1.Who are prone to bladder cancer?
Bladder cancer is the most common malignant tumor in the urinary system, ranking eighth in the list of top ten malignant tumors in China, and is common in patients over 50 years old. Bladder cancer is known as environmental tumor and is closely related to the external environment. Risk factors for the development of the disease include: environment, occupation, infection, chronic inflammation, stones, foreign bodies, pelvic irradiation, cytotoxic chemotherapy drugs, etc.
The relatively clear carcinogenic chemicals are 2-naphthylamine, benzidine, 4-aminobiphenyl, and the corresponding risk occupations are: dye, textile, rubber, paint, truck driver, chemical, petroleum, hairdresser, aluminum factory, etc.
Bladder tumors are closely related to gender, the incidence rate of men is 2-10 times higher than women, regardless of male/female. Smoking can greatly increase the chance of bladder cancer, mainly because smokers have higher levels of the carcinogen tryptophan in urine.
Once the above-mentioned susceptible people have discomfort, especially hematuria, they should seek medical consultation immediately.
2.How to detect bladder cancer at an early stage?
Early diagnosis of bladder cancer is crucial to the prognosis of patients. So how to detect and diagnose bladder cancer at an early stage? We should follow four recipes step by step, namely: abnormal urination should be alerted, initial screening of tumor by urinalysis, confirmation of diagnosis by cystoscopy, and comprehensive evaluation by imaging.
Abnormal urination should be alerted to.
The most common symptom of bladder cancer is hematuria without any sensation and visible to the naked eye, which is a unique “abnormal urination signal” of bladder cancer and occurs in almost every patient. About 85% of patients are seen for hematuria. Hematuria is more often seen throughout urination, or only at the beginning or end of urination. The hematuria is often painless and intermittent, and can reduce or stop on its own, making it extremely easy to create the illusion that the disease has healed. In addition, a small number of patients have symptoms of increased urination, urgency and painful urination like “cystitis”, so we should be alert to the possibility of bladder cancer in “cystitis” that is not cured by taking antibacterial agents for a long time. When people have the above “abnormal urination signs”, especially painless hematuria, even if it only occurs once, they should be fully alert and investigated to the end.
Primary screening urinalysis.
A few patients with bladder cancer may not have visual hematuria but only have microscopic hematuria when the red blood cells are found to be over the limit during microscopic examination of urine, and other patients may also have microscopic hematuria after the visual hematuria stops on its own. A very simple routine urine examination is valuable for early detection of bladder cancer when normal people pay attention to it during 1-2 annual general physical examinations. Most bladder cancers occur in the bladder mucosal epithelium, and tumor cells are easily mixed in the urine. Microscopic urine exfoliative cell examination is a simple, non-invasive and economical method for initial screening of patients with hematuria. Therefore, outpatient physicians should pay attention to routine urine microscopic examination and urine exfoliative cell microscopic examination.
Definitive diagnosis by cystoscopy.
When a patient presents with signs of abnormal urination, especially painless carnal hematuria, or repeated findings of microscopic hematuria, they should undergo cystoscopy. Cystoscopy is the only means to confirm the diagnosis of bladder cancer before surgery. The cystoscope is inserted into the bladder along the urethra to observe the whole bladder and the urethra at the same time to directly see the tumor site, size, number, infiltration degree, etc. If biopsy is taken at the same time, the nature of the tumor can be clarified.
Comprehensive estimation relies on imaging.
The whole urinary tract from calyces, pelvis, ureter, bladder and urethra are covered by uroepithelium, and uroepithelial tumor can be multiple, so if it is clear that the patient has bladder cancer, it is necessary to perform intravenous urography to show the calyces, pelvis and ureter through intravenous injection of contrast agent to clarify or exclude the suspected tumor. In addition, ultrasound and CT examinations can help to estimate the extent and depth of bladder cancer infiltration and the presence or absence of surrounding lymph node invasion. Necessary imaging examinations are important to fully evaluate the disease and decide the treatment plan.
The implementation of the above four tips is usually performed in outpatient clinics and should be done step by step so that bladder cancer can be detected early and diagnosed clearly, providing the necessary information to decide the correct treatment plan through a comprehensive understanding of the disease.
3.What are the treatment methods for bladder cancer?
The specific treatment plan for bladder cancer should be formulated by doctors according to different pathological conditions and the results of some clinical examinations, which is generally based on surgery and integrated with chemotherapy, radiotherapy and biological therapy. Surgical modalities include.
