ducts. An admixture of blood appears in the urine. The patient feels inexplicable discomfort. A tumor after examination under a microscope is similar to a tumor that forms in the bladder - they have the same structure.

Another rare type of cancer of the genitourinary system is cancer that affects the ureter. In this case, surgical intervention is used in combination with drug therapy. The main causes of the least common types of tumors in the organs of the genitourinary system are the frequent use of analgesics, as well as long-term professional activity in the petrochemical industry, plastics, etc.

Cancer of this type makes itself felt with pain affecting the lumbar region. The tumor grows very slowly, so the disease is dangerous because it can proceed without the manifestation of obvious symptoms. Frequent urination, the appearance of blood in the urine, increased fatigue and a general deterioration in well-being against the background of normal other indicators can alert. Treatment is usually removal of part of the ureter and surrounding tissues, chemotherapy, and radiation therapy.

In our clinic, patients have the opportunity to undergo a complete comprehensive examination of all organs of the genitourinary system to detect cancer cells. Remember, timely access to doctors gives the chances for a full recovery and full-fledged life in the future.

urethral cancer

Malignant tumors that appear below the urethra are not often found. This disease is more typical for women, and is caused by infectious diseases and injuries of the corresponding tissues. The disease can be diagnosed by palpation for the detection of tumors. In addition, in our clinic, patients will be offered to undergo urethrocystoscopy, computed tomography, retrograde urethrography. Urethral cancer is treated by surgical removal of the tumor, as well as modern methods - laser resection, radiation therapy. Treatment is not complete without chemotherapy. Most often, complex treatment is chosen, which is selected based on the results of the tests and the stage of the disease. In some cases, when the disease has an advanced form, a complete amputation of the genital organs in men is prescribed, and in women, the removal of the affected tissues along with the anterior wall of the vagina.

Tumor of the prostate (prostate cancer)

Most often, men over the age of forty are diagnosed with a prostate tumor. This is a slowly progressive disease that lasts for a long time without symptoms. Over time, there is a painful sensation in the lumbar region, in the femoral region, in the perineum. When urinating, pain, burning and other unpleasant symptoms are also felt.

The reason for the development of prostate cancer can be prostate adenoma, exposure to carcinogens, the influence of environmental factors, as well as the use of excessive amounts of animal fats. Therefore, elderly men should monitor their diet and environmental conditions, protecting themselves, if possible, from the harmful effects of environmental factors.

The definition of prostate cancer is made by palpation, using ultrasound, a biopsy procedure using a special needle. Cancer cells are thus found when examined under a microscope.

Radiation therapy and complex drug treatment are used to treat prostate cancer. In some cases, the patients of our clinic are offered to remove the prostate gland, but this operation can save the patient's life. Hormones are used to treat drugs. This is due to the fact that the growth of the tumor is due to the presence of the hormone testosterone in the blood. Our clinic specializes in the diagnosis and treatment of various types of cancer of the genitourinary system. Highly qualified specialists and modern high-tech equipment are the key to successful diagnosis and treatment of tumors of the genitourinary system.

Cancer of the genitourinary system is relatively rare. Bladder cancer occurs in men almost three times more often than in women. As a rule, they are sick people aged 50-70 years.

The first diagnostic sign of the disease is the appearance of blood in the urine. With light bleeding, urine has a faint pink tint, and with more intense bleeding, it is dark red. It often happens that a sick person does not pay attention to bleeding, as they appear periodically at long intervals. Sooner or later, bleeding becomes painful, sometimes after a year and a half after the first bleeding. More often, however, a patient already in the early stages of bladder cancer experiences discomfort and frequent urge to urinate. When bleeding, sharp pains can be caused by the appearance of blood clots in the bladder, provoking severe spasms that stop after the clots are removed from the urine.

The appearance of blood in the urine is a reason for examining the bladder with a cystoscope. For example, papillomas are clearly visible, bushy formations consisting of branching papillae of the bladder mucosa. Initially, they are usually benign in nature, and their transition to a malignant form can be quite difficult to catch.

