Bladder tumor is a common tumor with a high incidence in developed countries or regions. In foreign countries, the incidence of bladder tumor is second only to prostate cancer among male genitourinary tumors; in China, it is the first and has been increasing in recent years.
The causes of bladder cancer are not yet completely clear, but the more recognized ones are.
①Long-term exposure to aromatic substances, such as dyes, leather, rubber, painters, etc.
②Smoking is also a cause of increased incidence of bladder tumors.
③ abnormalities of tryptophan metabolism in the body.
④Long-term local irritation of bladder mucosa. Long-term chronic local irritation of the bladder wall, such as long-term chronic infection, long-term irritation of bladder stones and urinary tract obstruction, may be factors that induce cancer. And adenoidal cystitis and mucosal leukoplakia are considered to be precancerous lesions that can induce cancer.
⑤ Drugs. such as large amounts of phenacetine, which have been shown to cause bladder cancer.
(6) Parasitic diseases.
Most bladder tumors occur in the triangle, both walls and the neck. Among bladder tumors, malignant tumors account for the great majority, of which more than 86% originate from uroepithelial cells, while undifferentiated carcinoma, squamous cell carcinoma and adenocarcinoma are rare. According to the degree of cell differentiation, i.e. tumor cell size, morphology, chromatin, nuclear changes and splitting image, bladder tumors can be classified into three grades: grade I refers to well differentiated cells, which usually do not involve the lamina propria; grade II shows poorly differentiated cells; grade III is poorly differentiated cells with severe interstitial changes. The tumor most often metastasizes to the peri-cystal, common iliac and lumbar lymph nodes. Hematogenous metastases are mostly in advanced stages, and liver, bone and lung are the most commonly involved organs.
Examination and diagnosis:
The possibility of urological tumors should be thought of in any adult over 40 years of age who develops painless carnal hematuria of unknown origin, among which bladder tumors are most common. Since hematuria is a symptom common to various diseases of the urinary tract, further investigations are necessary.
Diagnostic criteria:
(1) Principles of clinical diagnosis.
The diagnosis of bladder tumor should be made by painless, simple and non-invasive examination first, then by invasive examination. At the same time, one should not be satisfied with the clinical diagnosis only, and obtain pathological confirmation as much as possible before treatment. It should be affirmed that pathologic confirmation is possible in most patients with bladder tumors.
(2) Clinical diagnosis step gathering.
①History, symptoms and physical examination.
② Routine urine examination. It is a simple and easy laboratory test. Red blood cells can be found under high magnification microscopic field after centrifugation to confirm the presence of hematuria.
(③) Urine concentration to find pathological cells. It is a non-invasive test and should be repeated for all patients with hematuria.
④B-type ultrasonography.
⑤ Urogram and intravenous pyelogram. The value of relying on intravenous pyelogram as a routine test is to exclude tumors of the renal pelvis and ureter in order to identify metastatic bladder tumors or primary bladder tumors originating from the renal pelvis and ureter.
(6) Cystoscopy and tumor tissue biopsy. Cystoscopy can not only clarify the presence or absence of tumor, but also observe the location of tumor and whether the lesion is solitary or multiple, and directly understand the morphology of the tumor (papillary, non-tip or flattened).
Treatment:
The treatment principles of bladder tumor are the same as other tumors, including surgery, radiotherapy, chemotherapy, immunotherapy and new technologies, but surgery is still the main treatment. The specific scope and method of surgery should be analyzed comprehensively according to the stage of tumor, malignancy degree, pathological type and tumor size, location, and whether there is involvement of adjacent organs.
Surgical treatment.
(1) Local resection and electrocautery of bladder tumor.
Applicable evidence of surgery: bladder papilloma with tumor only infiltrating mucosa or submucosa layer, low malignancy and thin basal tip.
(2) Partial cystectomy.
Indications for surgery: It is suitable for invasive papillary carcinoma with more limited scope and tumor located away from the bladder triangle and neck area.
(3) Total cystectomy.
Surgical indications: For tumors with large scope and scattered multiple tumors, which are not suitable for local excision; tumors located near the bladder triangle; or invasive tumors located in the bladder neck, total cystectomy should be used.
The general condition of the patient must be improved before total cystectomy. For those who use bowel for urinary diversion, bowel preparation, blood preparation, preoperative enema, and vaginal disinfection for women are required.
(4) Transurethral bladder tumor electrosurgery or laser treatment.
Transurethral bladder tumor electrosurgery (TURBT) is a treatment method for superficial non-invasive bladder tumors, which has the advantages of less injury, quick recovery, can be repeated, few surgical mortality, and can preserve bladder urinary function. This method is also usually a combination of diagnostic and therapeutic approach, which can avoid or reduce open bladder surgery. The introduction of laser fiber into the human cavernous organs through endoscopy to treat the disease is a major advance in treatment.
(5) Interventional therapy.
In recent years, interventional therapy has been widely used to treat tumors, and interventional therapy for bladder tumors has also been reported. Its treatment method mainly refers to subabdominal artery cannulation chemotherapy.
(6) Radiation therapy.
The effect of radiation therapy for bladder cancer is not ideal, and at present it is mainly used for palliative treatment of patients with advanced tumors, or pavement therapy for patients undergoing surgery or chemotherapy.
(7) Heating therapy.
The theory of using a temperature higher than body temperature (43℃) to inhibit the growth of cancer cells while leaving normal tissues undamaged.
Postoperative management and follow-up.
The recurrence rate of bladder tumor by surgery alone is high, and one of the big problems faced clinically after superficial tumor by TURBT is also the problem of tumor recurrence, and the pathological grading and clinical staging of tumor recurrence will be aggravated. Therefore, in addition to other treatment methods before surgery, chemotherapy in the bladder cavity should be performed immediately after surgery to prevent recurrence. The more commonly used chemotherapeutic drug is intravesical bladder instillation.
Cystoscopy should be performed every 3 months during the treatment period for recurrence prevention. If meatus hematuria occurs during follow-up, the possibility of recurrence should be considered and a cystoscopic review should always be done earlier. Regular urine routine and cytopathological examination of urine exfoliated cells can also be done regularly, and if recurrence is suspected, cystoscopic review should be done earlier.
Prevention.
Primary prevention: strong labor protection and minimizing or avoiding exposure to relevant carcinogens such as benzidine, β-aniline, azo dyes, etc. can effectively prevent the occurrence of bladder cancer.
Secondary prevention: At present, it is considered that bladder epithelial tumor is a continuous process of cancer occurrence from benign to malignant. Therefore, timely detection and treatment of benign bladder tumors is an effective prevention of bladder cancer.