Most bladder cancers are detected due to painless carnal hematuria. Bladder cancer is generally divided into superficial bladder cancer and invasive bladder cancer, but most of them are superficial. Although medical science has improved the treatment of bladder cancer to date, the only means of cure is surgical resection or other surgical methods to eliminate the tumor. Can surgical methods cure bladder cancer? It mainly depends on the following aspects.
1. How to know whether bladder cancer is early or late? The stage of bladder cancer (early or late degree).
It mainly depends on the infiltration depth and metastasis of the tumor, and the infiltration depth is the basis of clinical (T) and pathological (P ) staging of the tumor. According to the depth of cancer infiltration into the bladder muscle wall (except papilloma), the TNM staging criteria are mostly used: Tis carcinoma in situ; Ta papillary carcinoma without infiltration; T1 infiltrating the lamina propria; T2: infiltrating the muscle layer, which is further divided into T2a infiltrating the superficial muscle layer (1/2 inside the muscle layer), T2b infiltrating the deep muscle layer (1/2 outside the muscle layer); T3 infiltrating the fatty tissue around the bladder, which is further divided into T3a microscopic The tumor is found to invade the peri-vesical tissue; T3b is visible to the naked eye; T4; infiltrates the prostate, uterus, vagina and pelvic wall and other adjacent organs. Clinically, it is customary to refer to Tis, Ta, and T 1, stage tumors as superficial bladder cancer generally belong to early stage tumors.
Most bladder cancers are confined to the innermost layer of the bladder mucosa when they first occur, and are not highly malignant and are early stage diseases. As the severity of the disease gradually increases, the cancer cells will gradually invade the outer layer (submucosa – muscle layer – plasma layer of the bladder) and finally invade the surrounding adjacent organs, and some of them will metastasize and spread to distant organs (liver, lung, bone, etc.). Once the surrounding organs are invaded or metastasized, the disease is advanced and incurable.
Lymphatic metastasis is the main metastatic route, mainly to the pelvic lymph nodes, such as the closed foramen, intra- and extra-skeletal and common skeletal lymph node groups. About 50% of the lymphatic vessels are infiltrated with cancer cells in the superficial muscular layer, and almost all of the lymphatic vessels are infiltrated with cancer cells in the deep muscular layer. Blood-borne metastases are mostly in the late stage, mainly to liver, lung, bone and skin. Those with poorly differentiated tumor cells are prone to infiltration and metastasis.
2. How to reflect the malignant degree of bladder cancer?
In 1973, the World Health Organization (WHO) classified bladder tumor cells into papillary tumors according to their morphology, structural characteristics and intercellular arrangement; 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 dangerous tendency of tumors, in 2004, WHO classified uroepithelial tumors such as bladder into papillary tumors, papillary uroepithelial tumors with low malignant tendency, low-grade papillary uroepithelial carcinoma (low malignancy) and high-grade papillary uroepithelial carcinoma (high malignancy).
3.Tumor size
Tumor volume is related to recurrence. Tumors ≤3cm have lower recurrence rate than tumors >3cm.
4.Tumor morphology
Tumor morphology is more important than tumor volume. Papillary tumors have better prognosis than solid (non-tipped or nodular) tumors.
5.Number of tumors
Bladder tumors with multiple tumors have poor treatment outcomes. Multiple occurrences imply the presence of extensive abnormalities in the bladder and a relatively high risk of subsequent recurrence.
6.Time of tumor recurrence
Tis in situ cancer has a five-year recurrence probability of 50%-90%; Ta, low-grade has a five-year recurrence probability of 50%; Ta, high-grade has a five-year recurrence probability of 60%; T1 low-grade has a five-year recurrence probability of 50%; T1 low-grade has a five-year recurrence probability of 50%-70%.
7.Whether there is carcinoma in situ
Bladder carcinoma in situ (Tis): These “flat” tumors are confined to the mucosa of the bladder and are multifocal, highly graded, highly invasive, and potentially fatal. The tumors may appear as red, hairy or granular areas and are sometimes undetectable on cystoscopy but can be detected on random biopsy of the bladder mucosa. If a patient has diffuse Tis with symptoms of irritation, the likelihood of progression to invasive disease is as high as 80%; for patients with limited Tis without symptoms of irritation, the likelihood of progression is less than 10%.
8.Risk classification of non-muscle invasive bladder cancer?
Low risk NMIBC : Primary, solitary, TaGl (low grade uroepithelial carcinoma), <3cm in diameter, no CIS . (Note: You must have both of the above to be at low risk for non-dirty invasive bladder cancer).
Intermediate-risk NMIBC: All NMIBC that are not included in the low-risk and high-risk categories.
High-risk NMIBC: any of the following: stage T1 tumor; G3 (or high-grade uroepithelial carcinoma); CIS; TaGIG2 (or low-grade uroepithelial carcinoma) that also meets the criteria of multiple, recurrent and >3 cm in diameter
Low risk patients had a recurrence rate of 15% at 1 year and 30% at 5 years; patients in the intermediate risk group had a recurrence rate of 38% at 1 year and 62% at 5 years; patients in the high risk group had a recurrence rate of 61% at 1 year and 78% at 5 years.
9.The natural course of 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. The size, number, stage and grade of bladder cancer are closely related to its progression, especially stage and grade, with low stage and low grade tumors having a lower risk of disease progression than high stage and high grade tumors. Overall, the risk of muscle infiltration in stage T1 bladder cancer is much higher than that in stage Ta. The risk of progression in G1 bladder cancer (6%) was found to be only 1/5 of that in G3 bladder cancer (30%). a 20-year follow-up data set found that the risk of disease progression was higher in G3 bladder cancer, 14% in TaG1 bladder cancer and up to 45% in T1G3, but the risk of recurrence was the same, about 50%.
The 5-year survival rates for patients with each stage of bladder cancer were 91, 9% for Ta-T1, 84, 3% for T2, 43, 9% for T3, and 10, 2% for T4. The 5-year survival rates for patients with each grade of bladder cancer were 91, 4% for G1, 82, 7% for G2, and 62, 6% for G3.
Even with surgical treatment combined with other treatments such as interferon, interleukins, molecularly targeted drugs, and immunotherapy, only a minority of patients with advanced bladder cancer survive long term, with a median survival time of about 14 months, and about 15% of patients are able to achieve tumor progression-free survival; most patients will lose their lives within 5 years due to tumor progression.
Regardless of the stage of bladder cancer, actively pursuing surgical treatment has the hope of cure, only that the earlier the cure, the greater the hope, and the later the chance of cure, the smaller the chance.