In the treatment of bladder cancer, the size of the tumor and the condition of the patient are taken into account. Radiation therapy gives good results, but if necessary, resort to surgical intervention. Both methods are often used at the same time.

The first sign of kidney cancer is also the appearance of blood in the urine. Sometimes blood can be released so little that it can only be detected in a urine test. In other cases, severe bleeding is observed, but it also happens that, due to the location of the tumor, the blood in the urine is completely absent. Blood may come out irregularly, at long intervals, or every few days. Often the discharge of blood is accompanied by spasmodic pains, and thread-like blood clots are found in the urine. Another sign indicating a kidney problem is back pain in the area below the ribs near the spine. Spasmodic pains also radiate to the same area during the passage of blood clots through the ureter.

Diagnosis of kidney cancer includes x-ray examination using a contrast agent and the determination of tumor cells in the patient's urine.

After an accurate determination of the location and size of the kidney tumor, surgery is necessary, the diseased kidney is removed. Then radiation therapy is given. The sooner the patient goes to the doctor, the more successful the treatment. In order to detect the disease in the initial stage, you need to see a doctor immediately after detecting blood in the urine or if you suspect the presence of blood in the urine.

Testicular cancer is very rare and affects young men between the ages of 20-35. Sometimes the tumor is palpated in the form of a seal, in other cases there is swelling or an increase in one of the testicles. The testicle can be enlarged evenly while maintaining its normal shape. In another case, only part of the testicle can be enlarged, and its shape changes. When examining the affected testicle, it becomes noticeable that it has become more dense and firm to the touch, the elasticity characteristic of a healthy testicle disappears. It becomes more sensitive, patients feel an increase in its weight.

Sometimes cancer develops in the testicle, which during the development period did not descend from the abdominal cavity into the scrotum. To prevent the possibility of cancer, the testicle is surgically lowered or removed.

Testicular cancer is treated surgically, as well as radiation and chemotherapy.

Cancer prevention

Preventive measures applied to cancer include two main areas: 1) early recognition and treatment of precancerous changes and conditions and 2) detection of carcinogenic factors in the environment, their elimination or weakening of their action. Preventive measures are divided into individual, social, medical, technical and administrative. Individual prevention measures are mainly medical and can be applied independently. At present, when the environment around us is replete with various carcinogens, prevention should be started as early as possible. Pregnant women and nursing mothers should be especially careful, since microdoses of carcinogens can pass through the placenta or mother's milk to a child whose tissues are especially sensitive to carcinogenic factors.

Cancer is becoming more and more common every year. Stage 1-4 bladder cancer spreads especially fast. In men, life expectancy with this disease is much less than in women. This may be due to the fact that bladder cancer occurs much less frequently in women.

Classification

Bladder cancer accounts for 5% of all cancer cases. This is the 5th place in prevalence among oncopathologies. Most of the patients are elderly men. The incidence rate among them is 4 times higher than among women. The average age of the patient is about 60 years, but it becomes lower from year to year.

This type of cancer is dangerous because it has no symptoms at the initial stage. And later stages of bladder cancer are more difficult, longer and less successful. With bladder cancer, the prognosis depends on how early the patient seeks help. If this happened at the stage of metastasis, then a cure is unlikely.

Bladder cancer affects the walls of the organ, on which there are foci of the transition of normal cells to tumor cells. Transformation begins with epithelial cells that form the inner surface of the organ. With the help of modern diagnostic methods, a tumor can be detected before it begins to change the muscle layer. But if cancer cells leave the bladder and form metastases in other organs, the disease is almost impossible to stop.

Bladder cancer affects different types of cells. Depending on this, several types of the disease are distinguished:

• transitional cell carcinoma (up to 90% of cases);
• squamous cell tumor (the second most common type, most often develops due to chronic cystitis);
• adenocarcinoma;
• poorly differentiated carcinoma;
• lymphoma and other rare but occurring forms.

