Bladder cancer is one of the more common tumors in the whole body and the most common tumor in the urological system. Its incidence is increasing year by year, and its etiology is not fully understood and may be related to the environment and some specific occupations. Early bladder cancer has more typical clinical manifestations and can achieve quite good therapeutic effect after standardized treatment.
1.What is the incidence rate of bladder cancer? Is there any difference in gender and age?
In China, the incidence rate of bladder cancer ranks the eighth among all tumors in men and the twelfth among women, which is much lower than that in western countries. 2002, the age-standardized incidence rate of bladder cancer in China was 3.8/100,000 for men and 1.4/100,000 for women. In recent years, reports on the incidence of tumors in some cities in China have shown an increasing trend in the incidence of bladder cancer.
The incidence rate of bladder cancer in men is 3-4 times higher than that in women. And for bladder cancer with the same grading, the prognosis of women is worse than men. The higher incidence of bladder cancer in men than in women may be related to smoking habits, occupational factors, and sex hormones may also be a cause.
Bladder cancer can occur at any age, even in children. However, the main age of onset is after middle age, and its incidence increases with age.
2.What are the factors for the development of bladder cancer?
The occurrence of bladder cancer is a complex, multifactorial and multi-step pathological process, which has both external environmental factors and internal genetic factors.
Among the environmental factors, the two clear risk factors are smoking and long-term exposure to industrial chemical products. Smoking is the most certain risk factor for bladder cancer, about 30%~50% of bladder cancer is caused by smoking, and smoking can increase the risk rate of bladder cancer by 2~4 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. However, it is not true that all people exposed to these industries in the chemical industry will get bladder cancer, and further research by the medical community is needed to truly identify the cause of bladder cancer. Other possible causative factors include chronic infections, application of the chemotherapy drug cyclophosphamide, abuse of painkillers containing finasteride (for more than 10 years), pelvic radiotherapy, long-term consumption of water with high arsenic content and chlorine disinfected water, coffee, artificial sweeteners and hair dyes.
Among genetic factors, the risk of bladder cancer is significantly increased in those with a family history of bladder cancer, and the incidence of bladder cancer is significantly higher in patients with hereditary retinoblastoma.
Chronic urinary tract infection, residual urine and long-term foreign body irritation (indwelling catheter, stone) are closely related to the occurrence of muscle invasive bladder cancer, which is mainly seen in squamous cell carcinoma and adenocarcinoma.
3.What are the pathological types of bladder cancer?
Bladder cancer includes uroepithelial cell carcinoma, squamous cell carcinoma and glandular cell carcinoma, followed by the less common metastatic carcinoma, small cell carcinoma and carcinosarcoma. Among them, uroepithelial carcinoma of the bladder is the most common, accounting for more than 90% of bladder cancer. Squamous cell carcinoma of the bladder is relatively rare, accounting for 3% to 7% of bladder cancers. Bladder adenocarcinoma is even less common, accounting for <2% of bladder cancer. Bladder adenocarcinoma is the most common cancer in patients with bladder exstrophy. According to the malignancy of cancer cells, pathologists can give a score of highly differentiated or poorly differentiated.
4.How to determine the clinical stage of bladder cancer?
The stage of bladder cancer refers to the depth of tumor infiltration into the muscular layer of bladder wall and metastasis, which is the most valuable parameter to judge the prognosis of bladder tumor. Currently, TNM staging is commonly used, which is divided into non-muscle invasive bladder cancer (Tis,Ta,T1) and muscle invasive bladder cancer (T2 or above). Although carcinoma in situ also belongs to non-muscle invasive bladder cancer, it is generally poorly differentiated and is a highly malignant tumor with a much higher chance of progression to muscle invasive.
5.What are the clinical manifestations of bladder cancer?
Hematuria is the most common symptom of bladder cancer, especially intermittent full course painless carnal hematuria, which can be manifested as carnal hematuria or microscopic hematuria, sometimes accompanied by blood clots. The amount of time of hematuria appearance and the amount of bleeding are not consistent with the malignancy, stage, size, number and morphology of the tumor. Sometimes a very small tumor may present with a large amount of hematuria.
Patients with bladder cancer also have urinary frequency, urgency, painful urination and pelvic pain as the first manifestation, which is another common symptom of bladder cancer, often associated with diffuse carcinoma in situ or invasive bladder cancer.
Other symptoms include pain in the lumbar region due to ureteral obstruction, edema in the lower limbs, pelvic mass, and urinary retention. Some patients show weight loss, renal insufficiency, abdominal pain or bone pain at the time of consultation, all of which are advanced symptoms.
6.How to detect bladder cancer as early as possible?
The first manifestation of bladder cancer is usually due to tumor rupture and painless hematuria. Therefore, if you find hematuria, you should think about the possibility of urinary tract tumor, especially if you are over 40 years old and have painless hematuria. If it is bladder cancer, most of them are in well differentiated or moderately differentiated early bladder cancer, and the treatment effect is better.
The main reason for patients to delay the treatment of bladder cancer may be that due to the intermittent manifestation of hematuria, some patients have only one or two episodes of hematuria, and sometimes even the second episode of hematuria occurs only in a few months, so it is easy to be ignored when the hematuria stops, and they only go to the hospital when they have frequent hematuria; some patients only have microscopic hematuria, which is not taken seriously because it is not accompanied by other symptoms, and they often do not go to the hospital until they have carnal hematuria. Some patients only show microscopic hematuria because it is not accompanied by other symptoms and is not taken seriously.
7.Why should cystoscopy and pathological biopsy be done to consider bladder cancer?
Cystoscopy is the most reliable method to diagnose bladder cancer. The purpose of cystoscopy is to find out whether there are tumors in the bladder and to clarify the number, size, shape and location of tumors; the purpose of pathological biopsy is to make pathological diagnosis of tumors and suspected lesions.