Article

Blaascarcinoom

21(5):200-205. DOI: 10.1007/BF03059854

ABSTRACT Het blaascarcinoomcarcinoom, blaas is een kwaadaardige woekering van het blaasepitheel, het zogenoemde overgangsepitheelcarcinoom of urotheelcelcarcinoom. Naast
de blaas is ook de gehele tractus uropoeticus bekleed met overgangsepitheel. Dit type carcinoom kan dan ook ontstaan vanaf
de nierpapil tot aan de urethra. Het overgrote deel van de overgangsepitheelcarcinomen ontstaat echter in de blaas zelf. In
Nederland is de incidentie van blaascarcinoom 15 nieuwe gevallen per 100.000 per jaar – 23 mannen en 7 vrouwen per 100.000
– wat neerkomt op 2350 nieuwe gevallen per jaar. De belangrijkste tot nu toe bekende etiologische factoren zijn contact met
aromatische aminen, roken van sigaretten, overmatig gebruik van fenacetine en infectie met de zogeheten blaas-Schistosoma.
De voornaamste symptomen zijn microscopische en macroscopische hematurie, recidiverende urineweginfecties en pijn bij de mictie.
In 75% van de gevallen is er sprake van oppervlakkig urotheelcelcarcinoom, een epitheelwoekering die niet verder infiltreert
dan de lamina propria van de blaas. In 25% is er sprake van infiltratief urotheelcelcarcinoom, dat in de blaasspier zelf infiltreert.
Voor de behandeling en de prognose is het essentieel om een onderscheid tussen deze twee manifestaties van blaaskanker te
maken. Bij het niet-infiltrerend carcinoom kan meestal worden volstaan met een blaassparende behandeling in tegenstelling
tot het infiltrerende carcinoom, waarbij verwijdering van de blaas de behandeling van eerste keuze is. De verschillen tussen
de twee typen blaascarcinoom komen ook tot uiting in de prognose. Terwijl het infiltrerende blaascarcinoom een levensbedreigende
tumor is waarbij ongeveer de helft van de patiënten overlijdt aan de gevolgen, blijft het overgrote deel van de patiënten
met een niet-infiltrerend carcinoom in leven. Een snelle diagnose en behandeling zijn belangrijk voor een goede afloop. De
laatste tien jaar zijn grote vorderingen gemaakt in de reconstructie van de urinewegen na het verwijderen van de blaas. Voor
zowel de oncologische als de reconstructieve parameters lijken de resultaten beter in ziekenhuizen waar jaarlijks een groot
aantal patiënten wordt behandeld. Terwijl de prognose bij uitgebreide metastasering infaust is, biedt combinatiebehandeling
bij beperkte metastasering nog uitzicht op langdurige progressievrije overleving (en mogelijk curatie).

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