I. Why do we get bladder tumors and what factors are associated with them? There are many causes of bladder tumors, and it is generally believed that the onset of bladder tumors is related to the following risk factors. 1. Occupational personnel with long-term exposure to certain carcinogenic substances, such as dyes, textiles, leather, rubber, plastics, paints, printing, etc., have significantly increased the risk of bladder cancer. It has been recognized that the main carcinogenic substances are benzidine, Khan Cai Amine, 4 one-amino biphenyl, etc. The incubation period is long, up to 15 years. The incubation period is long, up to 15-40 years. Individual differences in susceptibility to carcinogens are extremely large; 2. Smoking is the most common cancer-causing factor, and about l / 3 of bladder cancer is related to smoking (this is more conservative data Oh). The carcinogenicity of smoking may be related to the fact that cigarettes contain a variety of aromatic amine derivatives of carcinogens. The greater the amount of smoking, the longer the history of smoking, the greater the risk of bladder tumors; 3, chronic bladder infections and long-term stimulation of foreign bodies will increase the risk of bladder cancer, such as bladder stones, bladder diverticulum, Schistosomiasis Egyptian cystitis, etc., easy to induce bladder cancer, squamous carcinoma is more common; 4, the other long-term large amount of analgesic finasteride, endogenous tryptophan metabolism abnormality, etc., may be a cause or a cause of bladder cancer. Causes of bladder cancer. In recent years, a lot of research data show that most bladder cancers are induced by the activation of oncogenes and deletion of oncogenes, etc., which make the genome of shifted epithelium undergoes multiple lesions, leading to unlimited proliferation of cells, and finally forming cancer. What are the pathologic types of bladder cancer? More than 95% of the tissue types are epithelial tumors, the majority of which are migratory papillary carcinoma, squamous carcinoma and adenocarcinoma, each accounting for 2% to 3%. Nearly one-third of bladder cancers are multiple tumors. Non-epithelial tumors are rare, most of them are sarcomas such as rhabdomyosarcoma, which occur in infants and young children. How to reflect the malignancy of bladder cancer? It mainly depends on the degree of differentiation. In 1973, the World Health Organization (WHO) classified bladder tumors into papillary tumors according to the degree of differentiation of bladder tumor cells; uroepithelial carcinoma grade 1, which is well-differentiated and less malignant; uroepithelial carcinoma grade 11, which is moderately differentiated and moderately malignant; and uroepithelial carcinoma grade 111, which is poorly differentiated and more malignant. In order to better reflect the risk tendency of the tumor, in 2004, WHO classified uroepithelial tumors such as bladder into papillary tumors, papillary uroepithelial tumors with low malignant tendency, low-grade papillary uroepithelial carcinoma (less malignant) and high-grade papillary uroepithelial carcinoma (more malignant). IV. How to know whether bladder cancer is early or advanced? It mainly depends on the infiltration depth and metastasis of the tumor, and the infiltration depth is the basis for clinical (T) and pathological (P) staging of the tumor. According to the depth of infiltration of cancer into the bladder muscle wall (except papilloma), TNM staging criteria are mostly used: Tis carcinoma in situ; T . papillary carcinoma without infiltration; Tl infiltration of the mucosal lamina propria; T2: infiltration of the muscularis propria, subdivided into T2a infiltration of the superficial muscularis propria (1/2 of the muscularis propria), T2b infiltration of the deep muscularis propria (1/2 of the muscularis propria); T3 infiltration of the peripheral adipose tissues of the bladder, subdivided into T3a invasion of peripheral tissues of the bladder by the tumor under the microscope, T3b invasion of peripheral tissues of the bladder by the naked eye, and T4 infiltration of adjacent tissues such as the prostate, the uterus and pelvic wall, T4; infiltration of prostate, uterus, vagina, pelvic wall and other neighboring organs. Clinically, it is customary to refer to Tis, T . , and T 1, stage tumors are called superficial bladder cancer generally belonging to early stage tumors. Tumor spread mainly infiltrates into the bladder wall until it involves extraves bladder tissues and adjacent organs. Lymphatic metastasis is the most important metastatic pathway, mainly to the pelvic lymph nodes, such as the closed hole, endoskeletal, exoskeletal and common skeletal lymph node groups. About 50% of the lymphatic vessels infiltrated superficial muscle layer have cancer cells, almost all of the lymphatic vessels infiltrated deep muscle layer have cancer cells, and most of those infiltrated around the bladder have distant lymph node metastasis. Hematogenous metastasis mostly occurs in the late stage, mainly to liver, lung, bone and skin. Those with poorly differentiated tumor cells are prone to infiltration and metastasis. V. What symptoms may be present in bladder tumor? Early bladder cancer can have no symptoms. Hematuria is the most common and earliest symptom of bladder cancer. It often manifests as intermittent hematuria, which can be alleviated or stopped by itself, thus it is easy to give patients the illusion of “improvement” or “cure” and delay treatment. Blood clots found in urine or “rotten meat”-like necrotic tissue mixed in urine should be highly alerted; tumors in the triangle area and bladder neck can obstruct the outlet of bladder, resulting in difficulty in urination and even urinary retention. In the advanced stage of invasive cancer, a lump can be touched in the suprapubic area of lower abdomen, which is hard and does not subside after urination. How is bladder cancer diagnosed? 