Bladder and bladder cancerThe bladder is located in the anterior part of the small pelvic cavity and is an extremely important muscular organ of the urinary system, whose function is to store and excrete urine. Like many other organs, malignant tumors can occur in the bladder, and it ranks eighth in the incidence of systemic tumors. It takes the first place among male urogenital tumors in China. In recent years, the incidence of bladder cancer has been on the increase.
Bladder cancer symptoms The most common first symptom of most bladder tumor patients is painless hematuria. Other symptoms include: when tumor necrosis, ulceration, combined inflammation and formation of infection, patients may experience bladder irritation symptoms such as urinary frequency, urinary urgency and pain; when tumor infiltration reaches the muscular layer, painful symptoms may appear; when tumor is large and affects bladder capacity or tumor occurs in the bladder neck, or bleeding is serious and forms blood clot, etc. which affects urinary flow discharge, it may cause urinary difficulty or even urinary retention. If the bladder tumor is located near the ureteral orifice and affects the urinary drainage of upper urinary tract, it may cause hydronephrosis on the affected side. Patients with advanced bladder tumor have symptoms such as anemia, swelling and lower abdominal mass.
The pathological cell types of bladder cancer are most commonly urothelial (migratory) epithelial carcinoma, which accounts for about 90% or more of bladder cancer. Other cell types include squamous cell carcinoma and glandular cell carcinoma, as well as the less common metastatic carcinoma, small cell carcinoma and carcinosarcoma. Pathologists can assign a score of highly or poorly differentiated according to the malignancy of the cancer cells.
Risk factors for developing bladder cancer The development of bladder cancer is a complex, multifactorial, multi-step pathological process with both intrinsic genetic factors and extrinsic environmental factors. Two of the more clearly identified risk factors are smoking and long-term exposure to industrial chemical products. Smoking is the most definite risk factor for bladder cancer, about 30% to 50% of bladder cancer is caused by smoking, and smoking can increase the risk rate of bladder cancer by 2 to 4 times, and the risk rate is proportional to the intensity and duration of smoking. Another important risk factor for bladder cancer is long-term exposure to industrial chemical products. Occupational factors are the first known risk factors for bladder cancer, and about 20% of bladder cancers are caused by occupational factors, including those involved in textiles, dye manufacturing, rubber chemistry, pharmaceutical and pesticide production, paint, leather, and aluminum, iron and steel production. Diesel exhaust accumulation can also increase the risk of bladder cancer.
How to prevent the occurrence of bladder cancer?
Smoking is the most certain risk factor for the occurrence of bladder cancer, so quitting smoking is the most effective way to prevent the occurrence of bladder cancer; and in fact, quitting smoking plays an important role in preventing the recurrence and progression of bladder cancer. Secondly, avoiding exposure to harmful chemical substances and strengthening the protection of such occupational workers also have a preventive effect on the occurrence of bladder cancer. Finally, once there is visual hematuria, especially painless hematuria, seek early medical consultation. Screening for high-risk groups is also useful.
What are the screening tests for bladder cancer?
Urological tumors should be thought of in adults, especially if they are over 40 years old and have painless hematuria, especially if they have not had final hematuria. Physical examination, urinary routine, ultrasound, urine exfoliative cytology, intravenous urography, CT, MRI and other examinations are needed to initially exclude and diagnose bladder cancer. Cystoscopy and pathological biopsy or diagnostic TUR should be performed for all patients considering bladder cancer; most patients with bladder cancer are in well-differentiated or moderately differentiated non-muscle invasive bladder cancer at the time of diagnosis, and about 10% of them eventually develop into muscle invasive bladder cancer or metastatic bladder cancer.
Can I keep my bladder after having bladder cancer?
Whether bladder cancer patients can keep their bladders depends on which treatment method is beneficial to the patient’s tumor-free survival and can prolong the patient’s life. The next consideration is the patient’s survival and quality of life. There are two key factors that determine the prognosis of bladder cancer patients (tumor recurrence and metastasis, survival time): First, the clinical and pathological stage of bladder cancer, which is commonly known as early or late stage, depends on the depth of cancer involvement (infiltration) in the bladder, the presence of surrounding tissues and organs, lymph nodes and distant metastases. Secondly, the type and malignancy of bladder cancer cells, the worse the differentiation of tumor cells, the higher the malignancy. Therefore, the treatment of bladder tumor should mainly be based on the stage, the number, size, location, malignancy degree of tumor and clinical to decide the appropriate treatment plan. Different stages of bladder cancer, different types of tumor cells, different cell differentiation, and different treatment plans and strategies should be used.
For many non-muscle invasive bladder cancers with low malignancy, small, limited tumors, and no invasion of the bladder muscles, transurethral resection (TUR-BT) is the primary treatment option. Most patients with bladder tumors may be able to achieve disease control and bladder preservation with this minimally invasive procedure. Postoperative treatment is often supplemented with chemotherapy, radiotherapy, and Chinese medicine to obtain satisfactory results.
For bladder cancer with higher malignancy, larger tumor, more extensive lesions, extensive and multiple lesions in the bladder, which have invaded the muscle (infiltrative), or when the tumor recurs, the malignancy grade increases and the disease progresses within a short period of time after being treated with TUR-BT surgery, then radical total cystectomy should be used decisively in a timely manner in order to obtain the best therapeutic effect. In addition to radical total cystectomy, a standard pelvic lymph node dissection must be performed. Thorough pelvic lymph node dissection maximizes patient survival and avoids local recurrence and distant metastases. In some patients with localized pelvic lymph node metastases, lymph node dissection may even need to be extended to the subperitoneal mesenteric level.