Bladder and bladder cancer
The bladder is located in the anterior part of the small pelvic cavity and is an extremely important muscular organ of the urinary system, whose function is to store and excrete urine. Like many other organs, malignant tumors can occur in the bladder, and its incidence ranks eighth among systemic tumors. It takes the first place among male urogenital tumors in China. In recent years, the incidence of bladder cancer has been on the increase.
Bladder Cancer Symptoms
The most common first symptom of most bladder tumor patients is painless hematuria. Other symptoms include: when tumor necrosis, ulceration, combined inflammation and formation of infection, patients may experience bladder irritation symptoms such as urinary frequency, urinary urgency and pain; when tumor infiltration reaches the muscular layer, painful symptoms may occur; when tumor is large and affects bladder capacity or occurs in the bladder neck, or bleeding is serious and forms blood clot, it may cause difficulty in urination or even urinary retention. If the bladder tumor is located near the ureteral orifice and affects the urinary drainage of upper urinary tract, it may cause hydronephrosis on the affected side. Patients with advanced bladder tumor have symptoms such as anemia, swelling and lower abdominal mass.
Bladder cancer disease
The most common pathological cell type of bladder cancer is urothelial (metastatic) epithelial carcinoma, which accounts for about 90% or more of bladder cancer. Other cell types include squamous cell carcinoma and glandular cell carcinoma, as well as the less common metastatic carcinoma, small cell carcinoma, and carcinosarcoma. Pathologists can assign a score of highly or poorly differentiated according to the malignancy of the cancer cells.
Risk factors for developing bladder cancer
The development of bladder cancer is a complex, multifactorial and multi-step pathological process with both intrinsic genetic and extrinsic environmental factors. Two of the more clearly identified risk factors are smoking and long-term exposure to industrial chemical products. Smoking is the most definite risk factor for bladder cancer, about 30% to 50% of bladder cancer is caused by smoking, and smoking can increase the risk rate of bladder cancer by 2 to 4 times, and the risk rate is proportional to the intensity and duration of smoking. Another important risk factor for bladder cancer is long-term exposure to industrial chemical products. Occupational factors are the first known risk factors for bladder cancer, and about 20% of bladder cancers are caused by occupational factors, including those involved in textiles, dye manufacturing, rubber chemistry, pharmaceutical and pesticide production, paint, leather, and aluminum, iron and steel production. Diesel exhaust accumulation can also increase the risk of bladder cancer.
How to prevent the occurrence of bladder cancer?
Smoking is the most certain risk factor for the occurrence of bladder cancer, so quitting smoking is the most effective way to prevent the occurrence of bladder cancer; and in fact, quitting smoking plays an important role in preventing the recurrence and progression of bladder cancer. Secondly, avoiding exposure to harmful chemical substances and strengthening the protection of such occupational workers also have a preventive effect on the occurrence of bladder cancer. Finally, once there is visual hematuria, especially painless hematuria, seek early medical consultation. Screening for high-risk groups is also useful.
What are the screening tests for bladder cancer?
Urological tumors should be thought of in adults, especially if they are over 40 years old and have painless hematuria, especially if they have not had final hematuria. Physical examination, urinary routine, ultrasound, urine exfoliative cytology, intravenous urography, CT, MRI and other examinations are needed to initially exclude and diagnose bladder cancer. Cystoscopy and pathological biopsy or diagnostic TUR should be performed for all patients considering bladder cancer; most patients with bladder cancer are in well-differentiated or moderately differentiated non-muscle invasive bladder cancer at the time of diagnosis, and about 10% of them eventually develop into muscle invasive bladder cancer or metastatic bladder cancer.
Can I keep my bladder after having bladder cancer?
Whether bladder cancer patients can keep their bladders depends on which treatment method is beneficial for tumor-free survival and can prolong the patient’s life. The next consideration is the patient’s survival and quality of life. There are two key factors that determine the prognosis of bladder cancer patients (tumor recurrence and metastasis, survival time): First, the clinical and pathological stage of bladder cancer, which is commonly known as early or late stage, depends on the depth of cancer involvement (infiltration) in the bladder, the presence of surrounding tissues and organs, lymph nodes and distant metastases. Secondly, the type and malignancy of bladder cancer cells, the worse the differentiation of tumor cells, the higher the malignancy. Therefore, the treatment of bladder tumor should mainly be based on the stage, the number, size, location, malignancy degree of tumor and clinical to decide the appropriate treatment plan. Different stages of bladder cancer, different types of tumor cells, different cell differentiation, and different treatment plans and strategies should be used.
