Have you ever noticed that your urine has changed color, looks like it has a little blood in it? Or do you suffer from frequent urination, back pain, etc.? While we may think of these as simple urinary tract infections (UTIs), sometimes they can be a sign of something more serious. Today we are going to talk about one such condition, namely cancer of the urinary tract. Don't worry, we will talk about everything in simple terms.
What is Urothelial Carcinoma?
Simply put, Urothelial Carcinoma is a type of cancer that develops in our urinary system. It is also called Transitional Cell Carcinoma . Now you may be wondering what "Urothelium" is. It refers to a special protective cell membrane that lines our urinary system, that is, the bladder, the tubes that carry urine from the kidneys to the bladder (ureters), and the parts of the kidneys where urine collects. Just like the waterproofing on the walls of our house, the function of this cell membrane is to prevent urine from coming into contact with the rest of our body. So, when the cells in this protective cell membrane grow abnormally and become cancerous, we call it Urothelial Carcinoma.
A question that many people ask is whether this is bladder cancer. In fact, 90% of bladder cancers are of this type. However, it can also develop in the kidneys. The best thing is that this cancer can be almost completely cured if detected early .
What are the main types of this cancer?
This cancer can be divided into several main types based on how it grows and spreads. This classification is very important in determining treatment.
| Classification | Simple explanation |
|---|---|
| Invasive vs. Non-invasive | Non-invasive means that the cancer is limited to the protective layer of cells mentioned above. Invasive means that the cancer has spread beyond that boundary and into the muscle of the bladder. |
| High-grade vs. Low-grade | Low-grade cancer cells are similar to normal cells and grow slowly. High-grade cancer cells are more abnormal and have a higher chance of growing and spreading rapidly. |
| Papillary vs. Flat | Papillary carcinoma grows into the bladder in a mushroom-shaped pattern, similar to fingers. Flat carcinoma (Carcinoma in situ) is flat and adheres to the bladder wall. |
Why does this type of cancer develop? What are the risk factors?
Although scientists have not yet discovered the exact cause, they have identified several factors that increase the risk of developing this cancer.
- Smoking and tobacco use: This is the main and biggest risk factor . The carcinogenic chemicals in cigarettes pass through the blood and accumulate in the urine. These toxic chemicals damage the protective cell membranes of the urinary system, paving the way for cancer to develop.
- Exposure to chemicals in the workplace: This risk is higher for those who work in places that make certain dyes, rubber, textiles, leather goods, and hairdressing supplies.
- Frequent urinary tract infections: If you have urinary tract infections (UTIs) for a long time or use catheters for a long time, the inflammation can damage cells and increase your risk of cancer.
- Radiation Therapy: Radiation therapy to the abdominal area for other cancers and some anticancer drugs (e.g., cyclophosphamide) may also increase the risk.
- Family history: The risk is higher if someone in the family has had this type of cancer or has genetic conditions like Lynch syndrome.
- Other factors: Aging and being male are also risk factors. This cancer is more common in men than in women.
How do you find out if you have this disease?
If you have symptoms, your doctor will first do things like a urine test. Then, if cancer is suspected, these tests are usually done.
The main test is called a cystoscopy . In this, a thin tube with a camera is passed through the urethra into the bladder and looked inside. If something like a tumor is seen, a small piece of it can be taken and examined (biopsy).
Sometimes, if the doctor is very sure that there is a tumor, he will perform a surgery called TURBT (Transurethral Resection of Bladder Tumor) under anesthesia in the hospital. In this, the tumor is completely cut out and removed during the cystoscopy and sent for testing. A small piece of the muscle is also taken to see if the cancer has spread to the muscles.
If the cancer is high-grade or invasive, the doctor may also recommend a CAT scan to see if it has spread to other parts of the body.
Do you have these symptoms too? (Symptoms)
The most common symptom of this cancer is blood in the urine . It may appear pink, orange, or dark red, but it may not always be visible.
In addition, see these features:
- Pain or burning when urinating
- Needing to urinate more often than usual
- Persistent pain on one side of the back
- Feeling tired for no reason (fatigue)
- Weight loss
- Feeling something like a lump in the abdomen or kidney area
- Malaise and low-grade fever
Women, be especially careful!
Many times, when women experience symptoms like burning or frequent urination, they assume it's a simple urinary tract infection (UTI). However, sometimes it can be a sign of bladder cancer. Studies have shown that women are diagnosed with this cancer later than men.
If you are over 60, if you smoke, if you have persistent symptoms of a urinary tract infection despite taking antibiotics, and if you have blood in your urine, you should definitely see a urologist for advice.
Let's learn about the stages of cancer.
The stage is determined by how far the cancer has spread in the body. This is very important in choosing treatment.
| Cancer Stage | Meaning |
|---|---|
| Stage 0 | The cancer is limited to the lining of the bladder. |
| Stage I | The cancer has spread to the connective tissue under the lining, but not to the muscle. |
| Stage II | The cancer has spread into the muscle layer of the bladder. |
| Stage III | The cancer has spread to the fatty layer outside the bladder, to nearby organs (uterus, prostate gland), or to nearby lymph nodes. |
| Stage IV | The cancer has spread to distant organs (lungs, bones, liver) or distant lymph nodes. This is also called metastatic cancer. |
What are the treatments for this?
There are many effective treatments for this cancer. Treatment is very simple, especially if detected early. The treatment method is determined by the type, grade, and stage of the cancer.
- Surgery:
- TURBT: As mentioned above, early-stage tumors can be completely removed with this method.
- Cystectomy: If the cancer has spread to the muscles or if the cancer has come back high-grade, the entire bladder may need to be removed. Then, alternative ways to pass urine will be developed. Your doctor will explain this to you.
- Chemotherapy:
- Intravesical Chemotherapy: After TURBT surgery, anti-cancer drugs are placed directly into the bladder through a tube. This can help prevent the cancer from coming back.
- Systemic Chemotherapy: If the cancer has spread, chemotherapy is given to the entire body through a vein (IV).
- Radiation Therapy: For cancer that has spread to the muscles, high-energy rays are used to destroy cancer cells if surgery to remove the bladder is desired.
- Immunotherapy: This is a very advanced treatment method now. It involves stimulating our own immune system to fight cancer cells. Some drugs are given directly into the bladder, while some advanced drugs (checkpoint inhibitors) are given through a vein. These have yielded very good results.
- Targeted Therapy: These are not like traditional chemotherapy. These drugs are designed to recognize and attack specific features of cancer cells. They are also a new and successful treatment option.
Take-Home Message
- Urothelial carcinoma is the most common type of cancer that develops in the urinary system, especially the bladder.
- Blood in the urine is the main symptom of this disease. Never ignore such a symptom, see a doctor immediately.
- Smoking is the main risk factor for this cancer. You can reduce your risk by quitting smoking today.
- If this cancer is detected at an early stage, it can be treated and cured very successfully . So, do not be afraid and seek proper medical advice.
- Thanks to modern treatments such as Immunotherapy and Targeted Therapy, the number of people recovering from this disease has now increased significantly.
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