Why does bladder cancer occur?

Scientists do not yet name the exact reasons, there are only a few theories of the occurrence of cancerous cell transformation. But doctors were able to determine the factors contributing to the development of the tumor:

• Industrial poisons - when working in hazardous production with solvents, dyes, benzene and other harmful substances or when living in an industrial city, near an industrial area or with a working plant.
• Tobacco smoking - tobacco combustion products contain substances that activate oncogenes. These are the genes that are responsible for the tumor transformation of cells. The chemical components of cigarette smoke with the blood flow enter the bladder and settle on its mucous membrane.
• Alcohol abuse - toxins through the blood are in the bladder, where they affect its mucosa, triggering the transformation of normal cells into tumor cells.

• Radiation therapy - treatment with radioactive irradiation of internal organs located in the small pelvis, can start the process of oncotransformation of cells of the bladder mucosa.
• Chronic diseases of the excretory system: schistosomiasis, cystitis, ICD (urolithiasis).
• Taking strong drugs - treatment with chemotherapeutic drugs adversely affects the condition of the bladder mucosa.
• Genetic predisposition - the inheritance of oncogenes increases the predisposition to the development of oncology. If a family has had cases of cancer, a person has an increased risk of developing this disease.
• Congenital pathologies of the excretory system, in particular the bladder.
• Prolonged exposure to stress or physical overexertion.
• HPV (human papillomavirus) - there are oncogenic strains of the virus (16 and 19) that can provoke the development of cancer at the site of papillomas, in particular in the bladder.
• Unhealthy diet - eating a lot of fried and fatty foods.

The absence of exposure to causative factors does not guarantee the absence of cancer development. But this will reduce the risk of tumor cell transformation.

Causes of bladder cancer

How does cancer manifest itself?

Cancer develops in stages. Bladder cancer has only 4 stages. Bladder cancer stages differ in the degree of transformation of normal cells into tumor cells, the prevalence of the oncological process in the body and the involvement of other organs in this process. Bladder cancer from stage to stage becomes more resistant to therapy and manifests itself with more obvious symptoms.

• Zero stage - this stage is characterized by the localization of the tumor process only in the bladder and minimal symptomatic manifestations, which are eliminated in almost 100% of cases with timely treatment.
• Stage 1 - cancer cells affect the bladder mucosa and grow at a high rate, but the symptoms do not yet appear clearly, while the chances of a complete cure are still high.
• Stage 2 - the tumor grows into the muscle layer, but does not pass through it (2A - cancer cells affect the inner muscle layer, being within it, 2B - the oncological process affects the outer muscle layer), the chance of successful therapy reaches 60%.
• Stage 3 - cancer cells grow to the surface layer, affecting the fatty membrane (3A - cells on the surface layer are visible only with microscopy, 3B - the tumor is noticeable using other research methods), the success of treatment is 20%.
• Stage 4 is the most difficult stage, when the tumor moves to other organs, cancer cells spread with lymph flow, grow into the pelvic bones, which causes unbearable pain, and blood is found in the urine.

Stage 4 bladder cancer is considered an incurable condition. Therapy for cancer at this stage is not aimed at recovery, but at alleviating the patient's condition.

Zero and first stage cancer is almost asymptomatic. Minor and non-specific symptoms can lead to the presence of a neoplasm. For example, pain when urinating. And also common signs include weakness, drowsiness and sudden weight loss. This should be the reason for going to the doctor, since this degree of the disease allows you to cure it without further consequences.

Over time, characteristic signs of damage to the urinary system are added to nonspecific symptoms:

• constant feeling of fullness of the bladder (even immediately after emptying);
• pain when urinating;
• pain during palpation in the lower abdomen;
• excretion of blood in the urine.

When such symptoms are detected, urgent medical intervention is necessary. If you start the disease at this stage, then the chances of a cure will rapidly decline.

