Bladder tumors

　　Bladder tumors are common urinary system tumors. About 50% of patients with large amounts of hematuria in clinical practice are caused by bladder tumors. Malignant tumors account for 80%, with more males than females, approximately 3:1, and the vast majority are over 40 years old. Children and young adults are more likely to have non-epithelial cell tumors. The etiology is complex, and the cause of most patients in clinical practice is unknown.

　　1. Hematuria

　　Most bladder tumors present with painless gross hematuria or microscopic hematuria as the initial symptom, with patients showing intermittent and whole-course hematuria, sometimes accompanied by blood clots. Therefore, intermittent painless gross hematuria is considered a typical symptom of bladder tumors. The amount of bleeding and the duration of hematuria are related to the malignancy degree, size, extent, and number of the tumor, but do not necessarily correlate proportionally. Sometimes, when gross hematuria occurs, the tumor may already be large or in an advanced stage; on the other hand, even small tumors can cause a large amount of hematuria. Since hematuria is intermittent, it is easily overlooked by patients when it stops, mistakenly believing that the disease has disappeared and not seeking further examination in a timely manner. When patients only show microscopic hematuria, it is often not discovered because it is not accompanied by other symptoms, and attention is usually drawn only when gross hematuria appears.

　　Compared to hematuria caused by other diseases, hematuria in bladder cancer has two characteristics:

　　It is painless, meaning that when hematuria occurs, the patient experiences no pain or other discomfort symptoms, which is medically referred to as painless hematuria. This differs from the hematuria associated with kidney and ureteral pain in stones, as well as the hematuria accompanied by frequent urination, urgency, and dysuria caused by cystitis. However, when there is necrosis, ulceration, and infection, urinary frequency, urgency, and dysuria as bladder irritation symptoms may occur.

　　It is intermittent, meaning hematuria appears intermittently and can stop or decrease spontaneously, with intervals between episodes of hematuria that can range from several days to several months, even up to half a year. This can easily create a misconception that the hematuria has been cured and improved, thus leading to a delay in seeking timely medical examination and treatment.

　　2. Bladder irritation symptoms

　　Early-stage bladder tumors rarely present with urinary tract irritation symptoms. If the bladder tumor is accompanied by infection, or occurs in the bladder trigone area, urinary tract irritation symptoms may appear earlier. In addition, one must be vigilant for symptoms such as frequent urination and urgency, which may indicate the possibility of bladder in situ carcinoma. Therefore, for patients with urinary tract irritation symptoms without evidence of infection, active and comprehensive examination measures should be adopted to ensure early diagnosis.

　　3. Difficulty in urination

　　A few patients may experience urinary obstruction, difficulty in urination, or even urinary retention due to large tumors, tumors located at the bladder neck, or blood clots.

　　4. Symptoms of upper urinary tract obstruction

　　When the cancerous mass infiltrates the ureteral orifice, it can cause dilation and积水 of the renal pelvis and ureter, even infection, leading to symptoms such as varying degrees of lumbago, back pain, and fever. If both ureteral orifices are infiltrated, acute renal failure symptoms may occur.

　　5. General symptoms

　　Including nausea, anorexia, fever, weight loss, anemia, cachexia, leukemoid reaction, and others.

　　6. Symptoms of metastatic foci

　　Late-stage bladder cancer can cause perirectal infiltration or distant metastasis. Common sites of distant metastasis include the liver, lung, and bone. When the tumor infiltrates the posterior urethra, prostate, and rectum, corresponding symptoms will appear. When the tumor is located at one ureteral orifice, causing infiltration of the ureteral orifice, it can lead to dilation of the ureter and renal积水. When the tumor is accompanied by bladder stones, symptoms such as urinary pain and hematuria may occur, similar to those of bladder stones.

　　7. Common complications

　　Common complications of bladder cancer include bladder pain, severe hematuria, urinary retention, and others.

　　1. Hematuria is the most common, characterized by intermittent, painless, gross hematuria throughout the urinary tract, with increased symptoms at the end.

　　2. Bladder irritation symptoms: Frequent urination, urgency, and dysuria are often late symptoms of tumors.

　　3. 'Rotten meat' in urine is often necrotic and shed tumor tissue.

　　4. Abdominal mass: Most are infiltrative cancers, with tumors appearing in the bladder area, which are hard, do not recede after urination, and are late symptoms.

　　4. Urinary retention, renal insufficiency, anemia, urinary tract infection, and other symptoms are late symptoms of bladder cancer. When the tumor spreads widely in the pelvic cavity, lymphedema may occur in the lower extremities and perineum.

　　1. Strengthen the publicity of cancer prevention knowledge, popularize cancer prevention knowledge, and strive to achieve early diagnosis and early treatment.

　　2. Workers who come into contact with chemical drugs and radioactive substances should strengthen labor protection and undergo regular physical examinations.

　　3. Try to avoid unnecessary radiological examinations and contact with chemicals, such as arsenic, mercury, and cyanides.

　　Of course, in addition to taking preventive measures against bladder cancer, it is also necessary to actively exercise and enhance the body's immune function. Consume more vitamin-rich foods to ensure adequate nutrition intake, and eat less spicy and greasy food. Use alkylating agents and certain immunomodulatory agents with caution, strictly control their indications, dosage, and treatment duration. Quit smoking and drinking, and during the treatment and recovery period, pay attention to careful living habits, moderate sexual activity, and contraception for women of childbearing age, with the principle of avoiding fatigue.

