Kasa İnvaze Olmayan Mesane Kanserine Yaklaşım
Özet
Mesane kanseri, dünya genelinde en sık görülen onuncu kanser türü olup halk sağlığı açısından büyük önem taşımaktadır. Hastalık genellikle orta ve ileri yaş grubunda ortaya çıkmakta ve erkeklerde kadınlara kıyasla yaklaşık üç kat daha fazla görülmektedir. Vakaların %50-60'ından sorumlu olan sigara kullanımı en güçlü risk faktörüyken; boya, kimya ve tekstil sektöründeki mesleki maruziyetler, arsenikli içme suları, pelvik radyoterapi, siklofosfamid kullanımı, batı tipi beslenme ve Şistozoma enfeksiyonları diğer önemli risk etmenleridir. Yeni tanı alan vakaların %75'ini mukoza ve submukozaya sınırlı Kasa İnvaze Olmayan Mesane Kanseri (KİOMK) oluşturur. Hastalığın en belirgin patognomonik bulgusu ağrısız, pıhtılı hematüridir. Tanı aşamasında ultrasonografi ve BT ürografi gibi görüntüleme yöntemlerinin yanı sıra yüksek dereceli tümörlerde duyarlılığı artan üriner sitoloji kullanılır; ancak kesin tanı sistoskopi ve tümörün transüretral rezeksiyonu (TUR-MT) ile konur. KİOMK yönetiminde doğru evreleme ve prognoz tayini için spesmende derin kas tabakasının varlığı kritik rol oynar. Floresan sistoskopi (PDD) ve dar bant görüntüleme (NBI) gibi yeni teknolojiler özellikle karsinoma insitu (CIS) tespitinde beyaz ışığa üstünlük sağlar. İlk rezeksiyondan 14-42 gün sonra yapılan ikinci rezeksiyon (RE-TUR), rezidüel tümörlerin temizlenmesi ve doğru evreleme için T1 ve yüksek dereceli Ta tümörlerde önerilir. Tedavi planlaması, EORTC skorlama sistemine göre belirlenen düşük, orta, yüksek ve çok yüksek risk gruplarına göre intravezikal kemoterapi veya immünoterapi şeklinde yürütülür.
Bladder cancer is the tenth most common malignancy globally and poses a significant public health challenge, occurring predominantly in older individuals and being three times more prevalent in men than women. Smoking stands as the primary risk factor, accounting for 50-60% of cases, while other critical risks include occupational exposure to chemicals in paint and textile industries, arsenic in drinking water, pelvic radiotherapy, cyclophosphamide treatment, Western-style diet, and Schistosoma infections. Approximately 75% of newly diagnosed cases are classified as Non-Muscle-Invasive Bladder Cancer (NMIBC), which is characteristically manifested by painless, gross hematuria. Diagnosis utilizes ultrasonography, CT urography, and urinary cytology, but definitive diagnosis is established via cystoscopy and transurethral resection of bladder tumor (TURBT), where capturing the deep detrusor muscle is vital for accurate staging. Advanced optical technologies like photodynamic diagnosis (PDD) and narrow-band imaging (NBI) enhance the detection of carcinoma in situ (CIS) compared to standard white light. A second resection (re-TUR) is strongly recommended within 14-42 days for all T1 and high-grade Ta tumors to eliminate residual disease and correct understaging. Ultimately, patient management and adjuvant intravesical chemotherapy or immunotherapy schedules are dictated by risk stratification into low, intermediate, high, and very high-risk categories calculated through established EORTC scoring models.
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