①Transurethral bladder tumor electrosurgery, the advantage is less damage and faster recovery, but not suitable for multiple or deeply infiltrated tumors;
②Partial cystectomy;
③ radical total cystectomy with ileal cystectomy, where urine flows through the abdominal wall;
④ radical total cystectomy with in situ ileal substitution cystectomy, where the patient’s urine also drains from the original urethra and has a higher quality of life.
All patients after bladder-preserving surgery (①+②) should be administered intravesical drug-infused chemotherapy postoperatively. Radiotherapy and systemic chemotherapy can be used for cases that are temporarily unable or unwilling to operate and for cases of postoperative recurrence, with some efficacy, and for some patients biological therapy and interventional therapy can also be considered.
4.Is it a dream to remove the whole bladder without urinary bag?
For patients suffering from bladder cancer, the traditional surgical treatment method is to remove the whole bladder and then let the patient “wear” a urinary bag, insert a catheter and “stoma” in the abdominal wall, which is very painful for the patient. Nowadays, “ileal neobladder reconstruction” brings good news to the patients. With radical total cystectomy plus ileal neobladder reconstruction, the catheter is removed in the third week after surgery, and the patients can urinate from the original urethra, and generally there is no urinary incontinence, urinary reflux and kidney function damage, and various urodynamic measurements are similar to normal bladder.
5.What are the postoperative treatment and health care of bladder cancer?
(1) For patients who have undergone bladder preservation surgery (partial cystectomy or transurethral resection), in order to prevent tumor recurrence, bladder surgery should be performed after surgery,
In order to prevent tumor recurrence, intravesical chemotherapy should be administered after surgery. After the perfusion, it should be kept for half an hour to two hours, and the position should be changed evenly in the supine, prone, left and right lateral position once a week for 6~8 times, and then changed to once every 2 weeks to once a month for 1~2 years. Routine examination of urine and blood should be done regularly during the treatment period.
(2) Cystoscopy should be done every three months for two years; if there is no recurrence within two years, it should be changed to once every six months for two years, and once a year from the fifth year. If meatus hematuria appears again during the follow-up period, it should be checked in advance at any time, and treated early once recurrence is detected.
(3) In addition to cystoscopy, urine cytology, B-ultrasound, excretory urography, CT, etc. can also be performed, which are chosen by the doctor according to different conditions.
(4) Patients who have undergone total cystectomy or ileal bladder surgery (Bricker procedure), where urine flows from the abdominal wall through the ileostomy, require a permanently placed urine collector. The urine collector consists of two parts, the sump and the urine bag, and the sump is usually replaced once in several days, and the urine bag is replaced once in 1~2 days. Care should be noted: people with permanent skin fistula should protect the skin around the stoma, wash and disinfect daily, apply zinc oxide ointment, etc.; if you find flocculent mucus in the urine, you can drink more water and take baking soda tablets orally to alkalize the urine and thin the mucus for smooth urination; pay attention to the occurrence of retrograde infection in the urinary system, if there is sudden high fever, you also need to go to the hospital for timely treatment; if there is bloody discharge from the urethra If there is bloody discharge from the urethra, you should be alert to the possibility of residual or occurrence of urethral tumor and come to the hospital in time.
(5) Patients should quit smoking after bladder cancer surgery and develop the habit of drinking more water.
(6) Patients with total cystectomy and in situ ileal substitution cystectomy, urine is still discharged from the original urethra, so they should do anal lifting muscle training to exercise perineal muscles, and should urinate once in 2 hours after catheter removal. Gradually extend the interval of urination to 3~4 hours, wake up at night with alarm clock, drink 2~3 liters of water daily, eat more salt appropriately, and check liver and kidney function and blood gas analysis once every 1-2 weeks for the first 3 months.
6.What is the difference between adenoid cystitis and bladder cancer?
Adenoid cystitis is a proliferative lesion of the bladder mucosa, most often involving the bladder neck and triangle, but can also involve the whole bladder mucosa or the ends of the ureters bilaterally and cause hydronephrosis. Bladder infections, stones and obstructive lesions are generally considered to be the causes of adenocystitis.
Adenocystitis itself is a benign proliferative lesion, but clinical data suggest a relationship with bladder cancer. It is now considered to be a pre-cancerous lesion and is therefore receiving increasing attention from clinicians, with treatment principles similar to those for bladder cancer.