Treatment and prognosis

If the patient went to the doctor in time, and the disease was diagnosed at an early stage, then a complete cure is possible. Bladder cancer is most commonly diagnosed in men. Survival of the patient depends on many factors, including age, general health and body. The prognosis for cancer can be either favorable or not, depending on the stage of the disease.

A surgical operation aimed at removing the bladder is considered a particularly effective method of treatment. A single operation can change a patient's life dramatically. In the later stages of the disease, cystectomy significantly increases the life expectancy of patients. Surgical intervention is carried out in the least traumatic way, so as not to provoke a recurrence of the disease and the rapid development of a neoplasm.

Chemotherapy and radiation therapy are especially effective after surgery. The site of the tumor is treated with highly active radiation in order to destroy those cells that could remain after the operation. To consolidate the positive effect, the patient is prescribed cytostatics. They inhibit the growth of pathological cells and prevent the disease from developing again.

Immunomodulators are used to restore the body and as an additional therapy. How long patients live after treatment depends on whether they follow the doctor's recommendations, and whether the causative factors are eliminated. Particular care should be taken to quit smoking tobacco and drinking alcohol. Since these causes most often become the determining factors in the development of cancerous cell transformation.

Video: Bladder cancer

is a malignant tumor of the mucous membrane or wall of the bladder. The manifestations of the pathology are hematuria, dysuria, pain above the pubis. Diagnosis requires a cytological examination of urine, TUR-biopsy, cystography, ultrasound of the bladder, and tomography. The disease treatment program may include a surgical approach (TURB, cystectomy, laser en-bloc resection) or conservative tactics (systemic chemotherapy, radiation therapy). In order to prevent relapse, intravesical chemotherapy and BCG therapy are used.

General information

Bladder cancer occurs in 70% of all urinary tract neoplasms encountered by specialists in the field of clinical oncourology. In the structure of general oncopathology, the proportion of neoplasia of this organ is 2-4%. Bladder cancer ranks 11th in women and 5th in men among malignant tumors of various localizations. Pathology is more common in residents of industrialized countries; the age of the diseased is predominantly older than 65-70 years.

The reasons

There is no generally accepted hypothesis regarding the etiology of bladder cancer. However, certain risk factors are known that significantly contribute to the development of a malignant tumor:

Bladder cancer differs in its histological type, the degree of cell differentiation, the nature of growth, and the tendency to metastasize. Accounting for these characteristics is extremely important when planning treatment tactics. According to morphological features, the most common are transitional cell (80-90%) and squamous cell tumors (3%), adenocarcinoma (3%), papilloma (1%), sarcoma (3%). According to the degree of anaplasia of cellular elements, low-, moderate- and highly differentiated neoplasias are distinguished.

Of practical importance is the degree of involvement in the tumor process of various layers of the organ wall, in connection with which they speak of low-stage superficial cancer or high-stage invasive cancer. The neoplasm may have a papillary, infiltrative, flat, nodular, intraepithelial, mixed growth pattern. According to the international TNM system, the following stages of neoplasia are distinguished:

• Ta - non-invasive papillary carcinoma
• Tis - flat carcinoma in situ
• T1 - tumor invasion affects subepithelial tissue
• T2 - cancer spreads to the muscle layer (T2a - superficial, T2b - deep)
• T3 - paravesical tissue is involved in the process
• T4 - invasion affects adjacent organs (vagina, uterus, prostate, abdominal wall)
• N1-3 - metastasis is detected in one (N1) or many (N2) regional lymph nodes or in the common iliac lymph nodes (N3).
• M1 - metastasis to distant organs is detected

Symptoms

An early manifestation of bladder cancer is the excretion of blood in the urine - microhematuria or macrohematuria. Minor hematuria leads to pinkish urine, may be episodic and not recur for a long time. In other cases, total hematuria immediately develops: in this case, the urine becomes bloody in color, blood clots may be released. Prolonged or massive hematuria sometimes causes the development of bladder tamponade and acute urinary retention, there is a progressive decrease in hemoglobin and anemia of the patient.

