Non-muscle invasive bladder cancer: Previously known as superficial bladder cancer, it accounts for 70% of primary bladder tumors and surgery is the main treatment.
Surgical treatment: 1. Transurethral resection of bladder tumor Transurethral resection of bladder tumor (TURBT) is both an important diagnostic method and the main treatment for non-muscle invasive bladder cancer. The exact pathologic grading and staging of bladder tumors is determined by the pathologic findings after the first TURBT. Transurethral resection of bladder tumors has two purposes: first, to remove the entire tumor visible to the naked eye, and second, to remove tissue for pathologic grading and staging. The TURBT procedure should completely remove the tumor until the normal bladder wall muscle is exposed. After tumor removal, basal tissue biopsy is recommended to facilitate pathological staging and determination of the next treatment plan.
2.Transurethral laser surgery Laser surgery can be coagulated or vaporized, and its efficacy and recurrence rate are similar to those of transurethral surgery, and tumor biopsy is required for pathological diagnosis before surgery. The energy of the 2μm continuous laser is completely absorbed by the water in the tissue to achieve vaporization and cutting, which can be used to accurately vaporize and cut all layers of the bladder wall without affecting the pathological stage of the tumor, and has been reported for the treatment of non-muscle invasive bladder cancer.
3. Other treatment options (1) photodynamic therapy, (2) partial cystectomy, (3) radical cystectomy II. Postoperative adjuvant therapy: Non-muscle invasive bladder cancer has a high postoperative recurrence rate after TURBT, and a small proportion of patients may even progress to muscle invasive bladder cancer. TURBT surgery alone for carcinoma in situ does not address the high postoperative recurrence rate and disease progression. Therefore, postoperative adjuvant bladder perfusion therapy, including bladder perfusion chemotherapy and bladder perfusion immunotherapy, is recommended for all patients with non-muscle invasive bladder cancer.
1.Commonly used drugs for bladder perfusion: pirarubicin, epirubicin, doxorubicin, hydroxycamptothecin, mitomycin, and gemcitabine can also be used for bladder perfusion chemotherapy.
2, immunotherapy commonly used drugs: BCG vaccine (BCG), and other include interferon, keyhole worm Chi-blood blue protein, etc.
In the follow-up of non-muscle invasive bladder cancer, cystoscopy is still the gold standard and biopsy and pathology should be performed once abnormalities are detected. Ultrasonography, urine cytology, IVU, etc. also have some value, but they cannot completely replace the status and role of cystoscopy. The first cystoscopy is recommended for all patients with non-muscle invasive bladder cancer at 3 months postoperatively, but may be advanced if there is incomplete surgical resection or rapid tumor progression, and subsequent follow-up is determined by the risk of recurrence and progression of bladder cancer. For high-risk patients, cystoscopy is recommended every 3 months for the first 2 years, every 6 months starting in the third year, and once a year for life starting in the fifth year; for low-risk patients, if the first cystoscopy is negative, a second cystoscopy is recommended at 1 year after surgery, and then once a year until the fifth year; for intermediate-risk patients, the follow-up schedule is in between, depending on individual prognostic factors and general conditions. In the event of recurrence during follow-up, the post-treatment follow-up protocol was restarted as described above.