Bladder Cancer… What Should We Know? Prof. Krasimir Neikov before FACTS

Bladder cancer is one of the most common types of cancer. A distinction is made between non-invasive and muscle-invasive carcinoma of the bladder. In the first case, only the lining of the patient's bladder was affected, and in the second – the cancer has spread to the muscles. What we need to know… In front of FACTS, Prof. Dr. Krasimir Neikov - specialist urologist, oncologist, who is currently part of the team of specialists at MC FemiClinic / FemiClinic, where he examines and performs operations at the St. Bogoroditsa Medical Center.

- Prof. Neikov, why are we increasingly faced with the diagnosis of bladder cancer?
- Epidemiologically, bladder cancer ranks seventh among all malignant tumors in men. When considered together with their frequency in women, they rank tenth. It is well known from clinical practice that the incidence is about 3 times greater in men than in women.

- From your practice, can you say that there is a factor that significantly influences the formation of bladder cancer…
- Smoking is one of the most significant factors for the occurrence of this malignant disease. Cigarette use causes 50% of cases. The frequency also increases according to how long in years it is and its intensity. Cigarettes that contain less tar do not lead to a reduced incidence of bladder cancer. Regarding electronic cigarettes, there is no unanimous opinion, but it should be borne in mind that carcinogens have been found in the urine of those who smoke such cigarettes. A high risk is also observed in passive smokers who, for one reason or another, share the environment of active smokers. Workers in an environment with aromatic amines, polycyclic aromatic hydrocarbons and chlorinated hydrocarbons are the second most frequent cause of such cancer observed in them.

- And what comes out. If we stop smoking, we reduce the risk. But we also have to be careful in what environment we work in…
- The simplest preventive measure is changing the working environment or if it is not possible – the use of more fluids and high diuresis. For smokers, cessation of smoking is strongly recommended.

- How to know that we have a bladder problem. What are the symptoms?
- The symptoms that are most often observed are the signal, one-time hematuria with or without clots. (p.b. - Hematuria is a medical term used to denote the presence of red blood cells in the urine) In the last few years, cases of accidentally discovered tumor processes of the bladder have become more frequent. This happens during ultrasound examination of the abdominal organs and bladder to look for other pathological changes. The patients had not previously observed the presence of blood in the urine.

- And how to act if we suspect a problem. What are the steps?
- If such a process is suspected, urethrocystoscopy is recommended, i.e. examination of the urethra and bladder under local anesthesia. The examination is performed with a flexible urethrocystoscope, which causes much less unpleasant sensations, especially in men compared to women. This is due to anatomical features, as women have a significantly shorter urethra. If such a process is observed during the examination, the type of tumor, whether it is single or multiple, its localization in the bladder cavity and the leg with which the tumor clings to the bladder wall is described.

- And can the disease be caught using tumor markers?
- There are no clinically proven tumor markers for this type of tumor. It is unnecessary to delay the diagnosis and distribution, which is important for the progress of the process.

- What's next…
- Timely treatment. Most often, in clinical practice, transurethral resection (bloodless surgical intervention through the urinary canal) of the tumor process is performed. This can be achieved through the classic transurethral resection (monopolar or bipolar) or with the use of laser energy, which can sometimes cut the tumor much faster and more efficiently than the previous method. An important condition for a quality diagnosis is to send the material from the tumor for histological examination. For this purpose, it is necessary to send material to:
1. Container containing tissue from the surface (the visible part of the tumor)
2. A container into which tissue from the root (base) of the tumor is sent, even though everything looks very well resected. The human eye cannot judge the presence of cancer cells. This is a microscopic diagnosis and is the job of the pathologist!
3. In some cases, it is recommended to take material in a third container, by which the pathologist can assess whether there are cancer cells around the base of the tumor

- What indicators determine what condition?
- The presence of cells from the true muscle layer of the bladder is necessary to stage the disease. If there are cancerous cells among these cells, the disease is staged as stage II. If cancer cells are absent, the disease is stage one. This is very important to distinguish for clinical practice because, generally speaking, in the first stage, antitumor antibiotics are administered in the bladder. In the second stage, more aggressive treatment is recommended, which may require removal of the bladder or chemo and radiation in case of failure. Even if it comes to the first possibility, early diagnosed bladder cancer has a more favorable prognosis than in advanced cases.

- What is modern treatment?
- The more frequently observed cases in the practice of the so-called non-muscle invasive carcinomas are treated with instillations of various substances into the bladder – chemo- or immunoprophylaxis of relapses. This treatment requires mandatory endoscopic monitoring over a period of time – urethrocystoscopy, preferably flexible. In the event that there is a suspicion of spreading the process outside the bladder, it is necessary to switch to imaging methods of observation – scanner or magnetic resonance imaging using contrast material.
The treatment of this malignancy should be carried out by a team with extensive experience in endoscopic diagnosis and treatment. If necessary, the treatment approach is re-evaluated with the application of more invasive surgical procedures, including laparoscopic or open surgical intervention. It is noteworthy that in recent years the number of radical cystoprostatectomies (removal of the bladder together with the prostate) with orthotopic removal has significantly decreased – with the construction of a new bladder from the patient's small or large intestine. The saving by the surgeon of the stages of the radical cystoprostatectomy is hardly compensated by adjuvant chemo-immunotherapy (b.r. - additional therapy that is determined after the operation) plus radiation therapy.
---------------------------------------------
Prof. Dr. Krasimir Neikov is a specialist urologist, oncologist with a specialty in health management. He has over 40 years of clinical experience. At the moment, he is part of the team of specialists of MC FemiClinic / FemiClinic, where he performs consulting activities, including diagnostic procedures such as:
- Rigid urethrocystoscopy
- Flexible urethrocystoscopy
- Puncture biopsy of the prostate
- Ambulatory endoscopic removal of small tumor formations from the bladder under intravenous anesthesia
As part of the team of the "Holy Mother of God" Medical Center performs operational interventions. His interests are related to transurethral surgery of the lower urinary tract, open operative interventions using a harmonic scalpel in resection of the bladder, removal of renal tumors incl. and ureters, laser surgical interventions for prostate adenoma, bladder tumors and breaking up bladder stones. Performs the following operative interventions: radical prostatectomy, organ-preserving operations of the genitourinary system, amputation of the penis with inguinal and pelvic lymph dissection, plastic urological operations, operations for testicular tumor formations, operations for congenital malformations of the genitourinary system, transurethral resection for bladder tumors, transurethral resection for obstructions of the bladder neck, operations to restore the patency of the urinary tract, laser enucleation and vaporization of the prostate with a volume of more than 100 grams using the country's most powerful 200W laser, laser removal of large tumor formations leg bladder, laser lithotripsy of large calculi in the bladder. Prof. Neikov examines children.