As the tumor grows, patients begin to worry about dysuric symptoms and pain. Urination, as a rule, becomes painful and rapid, with imperative urges, sometimes difficult. There are pains in the womb, in the groin, in the perineum, in the sacrum. At first, pain sensations occur only against the background of a filled bladder, then, with the germination of the muscular wall and adjacent organs, they become permanent.

Many symptoms of bladder cancer are not specific and can occur with other urological diseases: cystitis, prostatitis, urolithiasis, tuberculosis, prostate adenoma, sclerosis of the bladder neck, etc. Therefore, patients in the early stages are often treated conservatively for a long time and ineffectively. In turn, this delays timely diagnosis and initiation of treatment, worsening the prognosis.

Complications

Compression of the mouth of the ureter causes a violation of the outflow of urine from the corresponding kidney. Hydronephrosis develops, an acute pain attack similar to renal colic. When squeezing both mouths, renal failure increases, which can result in uremia. Some cancers with infiltrating growth are prone to disintegration and ulceration of the bladder wall. Against this background, urinary infections (cystitis, pyelonephritis) easily occur, urine acquires a purulent character and a fetid odor. The germination of neoplasia in the rectum or vagina leads to the formation of vesicorectal and vesicovaginal fistulas, accompanied by appropriate symptoms.

Diagnostics

To detect cancer and determine the stage of the oncoprocess, a comprehensive clinical, laboratory and instrumental examination is required. The laboratory diagnostic standard includes a general urine test to determine hematuria, a cytological examination of the sediment to detect atypical cells, a bacteriological urine culture to rule out infection, and a test for a specific BTA antigen. A blood test usually confirms varying degrees of anemia indicating bleeding.

• Bladder ultrasound. It reveals tumor formations with a diameter of more than 0.5 cm, located mainly in the region of the lateral cystic walls. To detect neoplasia in the cervical area, transrectal scanning is the most informative. Sometimes transurethral endoluminal echography is used, performed using a probe inserted into the bladder cavity.
• Tomographic diagnostics. The most valuable and informative methods are CT and MRI of the bladder. They allow to assess the depth of the spread of the tumor process, to identify tumors of small sizes that are not available for echographic visualization.
• Endoscopy of the bladder. An obligatory imaging diagnostic method is cystoscopy, in which the localization, size, appearance of the tumor, and the condition of the mouths of the ureters are clarified. Endoscopic examination can be supplemented by a biopsy, which allows for morphological verification of the neoplasm.
• X-ray diagnostics. Of the methods of radiation diagnostics for bladder cancer, cystography is performed, which reveals a filling defect and deformation of the contours of the bladder wall and makes it possible to judge the nature of tumor growth. Pelvic venography and lymphangioadenography are performed to identify the involvement of the pelvic veins and the lymphatic apparatus.

To detect local and distant metastases of bladder cancer, they resort to ultrasound of the abdominal organs, chest x-ray, ultrasound of the small pelvis, skeletal bone scintigraphy.

Bladder Cancer Treatment

Radical treatment can only be performed surgically. At the same time, the method and type of operation correlates with the stage of the oncological process. Types of surgical interventions for bladder cancer:

• TUR of the bladder. With non-muscularly invasive cancer, endoscopic surgery is performed - transurethral resection of the bladder wall with a tumor. During TURP, the tumor is removed with a resectoscope through the urethra.
• Laser en-bloc resection. The most modern method is laser thulium en-bloc resection. This method makes it possible to remove the tumor as a single block along with the muscle layer, which is very important for histological examination to assess the degree of invasion.
• Cystectomy. Bladder resection (open, laparoscopic, robot-assisted) has been resorted to less and less in recent years due to the high percentage of relapses, complications and low survival. In most cases of invasive bladder cancer, radical cystectomy is indicated. During this operation, the bladder is removed as a single block with the prostate gland and seminal vesicles in men; appendages and uterus in women. At the same time, part or all of the urethra, pelvic lymph nodes are removed.

