Bladder tumors are the most common tumors in the urinary system. Most are metastatic epithelial cell carcinomas. They are most frequent in the lateral and posterior walls of the bladder, followed by the triangle and the apex, and their occurrence can be multicentric. Bladder tumors may be sequentially or concurrently associated with tumors of the renal pelvis, ureter, and urethra. In foreign countries, the incidence of bladder tumor ranks 2nd after prostate cancer among male urogenital tumors; in China, it is the first. The incidence of bladder tumor in men is about 3-4 times that of women, and the age of 50-70 years old is the most common. The tissue type of epithelial tumor accounts for 95% of the disease, of which about 90% is metastatic epithelial cell carcinoma.
The causes of bladder cancer have not yet been studied clearly, but the common causes of bladder cancer are as follows
1, long-term exposure to aromatic substances, such as dyes, leather, rubber, painters, etc., have a high incidence of bladder tumors.
2. Smoking is also a cause that increases the incidence of bladder tumors. Recent studies show that the metabolism of tryptophan, a carcinogenic substance in the urine, increases by 50% in smokers, and when smoking stops, tryptophan levels return to normal levels.
The abnormal metabolism of tryptophan in the body can produce some metabolites, such as 3-hydroxy-2-aminoacetophenone and 3-hydroxy-o-aminobenzoic acid, which can directly affect the synthesis of cellular RNA and DNA. These metabolites are excreted into the bladder through the role of the liver and have carcinogenic effects after the action of β-glucuronidase.
4, the bladder mucosa local long-term chronic stimulation of the bladder wall long-term chronic local stimulation. Such as long-term chronic infection, long-term stimulation of bladder stones and urinary tract obstruction may be factors that induce cancer. And adenoidal cystitis and mucosal leukoplakia are considered to be pre-cancerous lesions, which can induce cancer.
5.Long-term application of certain drugs. For example, taking large amount of finasteride drugs has been proven to cause bladder cancer.
6.Some parasitic diseases, such as schistosomiasis, which occur in the bladder, can also induce bladder cancer.
Common clinical manifestations of bladder tumor.
1.Hematuria
Most of bladder tumors have painless hematuria or microscopic hematuria as the first symptom, and patients show intermittent or whole hematuria, sometimes accompanied by blood clots. Therefore, intermittent painless hematuria is considered to be the most typical symptom of bladder tumor in clinical practice. The amount of hematuria and the duration of hematuria are related to the malignancy degree, size, scope and number of tumor, but not necessarily proportional to each other. Sometimes the tumor is already very large or advanced when hematuria occurs; sometimes a very small tumor will show a large amount of hematuria. Since hematuria is intermittent, it is easy to be ignored by patients when hematuria stops, and they mistakenly think that the disease disappears and do not make timely further examination. When the patient only shows microscopic hematuria, it is not detected because it is not accompanied by other symptoms, and often it will not be noticed until the appearance of visual hematuria.
Compared with the hematuria caused by other diseases, the hematuria of bladder cancer has two characteristics: one is painlessness, that is, when hematuria occurs, the patient does not have any pain or other uncomfortable symptoms, which is medically called painless hematuria. This is different from the pain of kidney and ureter when stones have hematuria, and it is also different from the hematuria caused by cystitis which is accompanied by frequent, urgent and painful urination. However, if the cancer is necrotic, ulcerated and co-infected, bladder irritation symptoms such as urinary frequency, urinary urgency and urinary pain may occur. Secondly, it is intermittent, that is, hematuria appears intermittently and can be stopped or reduced by itself, and the interval between two hematuria can be several days or months, or even half a year, which can easily cause the illusion that hematuria has been cured and improved, thus failing to seek medical examination in time.
2.Bladder irritation symptoms
Early bladder tumor rarely shows symptoms of urinary tract irritation. If the bladder tumor is accompanied by infection or if the tumor occurs in the bladder triangle, the symptoms of urinary tract irritation can appear earlier. One must also be alert to bladder irritation symptoms such as urinary frequency and urgency, which may suggest the possibility of bladder cancer in situ. Therefore, any patient with bladder irritation symptoms lacking a basis in infection should use aggressive and comprehensive examination measures to ensure an early diagnosis.