For many non-muscle invasive bladder cancers with low malignancy, small, limited tumors, and no invasion of the bladder muscles, transurethral resection (TUR-BT) is the primary treatment option. Most patients with bladder tumors may be able to achieve disease control and bladder preservation with this minimally invasive procedure. Postoperative treatment is often supplemented with chemotherapy, radiotherapy, and Chinese medicine to obtain satisfactory treatment results.
For bladder cancer with higher malignancy, larger tumor, more extensive lesions, extensive and multiple lesions in the bladder, which have invaded the muscle (infiltrative), or when the tumor recurs, the malignancy grade increases and the disease progresses within a short period of time after being treated with TUR-BT surgery, then radical total cystectomy should be used decisively in a timely manner in order to obtain the best therapeutic effect. In addition to radical total cystectomy, a standard pelvic lymph node dissection must be performed. Thorough pelvic lymph node dissection maximizes patient survival and avoids local recurrence and distant metastases. For some patients with localized pelvic lymph node metastases, lymph node dissection may even need to be extended to the submesenteric level of the abdominal cavity.
What is the further treatment of bladder cancer after bladder preservation surgery?
Although TUR-BT can theoretically completely resect non-muscle invasive bladder cancer, in clinical treatment, without other adjuvant treatment, there is still a high probability of recurrence. 10%-67% of patients will recur within 12 months after TUR-BT, and 24%-84% of patients will recur within 5 years after surgery, which may be related to new tumor, tumor cell implantation or incomplete resection of the primary tumor. It may be related to new tumor, tumor cell implantation or incomplete resection of primary tumor. TUR-BT alone does not address the high postoperative recurrence and progression, therefore adjuvant bladder perfusion therapy with chemotherapeutic agents including pirarubicin, mitomycin, BCG and epirubicin is recommended for all patients with non-muscle invasive bladder cancer postoperatively. For some patients with multiple tumors, broad base and high cell malignancy, another electrical resection (Re-TURBT) should be performed about one month after surgery to re-evaluate the efficacy of the previous surgery, especially to make a diagnosis of whether cancer cells are still present in the bladder muscle under the microscope, in order to make extremely important decisions about further treatment. When the tumor recurs within a short period of time and the malignancy grade of the tumor increases, the treatment option of bladder preservation should be promptly and decisively abandoned and radical total cystectomy should be used in order to obtain the best treatment outcome.
How to solve the problem of urination after total cystectomy? Do I have to be hooked up to a urinary bag?
The physiological function of the bladder is mainly to store and pass urine. Since the entire bladder is removed, how to solve the urinary storage and voiding function in these patients has long been a hot topic of concern, research and exploration for urologists internationally. Total cystectomy is usually followed by urinary diversion or reconstruction of the “bladder” as a substitute to solve the voiding problem. At present, urinary diversion can be broadly divided into two categories: noncontinent diversion and continent diversion; controlled abdominal wall diversion refers to the use of a section of the intestine to make a sac-like urinary storage sac and a one-way “valve” abdominal wall The stoma is made by using a section of the intestine to make a capsule and a one-way “valve” in the abdominal wall, and the urine is discharged through regular home catheterization. Non-controlled urinary diversions consist of a direct ureteral wall stoma or a ureter connected to a section of bowel with a posterior intestinal wall stoma, where involuntary urine is collected in a urine collection bag. The urinary diversion procedure is relatively “simple” compared to the “bladder” replacement procedure. However, the skin around the stoma is prone to complications such as inflammation and ulcers; sometimes the urine bag can be accidentally dropped, resulting in “watery mountains”, and the damp clothes and odor of urine not only make the patient frustrated and unhappy, but also sometimes put the patient in a very embarrassing situation, and eventually the patient becomes very afraid to go to public places, which seriously affects The patient’s social activities and physical and mental health are seriously affected. Of course, the increased financial burden caused by the consumption of urinary bags and catheters and the aesthetic impact on the abdominal wall are also very obvious disadvantages of this type of surgery. In situ bladder reconstruction is one of the most common procedures performed internationally in recent years. Most of the ileum and colon are used to make a new urinary bladder according to the plastic surgery method, with the upper end connected to the ureter and the lower end connected directly to the urethra, avoiding the diversion of urine from the skin of the abdominal wall. The new “bladder” not only has a certain capacity, but also maintains a low tension. After some training, the patient can basically urinate more freely and can return to a condition close to the normal pre-operative urinary condition to meet his physiological needs of “normal urination”. Since 2000, the Department of Urology of Xinhua Hospital of Shanghai Jiao Tong University has successfully performed more than 100 cases of in situ bladder replacement surgery with good results. However, there are certain indications for this surgery and the surgery is relatively large. In conclusion, how to solve urinary problems after total cystectomy should be decided by the physician and the patient according to the patient’s specific situation.