1. When painless hematuria occurs in middle and old age, the possibility of urinary tumor should be thought of firstly; 2. Urine examination – it is confirmed to be hematuria in patient’s fresh urine; 3. Ultrasound can find the bladder mass which does not move according to the body position, and ultrasound is simple and easy to carry out, and it can find the tumor with diameter of 0.5 Cm or more, and it can be diagnosed as a tumor of the bladder. B ultrasound is easy to use and can detect tumors with a diameter of 0.5 Cm or more, and can be used as the initial screening of patients. It can understand the location, size, number and infiltration depth of the tumor, and initially determine the clinical staging; 4. Cystoscopy: cystoscopy can directly observe the location of the tumor, its size, number, morphology, whether it is tibial or broad-based, and initially estimate the degree of infiltration at the base. The relationship between the tumor and ureteral orifice and bladder neck can be found in the examination. After finding the mass, tumor biopsy can be sent to pathological examination, and random biopsy should be performed if necessary, which can confirm the diagnosis of bladder tumor; 5. Other tests can further understand the severity of bladder cancer: intravenous pyelography (IVU) can understand whether there are tumors in the renal pelvis and ureter as well as the influence of bladder tumor on upper urinary tract; if there is hydronephrosis on the affected side or poor renal imaging, it often suggests that the tumor has invaded the ureteral orifice. Cystography can show filling defects, and CT and MRI are mostly used for invasive carcinoma, which can detect the depth of tumor infiltration into the bladder wall and local metastatic enlarged lymph nodes. CT and MRI are mostly used for invasive carcinoma, which can find out the depth of tumor infiltration and local metastatic lymph nodes. Treatment is mainly based on surgery. According to the clinical staging and pathology of the tumor and combined with the systemic condition of the patient, appropriate surgical methods should be selected. In principle, Ta, Tl and limited well-differentiated T2 stage tumors can be operated with bladder preservation, and T a, T 1: stage tumors, transurethral cystectomy (often called electrosurgery) is the main treatment method. If there is no electrodesiccation equipment, open bladder surgery can be performed. In order to prevent tumor recurrence, intravesical drug instillation can be used after surgery. Commonly used drugs include mitomycin, adriamycin, transketolide and BCG, etc., which can be instilled once a week and then changed to once a month after 8 times for 2 years. Large, multiple, recurrent and poorly differentiated T2 and T3 stage tumors, as well as invasive squamous carcinoma and adenocarcinoma, should undergo total cystectomy and urinary diversion at the same time. Non-controllable ileal cystectomy or colonic cystectomy, etc. are usually used. Radical total cystectomy is the basic treatment for invasive carcinoma of the bladder. T3 stage tumors such as well-differentiated, single confined, if the patient can not tolerate total cystectomy can be used for partial cystectomy, which can improve the quality of life of the patient after surgery. Old and weak people with advanced tumors who cannot tolerate larger surgery can be treated with ureteral skin stoma, which is simple and can solve the bleeding pain of advanced bladder cancer, but the ureteral orifice is easy to be narrowed. What should be paid attention to after electrodessication for early-stage bladder cancer? After various surgical treatments with bladder preservation, about 50% of the tumors may recur within 2 years, and often not in the original site, which is actually a newborn tumor. About 10% to 15% of the recurrent tumors have a tendency to increase in malignancy, and it is still possible to cure the recurrent tumors with timely treatment. Therefore, any patient after bladder preservation surgery should be closely followed up and have a hysteroscopic examination every 3 months, and if there is no recurrence in 2 years, it should be changed to every half a year. In order to prevent tumor recurrence, intravesical drug instillation can be used in the postoperative period. Commonly used drugs include mitomycin, adriamycin, transketolide and BCG. Postoperative bladder irrigation is divided into immediate postoperative irrigation and regular postoperative irrigation. Immediate postoperative lavage is usually performed on the same day after surgery, which is effective for some bladder tumors. Regular postoperative lavage is usually performed 1-2 weeks after operation, and the postoperative urination has returned to normal before starting the lavage, which is usually performed once a week, and after 8 times, it will be changed to l times a month for a total of 2 years. Lavage should pay attention to: empty the urine before lavage, after lavage, the drug is retained in the bladder for 30-45 minutes (different drugs for different times), the patient in four directions (supine, left lateral, prone) in each direction (right lateral, right lateral, prone), the patient in each direction (supine, left lateral, prone). The patient should lie in four directions (supine, left side, right side, prone) for about 10 minutes each, and drink water to empty the urine after the end of the procedure. IX. How to prevent bladder tumor? Prevention of bladder tumor is still lack of effective preventive measures, but occupational personnel who are in close contact with carcinogenic substances should strengthen labor protection, and smokers should quit smoking as early as possible, which may prevent or reduce the occurrence of tumor. For post-surgical patients with bladder retention, bladder instillation of chemotherapeutic drugs and BCG can prevent or delay the recurrence of tumor. Patients with bladder tumors are very different from each other, the tumors themselves have different characteristics, and the level of doctors treating them is also different, so there are differences in diagnosis and treatment, and individualized treatment plan is necessary.