3.Difficulty in urination
A few patients may have urinary flow obstruction, difficulty in urination or even urinary retention due to large tumor, or tumor occurring in the bladder neck, or blood clot formation.
4.Symptoms of upper urinary tract obstruction
When the tumor infiltrates the ureteral orifice, it causes dilated fluid in the renal pelvis and ureter, and even infection, causing different degrees of lumbar acidity, lumbar pain, fever and other symptoms. If bilateral ureteral orifices are invaded, acute renal failure symptoms may occur.
5. Systemic symptoms
Including nausea, loss of appetite, fever, emaciation, anemia, cachexia, leukemia-like reaction, etc., which are mostly the clinical manifestations of advanced bladder cancer.
6.. Metastatic foci symptoms
Advanced bladder cancer may occur as infiltration or distant metastasis around the pelvic floor. The common distant metastasis sites are liver, lung, bone, etc. When the tumor infiltrates into the posterior urethra, prostate and rectum, corresponding symptoms will appear. When the tumor is located in one side of ureteral orifice, causing infiltration of ureteral orifice, it may cause dilatation of one side of ureter and hydronephrosis. When the tumor is accompanied by bladder stones, symptoms of bladder stones such as painful urination and hematuria will appear.
7.Common complications
Common complications of bladder cancer are bladder cancer pain, severe hematuria, urinary retention, etc.
III. Pathological grading of bladder cancer
Grade I: well differentiated, with more than 7 layers of metastatic epithelium, slightly different from normal nuclear anisotropy, and occasional nuclear separation.
Grade II: epithelial thickening, cell polarity disappeared, moderate nuclear heterogeneity appeared, nuclear division was common.
Grade III: Undifferentiated type with no resemblance to normal epithelium and many nuclear divisions.
Generally speaking, the degree of malignancy is proportional to the degree of infiltration.
IV. Classification of bladder cancer
1.Major examination is single or multiple, most of them are papillary type, a few are nodular type or ulcerated type.
2.Microscopic examination 90% are metastatic epithelial cell carcinoma with different degrees of differentiation, a few are phosphoric carcinoma, and adenocarcinoma is less common.
V. Examination methods of bladder tumor
1.Urinary routine and urine cytology examination;
2.Cystoscopy;
3.B ultrasound examination;
4.Intravenous pyelogram or pelvic arteriogram;
5.CT, MRI examination;
6.Tumor marker measurement (ABO(H) blood group antigen, T-antigen, CEA, etc.)
In our daily life, we should go for regular medical checkups and pay attention to whether there are signs of bladder cancer in our body from time to time, and if there are some reactions, we should find out what causes the discomfort. To confirm whether it is bladder cancer or not, you need to go to the hospital for specific tests.
If it is diagnosed as bladder cancer, first of all, do not panic, you must make a judgment on how to treat it according to the specific situation and consult various aspects. With the emergence of early diagnosis methods of bladder cancer and the increasing maturity of treatment technology and post-operative comprehensive treatment, generally bladder cancer is treated well and has a better prognosis.
VI. Diagnosis of bladder cancer.
1.Conventional examination After centrifugation of urine, look for red blood cells under high magnification microscope to determine the existence of hematuria. This is the only way to diagnose occult hematuria, which is simple and easy to use. Using this method can detect information of early bladder cancer, and it can also be used as a routine examination item for high-risk people.
2.Urine exfoliative cell examination is a simple and non-invasive examination method, which is of great value to the diagnosis of bladder cancer.
3.X-ray imaging examination Through imaging, we can understand the filling of bladder and the scope and depth of tumor infiltration. Combined with renal pelvis and ureterogram, it can understand whether there is hydronephrosis, ureteral infiltration and the degree of infiltration.
4.Cystoscopy can directly see the growth site, size, number, shape, presence or absence of tissues, infiltration range of cancer, whether it is combined with bleeding, necrosis or stones, etc.
5.B ultrasound examination By filling the bladder and fully stretching the mucous membrane of the bladder wall, ultrasound can measure the size and location of the tumor as well as the degree of mucosal infiltration. If it is transrectal ultrasound scan, it can show the deformation of bladder wall at the base of tumor and the echogenicity of the mass protruding into the bladder cavity, and the scope of bladder tumor can be determined accordingly.
