Bladder cancer is one of the common tumors of the urinary system, with more male patients than female and most elderly patients, but also many young patients, with 40 to 70 years old being the high incidence age. It is said that although its incidence has remained at the same level in recent years, the incidence of bladder cancer in cities is predicted to rise further due to environmental pollution. From the characteristics of bladder cancer, easy recurrence is one of its features, but if it can be diagnosed and treated in time, its treatment effect is still satisfactory. Therefore, let’s pay attention to bladder cancer together to achieve early detection, early diagnosis and early treatment.
Bladder cancer is a very complicated disease, today let’s learn how to prevent care, how to treat and some of its characteristics!
Define the type before treatment
Since there are two completely different types of bladder tumors, they are completely different in the type of genetic mutation, clinical manifestations and prognosis. This also means that the treatment approach is also completely different.
The first type is superficial papillary uroepithelial carcinoma. Since this type of tumor grows inside the bladder, the prognosis is relatively good after treatment, but this type of bladder tumor is very prone to recurrence, but even if it recurs many times, the treatment effect is still good as long as it is closely followed and removed as soon as it recurs.
The second type is invasive uroepithelial carcinoma of the bladder. Since this type of tumor tends to infiltrate and metastasize to the outside, the malignancy is very high and the prognosis is very poor, so the treatment for this type of tumor should be very aggressive.
Before treating bladder cancer, it is important to clarify the type of patient so that the treatment can be targeted.
Generally speaking, superficial papillary uroepithelial carcinoma can be solved by minimally invasive tumor electrosurgery, which is very simple. For invasive uroepithelial carcinoma of the bladder or multiple, recurrent superficial papillary uroepithelial carcinoma, if the tumor grade and malignancy are further aggravated during the follow-up process, then total cystectomy or radical resection is appropriate for treatment at this time. Since the bladder is an organ with urinary function, total cystectomy will inevitably have a great impact on the patient’s quality of life, so along with total cystectomy, urinary diversion surgery should be performed for the patient. There are several methods of urinary diversion, if the general condition of patients or older patients, you can do ureteroscopic fistula, this method is simple, surgical trauma is small, but the impact on the patient’s quality of life is slightly larger; the second method is to use a section of intestine instead of a bladder, so that the abdomen is a mouth; the third method is to use a section of intestine instead of a bladder, placed in situ, called in situ This method can improve the patient’s quality of life, but relatively speaking, the complications may be higher. The choice of the method needs to be considered in terms of the patient’s condition and quality of life requirements, and the patient can communicate with the treating surgeon before surgery to decide.
Of course, there will always be some patients who are unable to undergo a total bladder removal and would prefer to have a high quality of life. So now there are some bladder preservation methods, such as partial resection, which can relatively preserve part of the bladder function and thus improve the patient’s quality of life, which is now the goal pursued by some international experts. However, it may be relatively more life threatening and only for patients who need a high quality of life.
In addition, for patients with advanced bladder cancer that cannot be removed by surgery, there are now some drug treatments, such as immunotherapy against PD1 and PDL-1 antibodies, which are very effective for patients with very high expression of PD1 molecule in the tumor.
For patients with poor treatment effect or recurrent metastasis, systemic chemotherapy can also be done, which can also be effective. For patients who have undergone surgery, infusion chemotherapy should also be given during the follow-up afterwards, which can reduce the recurrence rate of bladder cancer.
Prevention and care
The occurrence of bladder cancer is closely related to three factors: diet, smoking and drinking water; therefore, the prevention of bladder cancer should also start from the source.
1, should adhere to scientific dietary habits, eat more fresh vegetables and fruits, because fresh vegetables and fruits are rich in vitamins and trace elements, which can decompose carcinogenic substances in the body – nitrosamines, should try to eat less meat food, because meat food can produce substances similar to the structure of aniline and benzidine in the process of metabolism in the body, there has been an investigation
It has been found that workers in factories using aniline and benzidine chemical materials have more bladder cancer.
2, smoking habits, to quit smoking as soon as possible, research shows that cigarettes contain nicotine, tar, tobacco – specific carcinogenic substances such as sub-pin amine, a large number of people who smoke, the concentration of carcinogenic substances in the urine is higher, if the daily smoking index reaches 600 (the number of cigarettes per day × years of smoking), it reaches the dangerous point of bladder cancer.
3.Increase water consumption, because the amount of water consumption directly affects the concentration of urine in the bladder, which has an important impact on the occurrence of bladder cancer, and the urine in the bladder of those who drink less water must be reduced, while the concentration of carcinogenic substances in the urine is correspondingly higher after excreted from the kidneys to the bladder, and these high concentrations of carcinogenic substances will cause strong stimulation to the bladder mucosa. This creates favorable conditions for the reproduction of bacteria (such as E. coli) in the bladder, and most of those who often have bladder cancer are those who do not like to drink water or tea.
The increase of bacterial concentration in urine can not only trigger cystitis, but also produce adverse stimulation to bladder mucosa continuously, so that over time, under the double stimulation of bacteria and carcinogenic substances, the bladder mucosa can gradually become inflamed and erosion and lead to cancer.
Therefore, to prevent the occurrence of bladder cancer, we should drink enough water to make urine diluted and discharged in time, so that the bacteria and carcinogenic substances in urine will be relatively lower, which can reduce the stimulation and damage to bladder mucosa and play a role in preventing bladder cancer.
Two major characteristics to understand
Bladder cancer has two major characteristics, one is multiplicity and the other is recurrence. These two characteristics are very important for diagnosis and treatment follow-up, and also need to be paid attention by patients.
1. Multiplicity: There may be multiple tumors appearing inside the bladder at the same time, and they can appear in multiple locations. Especially beware, since the renal pelvis, ureter and bladder, are all of uroepithelial origin, so there can be tumors of the same nature in the renal pelvis and ureter, so once bladder tumors are found, then it is also important to check whether there are other tumors in the renal pelvis and ureter too.
2. Recurrence: 70% of bladder tumor patients will recur after surgery, that is to say, 2 out of 3 patients will recur, so after surgery treatment, bladder infusion chemotherapy must be performed, which can make the recurrence rate reduced by half. However, even so, the recurrence rate is still quite high, so this requires very close follow-up after treatment. Two years is the high recurrence period of bladder tumor, so postoperative follow-up initially requires cystoscopy every three months and urine examination every month, and after two years of observation, cystoscopy once every six months to once a year. Urinalysis can see the indicators of bladder tumor markers so that even if it has recurred, it can be removed in time.
In general, the treatment effect of bladder tumor is still good, especially for superficial bladder tumor. As the case mentioned at the beginning of the article, although the patient had 18 recurrences, she was able to detect them in time and is still being treated with minimally invasive methods because she complied with the doctor’s prescription and followed up on time, and she was able to keep her bladder. Therefore, we remind the patient again to follow the doctor’s advice and follow up closely, so that the tumor can be nipped in the bud and the life can be preserved.