Yüzeyel Mesane Kanserinde İntravezikal Tedaviler
Özet
Mesane kanseri, dünya genelinde sık görülen ve erkeklerde kadınlara kıyasla 3-4 kat daha fazla saptanan bir hastalıktır. Vakaların %75'ini oluşturan yüzeyel mesane kanseri, mukoza ve submukoza ile sınırlıdır. Tanı aşamasında ultrasonografi, bilgisayarlı tomografi ve intravenöz ürografiden yararlanılırken, kesin tanı sistoskopik muayene ve transüretral rezeksiyon (TUR-M) doku incelemesi ile konur. Tedavide ilk basamak TUR-M işlemidir ve gerekirse 2-6 hafta sonra tekrarlanır. Sonrasındaki süreç hastanın yer aldığı risk grubuna (düşük, orta, yüksek, çok yüksek) göre planlanır. Düşük ve nüks riski az olan orta risk grubunda, serbest tümör hücrelerini yok etmek amacıyla ameliyattan sonraki ilk 24 saat içinde tek doz intravezikal kemoterapi uygulanır. Orta ve yüksek risk gruplarında nüks ve progresyonu önlemek için 1 ila 3 yıl süreyle intravezikal BCG tedavisi tercih edilirken, çok yüksek riskli hastalar ile karsinoma in situ (CIS) olgularında yüksek progresyon riski nedeniyle radikal sistektomi önerilir. BCG tedavisine yanıt verilmemesi durumunda da mesane korunmadan sistektomiye geçilmelidir. Tedavi sonrası takip süreci risk düzeyine göre 5 yıl ile yaşam boyu arasında değişen sistoskopik kontrolleri kapsar. BCG uygulamasında sistit, ateş gibi lokal ve sistemik yan etkiler görülebilir; 48 saati aşan ateş, sepsis ve aktif idrar yolu enfeksiyonu gibi durumlarda tedaviye ara verilir veya tamamen kesilir.
Bladder cancer is a common disease worldwide, detected 3-4 times more frequently in men than in women, and superficial bladder cancer, which constitutes 75% of cases, is limited to the mucosa and submucosa. While ultrasonography, computed tomography, and intravenous urography are utilized during the diagnosis stage, the definitive diagnosis is established through cystoscopic examination and tissue analysis of transurethral resection (TUR-M). The first-line treatment is TUR-M, which is repeated after 2-6 weeks if necessary, and the subsequent process is planned according to the patient's risk group (low, intermediate, high, very high). In the low-risk and low-recurrence intermediate-risk groups, a single dose of intravesical chemotherapy is administered within the first 24 hours after surgery to eradicate free tumor cells. Intravesical BCG therapy is preferred for 1 to 3 years to prevent recurrence and progression in intermediate and high-risk groups, whereas radical cystectomy is recommended for very high-risk patients and carcinoma in situ (CIS) cases due to the high risk of progression. In case of non-responsiveness to BCG treatment, cystectomy should be performed without bladder preservation. The follow-up process after treatment includes cystoscopic controls ranging from 5 years to lifelong depending on the risk level. Local and systemic side effects such as cystitis and fever may be observed in BCG administration; treatment is suspended or completely discontinued in conditions like fever exceeding 48 hours, sepsis, and active urinary tract infection.
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