6.CT examination When bladder tumor tissue grows into the cavity or outside the wall and metastasis occurs, CT imaging can fully display its shape and size, with an accuracy rate of about 80%. This performance is helpful to the staging of bladder cancer. (Puncture biopsy is usually not recommended)
VII. Treatment of bladder tumor
1.Surgical treatment
Surgical treatment is the main method to treat bladder cancer. The specific scope and method of surgery should be determined according to the stage, malignancy and pathological type of the tumor, as well as the size, location and involvement of adjacent organs.
2.Radiation therapy
Radiation therapy for bladder cancer is mostly carried out before and after surgery. For cases with late stage of disease, lost time for surgery or refused surgery, as well as recurrence after surgery, palliative radiotherapy can also achieve positive effect.
3.Interventional radiotherapy
Interventional radiotherapy refers to the use of radiological technology to inject drugs directly into the feeding vessels of tumor through catheters to kill tumor cells. For patients with stage II-IV bladder cancer, this method can also be used to shrink the tumor lesions, improve the surgical resection rate and reduce the recurrence rate.
4.Chemotherapy
Chemotherapy for bladder cancer includes intravesical infusion chemotherapy, systemic chemotherapy, etc.
(1) Intravesical infusion chemotherapy is suitable for patients of all stages, especially for superficial tumors of stage 0-I. It cannot play a good therapeutic role for other lesions with deep infiltration, but still has a therapeutic role for superficial lesions.
Bladder perfusion with drugs (e.g., epirubicin) or immunologic agents (e.g., BCG) is the most effective way to prevent bladder cancer.
Bladder perfusion is the most common method to prevent recurrence of bladder cancer and can effectively prevent and treat superficial bladder cancer recurrence . The recurrence rate of bladder cancer with preserved bladder without perfusion chemotherapy is 50-70%; the peak of recurrence is within 24 months after surgery. Bladder perfusion chemotherapy can reduce the recurrence rate to 10-20%.
(2) Systemic combination chemotherapy Systemic combination chemotherapy can increase the surgical resection rate and improve the comprehensive treatment effect of bladder cancer.
5.Immunotherapy
Studies have shown that bladder metastatic cell carcinoma is antigenic in nature, and the impaired immunity of patients is highly related to tumor stage, grading and vascular lymphatic spread. Therefore, the disease is suitable for the application of immunotherapy.
VIII. Prevention of bladder tumor
Relevant experts believe that the secret of cancer prevention is very simple, which is to eat alkaline food often to prevent the accumulation of acidic waste, because the acidified body fluid environment is a fertile soil for normal cells to become cancerous, and adjusting the acid-base balance of body fluid is an effective way to prevent cancer.
1. Develop good living habits, quit smoking and limit alcohol. Smoking, the World Health Organization predicts that if people all stop smoking, after 5 years, the cancer in the world will be reduced by 1/3; secondly, do not abuse alcohol. Cigarettes and alcohol are extremely acidic acid, long-term smoking and drinking people, it is very easy to lead to acidic physique.
2.Don’t eat too much salty and spicy food, don’t eat food that is too hot, too cold, expired and spoiled; eat some cancer prevention food and alkaline food with high alkaline content as appropriate for those who are old and weak or have genes of certain diseases, and keep a good mental state.
3. Have a good state of mind to cope with stress, combine work and rest, and do not overwork. It can be seen that stress is an important cause of cancer. According to traditional Chinese medicine, stress leads to overwork and physical deficiency, thus causing a decline in immune function, endocrine disorders and metabolic disorders in the body, resulting in the deposition of acid in the body; stress can also lead to mental tension causing qi stagnation and blood stagnation and internal trapping of poisonous fire, etc.
4, strengthen physical exercise, enhance physical fitness, more exercise in the sun, more sweating can be acidic substances in the body with sweat out of the body, to avoid the formation of acidic physique.
People with irregular living habits, such as singing karaoke all night, playing mahjong, staying out all night, etc., will aggravate the acidification of the body and make it easier to develop cancer. You should develop good living habits to maintain alkaline physique so that various cancer diseases can stay away from you.
6. Don’t eat contaminated food, such as contaminated water, crops, poultry, fish and eggs, moldy food, etc., but eat some green and organic food, to prevent diseases from entering by mouth.