　　1. Urine cytology examination: Bladder tumors can be found in the urine of tumor shed cells. However, it is possible not to find tumor cells in the urine of well-differentiated papillary tumors or cancer. Urine cytology examination must be fresh urine, as it may deform and destroy after a few hours, making it difficult to recognize. Urine cytology is divided into 5 grades: Grade I and II are normal, Grade III is suspicious, and Grades IV and V are tumor cells.

　　2. Urine flow cytometry: It is ideal to use bladder lavage urine to evaluate the malignancy of the tumor based on the DNA content and aneuploidy of the cells. It can be used for screening high-risk populations.

　　3. Ultrasound: Transabdominal ultrasound examination is non-invasive and can be used as the initial screening for bladder cancer. It may find tumors as small as 1cm or even 0.5cm, and can understand the depth of infiltration of the tumor into the bladder wall.

　　4. CT examination: There is no need to perform CT examination for superficial bladder tumors. CT is mainly used for the diagnosis of infiltrative cancer, can understand the depth of infiltration of the tumor into the bladder wall, whether the bladder wall is thickened and deformed, and may find pelvic metastatic lymph nodes, which is helpful for the staging of infiltrative cancer. It is of special importance for the diagnosis of intravesical cancer and intramural bladder tumors.

　　5. MRI: MRI can perform sagittal, coronal, and cross-sectional examinations of the bladder, which can provide more information about the relationship between the bladder dome, bottom tumors, and the prostate and urethra. It can also diagnose the depth of infiltration of bladder cancer into the bladder wall, the relationship between pelvic organs and tumors, and whether the lymph nodes are involved, etc.

　　6. Urological imaging: Bladder tumor, especially upper urinary tract tumors, must undergo urological imaging examination to clarify whether there are tumors or other lesions in the renal pelvis and ureter, whether there are obstructive lesions, and the functional status of the kidneys. Bladder infiltrative cancer near the ureteral opening of the bladder can cause renal ureteral hydrops, even renal dysfunction.

　　6. Bladder imaging: When conducting excretory urography, releasing the band that compresses the ureter can obtain bladder imaging. It is helpful for diagnosis when it is difficult to get a full view of the bladder with a large cystoscope for treatment.

　　Bladder tumor is the most common tumor in the urinary and reproductive systems. More than 75% of patients present with hematuria as the first symptom. The degree of anemia caused by hematuria is generally proportional to the severity of the tumor. Frequent urination, dysuria, or frequent nocturia may indicate necrosis or infiltration of the bladder by the tumor, symptoms similar to cystitis. Tumors located at the bladder neck or with pedicles can cause difficulty in urination or urinary retention. Ureteral obstruction and infection can cause fever and pyuria. Urethral tumors are most commonly urethral cancer.

　　 It is recommended to

　　(1) It is recommended to consume more foods that have an anti-bladder and urethra tumor effect, such as toads, frogs, snails, kelp, seaweed, hawksbill, turtle, softshell turtle, sea cucumber, water snake, Job's tears, water chestnuts, walnuts, goat kidney, pork kidney, adzuki beans, sandworms, perch, mackerel.

　　(2) For urethral obstruction, eat kelp, wakame, nori, and green crab.

　　(3) For infection, eat fish maw, shark fin, water snake, pigeon, jellyfish, lotus root starch, buckwheat, Malan head, earth ear, turnip, olive, eggplant, fig, mung bean sprouts, soy milk, amaranth, kelp, and loach.

　　(4) For bleeding, eat celery, chrysanthemum, leek, winter melon, black plum, dried persimmon, sesame, lotus seeds, sea cucumber, and rat meat.

　　 Avoid

　　(1) Avoid smoking, alcohol, coffee, and cocoa.

　　(2) Avoid spicy, hot, and blood-moving foods.

　　(3) Avoid moldy, fried, greasy, and rich foods.

　　The treatment of bladder tumors is mainly surgical, and it is divided into non-muscle invasive and muscle invasive according to the depth of tumor invasion.

　　Non-muscle invasive bladder tumors (Ta-T1 stage) should undergo transurethral resection of bladder tumor (TUR-BT), and postoperative bladder instillation chemotherapy should be supplemented. There are many instillation regimens, commonly used ones include postoperative once a week for a total of 8 times, then changed to once a month for a total of 10 times, lasting for one year. The main instillation drugs include epirubicin, mitomycin, pirarubicin, doxorubicin, hydroxycamptothecin, etc., with basically the same effects. The instillation effect of BCG is the best, but it may cause serious irritative symptoms, bladder contraction, tuberculosis dissemination, etc., and is less commonly used in clinical practice, suitable for high-risk bladder cancer patients.

　　Bladder tumors with muscularis propria invasion should undergo radical cystectomy and pelvic lymph node dissection. This surgery is the standard treatment for invasive bladder cancer, and an effective treatment method to improve the survival rate of patients with invasive bladder cancer, avoid local recurrence, and prevent distant metastasis. Radical cystectomy can also be performed for high-risk non-muscle invasive bladder cancer T1G3 tumors, in situ carcinomas that are ineffective to BCG treatment, non-muscle invasive bladder cancer that recurs repeatedly, and extensive papillary lesions that cannot be controlled solely by TUR or endoscopic surgery.

　　For patients with invasive bladder cancer who cannot tolerate radical cystectomy or do not want to undergo radical cystectomy, comprehensive treatment that preserves the bladder can be considered.