To replace a removed organ, the following methods are used:

• implantation of the ureters into the skin - ureterocutaneostomy
• diversion of urine into the sigmoid colon - Bricker's way of diverting urine
• formation of an intestinal reservoir according to Studer (orthotopic bladder) from the tissues of the small intestine, stomach, and large intestine. Radical cystectomy with bowel plasty is optimal because it preserves continence and urination.

Surgical treatment can be supplemented with external or contact radiation therapy, systemic or intravesical immunotherapy.

Forecast and prevention

For non-invasive cancer, the 5-year survival rate is about 85%. Much less favorable is the prognosis for invasively growing and recurrent tumors, as well as bladder cancer that gives distant metastases. Quitting smoking, eliminating occupational hazards, drinking purified drinking water, and eliminating urostasis will help reduce the likelihood of developing a tumor. It is necessary to carry out preventive ultrasound, urinalysis, timely examination and treatment by a urologist for symptoms of urinary tract dysfunction.

11.1. BLADDER CANCER

Bladder cancer is one of the most common types of malignant tumors in Western countries. Bladder cancer develops predominantly in men. In Russia, the incidence of bladder cancer is about 9 per 100 thousand people per year. In the structure of incidence, bladder cancer ranks 8th among men and 18th among women, but the difference in incidence can vary by a factor of 10 depending on the region of Russia.

In most cases, the development of bladder cancer is associated with exposure to the uroepithelium of carcinogens excreted in the urine. The connection with the occupational hazards of this disease was identified as early as the 19th century. (cancer from exposure to aniline dyes). Currently, a carcinogenic effect of substances that workers in the rubber industry, oil refining, textile, etc. come into contact with. Some drugs increase the risk of bladder cancer (phenacetin, cyclophosphamide, etc.). Of the household carcinogens, smoking is the most significant. Chronic cystitis, bladder stones, and pelvic irradiation for any reason significantly increase the risk of the disease. Radioactive iodine therapy also increases the risk of developing bladder cancer. At the same time, drinking plenty of fluids significantly reduces the risk of developing bladder cancer.

The initial manifestations of bladder cancer do not have characteristic features and are similar to those with various inflammatory changes in the lower urinary tract: imperative urge to urinate, frequent and painful urination. Subsequently, pain in the area of ​​the projection of the bladder joins, however, hematuria is the leading symptom that makes one suspect a tumor disease. The latter does not depend on the volume of the bladder lesion and can appear as in

a small amount, and in the form of macrohematuria, up to bladder tamponade. Symptoms of weight loss, fatigue, lack of appetite, as a rule, are the result of a generalization of the process.

Bladder cancer has several variants. According to the histological structure, bladder cancer most often has a transitional cell structure; there are also squamous cell carcinoma, adenocarcinoma, and undifferentiated cancer. According to the form of growth, the tumor can have several options: either occupy a large surface of the bladder wall, or develop on a "leg" (Fig. 11.1) Often, bladder cancer has the structure of highly differentiated papillary cancer in situ which can cover a large area. Less commonly, infiltrative cancer develops, penetrating through the wall of the bladder, in which the formation of regional metastases is typical. Regional are the pelvic lymph nodes located below the bifurcation of the common carotid artery. Distant metastasis is noted in the lungs, bones of the skeleton, liver. The most important prognostic factor is the restriction of the tumor to the bladder. The detection of metastases is an indicator of poor prognosis. The wall of the bladder consists of several layers: epithelium, submucosal layer, muscular layer and paravesical tissue.

Rice. 11.1.ultrasound. Bladder cancer. The tumor is “pedunculated”, the bladder filling defect is visible (arrow)

Clinical classification of bladder cancer according to the TNM system.

T - primary tumor.

