Urinary Tumor

Urinary Tumor – General Information

Urinary Tumor generally consists of several types of malignant growths that can be found near or on the patient’s urinary bladder. It is characterized by abnormal and uncontrollable cell multiplication in the bladder. When a patient develops this condition, his cells lining the inside of his bladder are damaged. When these cells are affected, the disease starts to evolve; this disorder is also commonly known as urothelial cell or transitional cell carcinoma. In general, the bladder is a muscular organ that stores the patient’s urine and is located in the pelvis area of the body. This condition is also classified, depending on the stage of its evolution, according to the TNM system and can include Ta - Non-invasive papillary tumor, T1 - Invasive but not as far as the muscular bladder layer, T2 - Invasive into the muscular layer, T3 - Invasive beyond the muscle into the fat outside the bladder and T4 - Invasive into surrounding structures like the prostate, uterus or pelvic wall.

There are certain risk factors that can lead to the appearance of Urinary Tumor and can include exposure to environmental carcinogens, tobacco use, especially cigarettes, which is more common in male patients, and exposure at work to carcinogens, particularly benzidine. The most common work places from where the patient can develop the condition can include metal industry, rubber industry, textile industry and printing industry. There are cases in which patients working as hairdressers started to develop the condition, because of their permanent exposure to hair dyes. There are also cases in which Urinary Tumor can appear from medicine overuse. 

Urinary Tumor – Symptoms

Urinary Tumor has certain stages of evolution depending on the tumor’s location, size and spread also according to the Tumor Lymph node and Metastasis staging system, and can include: stage 0 – when the cancer cell are found only on the inner lining of the patient’s bladder, stage 1 – when  the cancer cells have proliferated to the layer beyond the inner lining of the patient’s bladder, but not affecting the bladder’s muscles, stage 2 – when the cancer cells have grown to the bladder’s muscles but not to the fatty tissue that is located in the surrounding areas of the patient’s bladder, stage 3 – when the cancer cells have proliferated to the fatty tissue that surrounds the patient’s bladder and to the other pelvic organs such as prostate gland, vagina, but not affecting the lymph nodes and critical organs, stage 4 – when the cancer cells have proliferated to the lymph nodes, pelvic and abdominal wall, and to the organs, and recurrent stage – when the cancer has recurred in the patient’s bladder or in other surrounding organ after it has been treated.

The most common sign symptom for Urinary Tumor is the presence of blood in urine. This symptom can be experienced by the patient in the first three stages of the disease, and can be seen with the naked eye or detectable only by using a microscope. There are other more common signs and symptoms of the condition and can include pain during urination, frequent urination and feeling the need to urinate but with no results.

Urinary Tumor – Treatment

The treatment for Urinary Tumor consists in two major trials, each one for the two forms of disease: non-muscle invasive and muscle invasive. There are two major procedures that can be applied to treat the non-muscle invasive type and can include intravesical immunotherapy or Bacillus Calmette-Guerin immunotherapy, and intravesical chemotherapy. The intravesical immunotherapy usually uses a live attenuated strain of Mycobacterium bovis. However, it has been proven that, because this kind of therapy uses a live attenuated organism it can lead to the appearance of complications that can cause symptoms similar to those of tuberculosis, a life threatening disease for the patient. There are cases in which the organism used to treat Urinary Tumor can enter the patient’s blood stream, possibly causing his death, and that is why this procedure is contraindicated in patient with gross hematuria. In most cases, the BCG therapy is applied for at least six weeks, and can be repeated if the tumor persists or recurs.

The intravesical chemotherapy is usually applied when patients do not respond to the BCG immunotherapy. The most common medicine used in this therapy is Valrubicin. There are also cases in which doctors can use intravesical triethylenethiopsosporamide or Triplex to treat this form of Urinary Tumor. This procedure has an increased rate of recurrence than the BCG immunotherapy. In treating the muscle invasive type there are two major procedures: adjuvant and neo-adjuvant chemotherapy and chemotherapeutic medicines for metastatic disease. There are cases in which the doctor can prefer the neo-adjuvant chemotherapy in treating the condition instead of applying cystectomy and external beam radiotherapy. Usually, the most common medicines used in the neo-adjuvant chemotherapy can include methitrexate, vinblastine, doxorubicin or Adriamycin and cisplatin or MVAC. These medicines can also be applied in combination with therapy.

Depending on the patient, the medicines can be effective, but there are cases in which cystectomy can be more efficient. The chemotherapeutic medicines for metastatic diseases can be less efficient than the adjuvant chemotherapy, but it causes less side effects. The most common medicines used in this therapy can include Gemcitabine and Cisplatin. Researchers try to discover certain medicines and combinations of them in order to increase the chances of healing and decrease the risks of recurrence, and the newest medicines include ifosfamide, paclitaxel, docetaxel and carboplatin. In treating Urinary Tumor, doctors can also choose the surgical treatment which can include many effective therapies such as endoscopic treatment, radical cystectomy, radical cystoprostatectomy, anterior pelvic exenteration, and pelvic lymphadenectomy.  The edoscopic treatment is the most used procedure in surgical treatment, especially in patients with bulky, high grade and multifocal Urinary Tumor. In male patients the most effective surgical procedure is radical cystoprostatectomy, which consists in removing the bladder, prostate, and pelvic lymph nodes. There are cases in which the endoscopic treatment leads to certain complications, and the first step is applying the anterior pelvic exenteration procedure, meaning the removal of the bladder, urethra, uterus, ovaries, anterior vaginal wall, and pelvic lymph nodes.