Bladder cancer has always been a very common malignancy of the genitourinary system in China, more in men than in women. Characteristics of high-risk groups include: smoking (including second-hand smoke), long-term exposure to chemical materials (commonly dyes/paints/artificial leather), radiation (mainly pelvic radiotherapy) or long-term inflammatory irritation (e.g., bladder stones), and poor lifestyle habits (drinking little water and often holding urine – drivers and conductors are also risk groups). As with all malignancies, bladder cancer is mostly curable with early detection. Therefore, it is all the more important for high-risk groups to have routine medical checkups to rule out bladder cancer.
In fact, most first-time patients are found to have “hematuria” on further examination. Some of them even have recurrent hematuria for several times and do not deal with it further after it gets better, and there are few patients who delay it for half a year, which are very dangerous behaviors. In recent years, the trend of bladder cancer is getting younger, so even young people who have ‘hematuria’ should be examined clearly. Experienced ultrasonographers can detect bladder tumors as small as 0.5 cm, which is also related to whether the urine is adequately held during the examination. Fortunately, nowadays, more and more patients have their bladder tumors detected by physical examination or at a very early stage. Nevertheless, the alarm of “hematuria” should be taken seriously.
So once bladder tumor is found, how to choose the treatment first?
Firstly, the nature and stage of the tumor should be clarified.
70-80% of bladder tumors are bladder cancer, that is, malignant tumors, while a few are benign tumors or inflammatory lesions. The routine examination to clarify the nature of tumor is cystoscopic biopsy. This examination can not only observe the visualization of tumor shape/size/number in the bladder, but also perform tumor biopsy at the same time (for those with uncertain nature) to clarify the diagnosis. However, considering that most bladder tumors are bladder cancer and the accuracy of visual diagnosis is high, for bladder cancer with early clinical stage, direct “diagnostic bladder tumor electrosurgery” can be considered, which can not only clarify the diagnosis but also remove the tumor and achieve the therapeutic effect. Further treatment will be carried out according to the postoperative pathological results. If cystoscopy or preoperative imaging (ultrasound/CT) considers muscle invasive (infiltrative) bladder cancer, then cystoscopic biopsy or bladder electrosurgical biopsy can be performed to obtain pathology to clarify the diagnosis and prepare for further diagnosis and treatment.
Second, subsequently, a treatment plan is developed.
Superficial bladder cancer Because of the alarm of “hematuria”, most patients are initially diagnosed with non-muscle invasive (superficial) bladder cancer, which is an early stage tumor. This type of bladder cancer is usually not life threatening, but is prone to recurrence after surgery and is commonly treated with “bladder tumor electrosurgery”. For bladder tumors that are evaluated by imaging/cystoscopy as early stage, “diagnostic bladder tumor electrosurgery” can be performed directly.
If the pathology shows multiple tumors (3 or more), high malignancy (high grade, G3), and infiltration of the submucosa (T1), which are high risk factors for tumor progression (invasive bladder cancer/metastases), a “second bladder tumor electrosurgery” is recommended for further staging and complete resection of the tumor. Depending on the final evaluation of the tumor, the options are: bladder perfusion, postoperative adjuvant radiation/chemotherapy, or total cystectomy.