Tx

T0- the primary tumor is not defined. Ta- papillary non-invasive cancer. Tis- preinvasive carcinoma (carcinoma in situ).T1- the tumor affects the mucous membrane and submucosal layer.

T2- the tumor affects the same layers + muscle layer. pT2a- a tumor with a lesion of the inner half of the muscle layer.

pT2b- a tumor with a lesion of the outer half of the muscle layer.

T3- the tumor affects all the above layers and perivesical fatty tissue.

pT3a- a tumor with a lesion of the perivesical adipose tissue, according to microscopic examination.

pT3b- a tumor with damage to the perivesical adipose tissue, according to macroscopic examination.

T4- the tumor affects adjacent organs and tissues (prostate gland, uterus, vagina, pelvic wall, abdominal wall).

T4a- the tumor affects adjacent organs and tissues (prostate gland, uterus, vagina).

T4b- the tumor affects adjacent organs and tissues (pelvic wall, abdominal wall).

N0

N1- metastasis to a single regional lymph node up to 2 cm in largest dimension.

N2- metastasis to one or more regional lymph nodes up to 5 cm in greatest dimension.

N3- Metastases in one or more regional lymph nodes larger than 5 cm in greatest dimension.

M - distant metastases.

Mx

М0 M1

For morphological verification of the diagnosis, a cytological examination of the urine sediment is used, and verification is achieved the more often, the lower the differentiation of the tumor (more than 90%). Ureterocystoscopy with biopsy gives a more thorough idea of ​​the extent of the lesion of both the bladder and urethra. In cystoscopy, photosensitizers can be used for diagnostic purposes. To assess the depth of invasion, the degree of elasticity of the walls of the bladder, therefore, its capacity, assess the state of regional lymph nodes using radiation methods - ultrasound, CT, MRI.

A feature of this localization of cancer is the frequent superficial location of the tumor (in 70% of cases) and multifocal growth (in 30% of cases), which makes it possible to perform transurethral resection of the tumor, and this functionally sparing intervention is often quite radical. In case of relapses with infiltrative growth or initially total bladder cancer, cystectomy is indicated. Chemotherapy is used in the treatment of common forms of transitional cell carcinoma. Squamous cell and transitional cell carcinoma is exposed to radiation either in combination with the surgical stage of treatment, or in terms of palliative self-treatment when it is impossible to perform the surgical stage.

11.2. KIDNEY CANCER

Kidney cancer is 2-3% in the structure of all malignant neoplasms in adults. In most developed countries of the world, a trend towards an increase in the incidence of kidney cancer is revealed. This disease occupies the 10th place in terms of the incidence of malignant tumors, it is about 9.5 per 100 thousand of the population. People of advanced age get sick more often, the peak incidence is noted at the age of 70 years. Men get sick 2 times more often than women. In the development of the tumor, the importance of smoking, obesity (estrogen-induced kidney tumors), arterial

noah hypertension, some drugs (diuretics, analogues of adrenaline).

In most cases, kidney tumors have the structure of cancer that develops from the epithelium of the tubules or renal pelvis. The disease is asymptomatic for quite a long time. Clinical manifestations that were considered typical for kidney cancer (pain, gross hematuria, palpable tumor) appear in advanced stages of the process. Pain in the abdomen is explained by the invasion of the tumor into the surrounding tissues or compression of neighboring organs. Arterial hypertension may develop, caused by compression of the segmental arteries, ureteral occlusion, the formation of arteriovenous shunts, or increased secretion of renin by the tumor, brain metastases. Amyloidosis of the kidneys, and then other internal organs, sometimes accompanies kidney cancer and is an unfavorable sign. Sometimes a syndrome of compression of the inferior vena cava develops, which is manifested by swelling of the legs, varicocele, dilatation of the saphenous veins of the abdomen, deep vein thrombosis of the lower extremities, and proteinuria. The syndrome is specific not only for kidney tumors. Its appearance should be kept in mind in many tumors, primary or metastatic, causing compression of the inferior vena cava or its thrombosis. General symptoms such as anemia, high ESR, loss of appetite, weight loss, weakness are signs of advanced disease.

