It is a very annoying and even alarming situation to find a growth in the bladder. This is because the most common cancer here is bladder cancer, one of the major tumors of the urinary tract. Bladder cancer occurs more in men than in women, and among the factors that can contribute to the development of cancer, smoking is the most definite and important. Consider the possibility of bladder cancer in the presence of blood in the urine, painful urination (as opposed to common infections), and variations in urination patterns. Diagnosis and Initial Treatment Most bladder cancers are identified through symptoms such as blood in the urine, ultrasound that reveals a mass in the bladder, and ultimately through cystoscopy, in which a urologist applies a special endoscope that allows him or her to see inside the bladder. When a tumor is found, most doctors now perform an endoluminal resection of superficial tumors, and a satisfactory treatment can be achieved, called transurethral resection of bladder tumors (TURBT) Superficial or invasive? After the bladder tumor is removed, the urologist and pathologist determine whether the tumor is superficial (confined to the mucosal layer of the bladder Ta-T1) or invasive (tumor invades beyond the submucosa > T1). This is a clear-cut watershed; superficial tumors do not yet have the ability to metastasize beyond the bladder, while the latter have the potential to quickly metastasize to other parts of the body. The good news is that four out of five bladder cancers are superficial when first detected. Risk of Recurrence Although superficial bladder tumors do not pose an immediate risk of metastasis, they can become invasive if left untreated. Cure can be achieved with complete removal of superficial tumors, however the bladder is still at risk for further tumor growth elsewhere. Once a superficial cancer occurs within the bladder mucosa, the chance of recurrent tumors thereafter is about 60-80%. An individual’s risk of recurrence includes tumor grade (degree of malignancy), number (single or multiple), and size of the primary tumor, among other things. Monitoring for recurrence Once the superficial tumor has been removed, the surgeon will perform regular cystoscopic reviews to monitor for recurrence. Cystoscopy is usually done every 3 months for the first 2 years after surgery, and can be extended to 6 months for the next 2 years if there is no recurrence. after 4 years, there is still no recurrence, and then it can be repeated every year. How can recurrence be minimized? Doctors generally reduce a patient’s risk of recurrence by applying medications, supplementing nutrients and improving lifestyle. Medication Medications against superficial tumor recurrence are instilled into the bladder, called intravesical instillation therapy. The drugs include chemotherapeutic agents, (e.g. mitomycin C, epothilone, etc., which inhibit the division of malignant tumor cells) and immunosuppressive (e.g. BCG, interferon, etc., which stimulates the body’s immune system and mobilizes its own defenses to fight against the tumor). Depending on the risk of recurrence, the doctor will select different drugs for instillation, and the instillation drugs can effectively reduce recurrence. Lifestyle changes Smoking is the most important factor associated with bladder cancer, greater than 50% of bladder cancers are associated with it. The easiest thing to do is to quit smoking, you must! Studies have shown that the occurrence of bladder cancer decreases when you quit smoking. Certain chemical solvents increase the chance of bladder cancer, let your doctor know if you suspect any of these substances in your exposure environment. Nutrition We know more and more about the link between bladder cancer and nutrition. Current information supports an increase in fruits and vegetables and a decrease in animal protein intake. And, evidence is accumulating that certain vitamin and nutrient supplements may reduce the recurrence of superficial bladder cancer. Nutrient Preparations (non-advertising, but readers are urged to choose carefully) In the early 1990s, Dr. Donald Lamm, a leading bladder cancer researcher in the U.S., conducted a prospective, randomized, double-blind study* to investigate the preventive effect of high-dose vitamin supplementation on bladder cancer recurrence. They divided patients with superficial bladder cancer into two randomized groups. Basal treatment in both groups consisted of BCG infusion and daily supplementation with a multivitamin preparation, but one group was additionally supplemented with a high-dose vitamin combination, including vitamins A, B6, C, E, and zinc. The results showed that the bladder cancer recurrence rate in the high-dose supplementation group was only half that of the control group. The American Urological Association published updated research in 2008 that high-dose nutrient supplementation of the same composition (with more vitamin D and folic acid added) given to BCG infusion-treated patients could achieve the same results as BCG infusion plus interferon. All of the above concerns superficial bladder cancer, but some bladder cancers are not detected in time or are so malignant that the bladder may not be saved. This part will be described later.