Bladder tumor is the most common type of tumor in the urinary system. Among bladder tumors, bladder cancer accounts for most of them, accounting for 3% of systemic malignant tumors.
Many patients are confused about what treatment method to choose after bladder cancer is clearly identified, so let’s take a look at how to choose bladder cancer treatment methods.
The treatment of bladder cancer is mainly based on surgery, and chemotherapy or immunotherapy for early bladder cancer after surgery, most of them have good effect. For advanced bladder cancer, the possibility of surgery to remove the primary lesion of the tumor is still considered first, supplemented by chemotherapy, radiotherapy and other supportive treatments, mainly for the purpose of controlling the spread of cancer and improving the patient’s quality of life.
When it comes to the treatment of bladder cancer, first of all, we have to figure out the stage of bladder cancer, which is commonly known as early, middle and late stage of tumor, then specifically bladder cancer is divided into non-muscle invasive bladder cancer and muscle invasive bladder cancer. The treatment methods of different stages are very different.
Here we first look at the treatment options for non-muscle invasive bladder cancer. Non-muscle invasive bladder cancer (NMIBC), previously known as superficial bladder cancer, accounts for 70% of primary bladder tumors, of which Ta (non-invasive papillary carcinoma) accounts for 20% and Tis (carcinoma in situ) accounts for 10%. Depending on the risk of recurrence and prognosis, non-muscle invasive bladder cancer can be divided into three different groups: low risk: primary, solitary, TaG1 (low grade), diameter <75 px, and no CIS intermediate risk: all NMIBC not included in the low and high risk classification high risk: any of the following: stage T1 tumor; G3 (or high grade); CIS; meeting both. Multiple, recurrent and TaG1G2 (or low grade) >75px in diameter.
Non-muscle invasive bladder cancer is treated mainly by transurethral resection of bladder tumors (TURBT), but also by laser surgery, with the main difference between the different subgroups being the number of postoperative bladder instillation chemotherapy and follow-up. Transurethral resection of bladder tumors (TURBT) (including diagnostic transurethral resection of bladder tumors) is both an important diagnostic method for non-muscle invasive bladder cancer (NMIBC) and the primary treatment: the tumor should be completely removed to expose the normal bladder wall muscles. Secondary resection is recommended in the following cases: incomplete resection, multiple, large, resection sample without muscular layer; initial resection for G3 and T1; secondary resection performed 2-6 weeks later.
Low risk: first bladder irrigation within 24 hours after surgery and no further irrigation thereafter; intermediate risk: first bladder irrigation within 24 hours after surgery and then once a week for 8 weeks and then once a month for 1 year after surgery; high risk: first bladder irrigation within 24 hours after surgery and then once a week for 8 weeks and then once a month for 1 year after surgery; or BCG for bladder irrigation immunotherapy, 100-150 mg BCG, diluted with 30-40 ml saline at the time of irrigation, and irrigated once a week for 6 times. Subsequently, the bladder is irrigated once or twice a month, depending on the patient, for a total of 8 to 12 times.
For muscle infiltrating bladder cancer, the main treatment is radical cystectomy-based comprehensive treatment. For different cases, whether to adopt simple radical cystectomy, preoperative adjuvant radiotherapy, or postoperative radiotherapy should be analyzed specifically, you can consult with doctors in professional hospitals, and I believe every doctor will make professional suggestions according to the principle of considering individual factors. Some patients cannot tolerate surgery or strongly request to preserve the bladder and undergo partial cystectomy, which requires strict indications for surgery, usually bladder cancer within T2 located in an easily dilated location (such as the top of the bladder), and post-operative compliance with the doctor’s follow-up plan (good compliance), otherwise there will be adverse consequences (such as recurrence or metastasis not detected in time).
Some patients will also ask how I should choose between open surgery and minimally invasive laparoscopic surgery for radical cystectomy. Here I will talk about my opinion: First, the purpose of both surgery and laparoscopic minimally invasive surgery is complete removal of the bladder, that is, both achieve the same effect; second, the technology of laparoscopy at home and abroad is very mature, radical cystectomy can be done completely laparoscopically, to reach the same effect as open surgery, and significantly reduce the trauma and bleeding of the patient, which has been Finally, the technology of laparoscopic radical cystectomy is also mature, but the requirements for the surgeon are even higher so the popularity is not very wide, and it is also a very good option for experienced laparoscopic surgeons to reduce the patient’s pain and make the patient’s recovery faster.