The examination algorithm for kidney cancer currently includes non-invasive radiation methods of ultrasound, CT, MRI. Tumor lesion of the kidney is recognized by the deformation of the contours, increase in size, deformation of the pyelocaliceal system, amputation of one or more cups. The contours of the node can be smooth or bumpy, indistinct, of different density, simulating cystic formations with calcifications in the area of ​​the tumor shadow. The accuracy of diagnosis is increased by using contrast during computed tomography (Fig. 11.2, 11.3). If the accumulation of contrast differs from the area of ​​unchanged kidney parenchyma, then this usually indicates a tumor process. These studies make it possible to adequately diagnose the tumor, its size, and its relationship with the surrounding organs. Assessment of the functional state of the opposite kidney is necessary to determine the treatment plan, the possibility of removing the affected kidney. This is achieved by performing excretory renography.

Rice. 11.2.Cancer of the lower pole of the kidney (arrow). Angioroentgenogram

Rice. 11.3.Cancer of the middle part of the kidney (arrow). Angioroentgenogram

In the majority of patients at the time of diagnosis, kidney cancer has a localized form, but in more than half of the patients later, after surgical treatment, a metastatic process is realized. Kidney cancer metastasizes by lymphogenous and hematogenous routes. Hematogenous metastases can be as many

feminine as well as solitary. They are observed in the lungs, bones, liver, brain, etc. and are accompanied by appropriate clinical manifestations. At the same time, solitary metastases to distant organs can be successfully treated surgically. This shows the need for careful collection of anamnestic data. There may be bone and organ metastases in the maxillofacial region.

Clinical classification of kidney cancer according to the TNM system. T - primary tumor.

Tx- it is impossible to determine the prevalence of the primary tumor.

T0- the primary tumor is not defined.

T1- tumor within the kidney no more than 7 cm in the greatest dimension.

T1a- a tumor within the kidney no larger than 4 cm.

T1b- a tumor within the kidney no larger than 7 cm.

T2- a tumor within the kidney larger than 7 cm.

T3- the tumor affects large veins, adrenal glands, perirenal fat, but does not extend to the renal fascia.

T3a- the tumor affects the adrenal glands, perirenal tissue, but does not penetrate beyond the renal fascia.

T3b- the tumor affects the renal vein, the vena cava below the diaphragm.

T3s- the tumor affects the vena cava above the diaphragm.

T4The tumor has spread beyond the renal fascia.

N - regional lymph nodes.

Nx - insufficient data to evaluate regional lymph nodes.

N0- there are no signs of damage to regional lymph nodes.

N1- Metastasis was found in one regional lymph node.

N2- Metastases were found in several regional lymph nodes.

M - distant metastases.

Mx- insufficient data to determine distant metastases.

М0There are no signs of distant metastases. M1- There are distant metastases.

The treatment of kidney cancer is mainly surgical, as this form of tumor is insensitive to radiation and chemotherapy. When diagnosing early forms of the disease, it is possible to perform organ-preserving operations (kidney resection). In the treatment of renal cell carcinoma, cytostatics and hormonal preparations such as progestins and antiestrogen have been used, but the effectiveness of such treatment is very low.

Given the facts of spontaneous regression of metastases, as well as the facts of long-term remission in the absence of specific treatment, the treatment of renal cell carcinoma began to be approached as an immunogenic disease. Immunotherapy currently plays a significant role in the treatment of common forms of kidney cancer. For this purpose, cytokine preparations interferon-alpha and interleukin-2 are used in monotherapy. Due to poor tolerability, cytokine therapy is contraindicated in some patients with concomitant pulmonary, cardiovascular and autoimmune pathologies (in 89% of patients). To a greater extent, success can be expected when using targeted therapy. Radiation therapy and bisphosphonates are used to treat bone metastases.