Bladder cancer is the most common malignant tumor of the urinary system and one of the ten most common tumors of the whole body, accounting for the first place in the incidence of genitourinary tumors in China and second only to prostate cancer in Western countries. Bladder cancer can occur at any age and its incidence increases with age, with a high incidence at the age of 50-70. The incidence of bladder cancer in men is three to four times higher than that in women.
Previously, the mucosal epithelium of the bladder was referred to as migratory cells. In 1998, the WHO and the International Society of Urological Pathology jointly recommended the term uroepithelium instead of the term migratory cells to distinguish it from migratory epithelium in the nasal cavity as well as in the ovaries, making uroepithelium the proper term for the urinary system. Pathological types of bladder cancer include uroepithelial carcinoma of the bladder, squamous cell carcinoma of the bladder, adenocarcinoma of the bladder, and other rare types include clear cell carcinoma of the bladder, small cell carcinoma of the bladder, and bladder carcinoid tumors. The most common type of bladder cancer is uroepithelial carcinoma of the bladder, which accounts for more than 90% of all bladder cancer patients.
There are many causes of bladder cancer, generally considered to be related to frequent exposure to carcinogens such as naphthylamine, benzidine, etc. Common dyes, textiles, leather, rubber, plastics, paints, detergents, etc. in daily life also have potential cancer-causing risks. In addition, smoking is also a carcinogenic factor of bladder cancer.
The initial clinical manifestation of patients with bladder cancer is hematuria, which usually appears as painless, intermittent, and fleshly hematuria throughout, and sometimes can be microscopic hematuria. The staining of hematuria varies from light red to dark brown, often dark red, and some patients describe it as flesh-washing or tea-like. Some patients with bladder cancer may first present with bladder irritation symptoms, which manifest as urinary frequency, urgency, painful urination and difficulty in urination, while the patient has no obvious visual hematuria. Tumors in the bladder triangle and bladder neck can obstruct the bladder outlet and cause the symptoms of difficult urination.
The treatment of bladder cancer is mainly surgical. According to the clinical stage and pathology of the tumor and combined with the patient’s general condition, the appropriate surgical method is selected. In principle, transurethral bladder tumor electrosurgery is feasible for superficial bladder tumors and those not infiltrating the submucosa layer, which can be supplemented with bladder thermal perfusion chemotherapy after surgery; patients with muscle layer infiltrating uroepithelial cancer and squamous and adenocarcinoma of bladder are mostly treated by total cystectomy.