Elderly bladder cancer

　　How is elderly bladder cancer caused? The etiology of bladder tumors has not been fully elucidated, and its occurrence is related to the following factors:

　　1, Chemical carcinogens.The carcinogenic substances are intermediates of dyes such as β-naphthylamine, azo dyes, α-naphthylamine, and 4-aminobiphenyl. The latent period from exposure to carcinogens to the occurrence of cancer is 5 to 50 years, with most cases occurring around 20 years.

　　The carcinogens mentioned above are absorbed through the skin, respiratory tract, or digestive tract, and then excreted in the urine as metabolites, which act on the urothelium to cause tumors. Urine stays in the bladder the longest, so the incidence of bladder cancer is high.

　　2, The relationship between endogenous tryptophan metabolism and bladder cancer.Many patients with bladder cancer do not have a clear history of exposure to chemical carcinogens, which may be related to abnormal tryptophan metabolism in the body.

　　3, Chronic infection and irritation.There is a certain relationship between bladder tumors and chronic infection and irritation.

　　4, Other.Cyclophosphamide can also cause bladder cancer, and other factors such as radiation can also cause cancer.

　　Elderly bladder cancer can be complicated by acute urinary retention, as well as liver, lung, and bone metastases. Elderly bladder cancer itself is a severe disease that endangers the health of the elderly and seriously affects their lifespan, so it must be treated in a timely manner.

　　What are the symptoms of elderly bladder cancer? Briefly described as follows:

　　1. Hematuria

　　Especially intermittent painless gross hematuria is the most common symptom of bladder tumors, with 80% of patients presenting with hematuria at the time of consultation, and 17% with severe hematuria. Since hematuria often appears intermittently, it is easy to give patients a false impression of 'cure', resulting in delayed treatment.

　　2. Bladder irritation symptoms

　　This symptom accounts for about 10%, and the frequent occurrence of urinary frequency, urgency, and dysuria often indicates invasive bladder cancer or primary in situ carcinoma, with the tumor having a high degree of malignancy and widely infiltrating the bladder wall. Primary in situ carcinoma, accompanied by bladder irritation symptoms and pain over the pubic symphysis or penile pain, the pain intensifies after urination.

　　3. Abnormal urination

　　A small number of patients may experience difficulty in urination and the expulsion of abnormal contents. Those with high malignancy can quickly spread to the prostate, causing difficulty in urination and even urinary retention. Benign prostatic hyperplasia can also cause difficulty in urination, so vigilance should be raised.

　　4. Metastasis symptoms

　　Advanced bladder cancer patients may present with symptoms such as inguinal mass, anemia, weight loss, edema, nausea and vomiting. If the tumor metastasizes to lymph nodes, invades a large part of the pelvic lymph nodes, symptoms such as pain, lower limb radiation pain, and lower limb回流 obstruction may occur. When metastasizing to the bones, pain in the corresponding areas of the bones may occur. The common sites of distant metastasis are the liver, lung, and bones.

　　Since the etiology of bladder cancer patients is not yet fully clear, the methods of prevention are not more than:

　　1. Try to minimize infections, avoid contact with radiation and other harmful substances, especially drugs that suppress the immune function;

　　2. Appropriate exercise, strengthening physical fitness, and improving the body's ability to resist diseases.

　　3. It mainly focuses on the prevention of various factors that may lead to bladder cancer. It is currently believed that the loss of normal immune surveillance function, the tumor-promoting effect of immunosuppressants, the activity of potential viruses, and the long-term use of certain physical (such as radiation) and chemical (such as antiepileptic drugs, adrenal cortical hormones) substances can all lead to the proliferation of lymphoreticular tissue, ultimately resulting in bladder cancer. Therefore, attention should be paid to personal and environmental hygiene, the avoidance of drug abuse, and personal protection in harmful environments.

　　What examinations should be done for elderly bladder cancer? Briefly described as follows:

　　1. Urine cytology examination

　　Specimens should be taken from fresh urine or physiologic saline bladder lavage fluid; the positive rate of urine cytology is closely related to the degree of tumor cell differentiation. Repeated and multiple urine specimen checks can improve the positive rate.

　　2. Cystoscopy

　　Cystoscopy can directly visualize the location, size, number, gross morphology, infiltration range, and relationship with the ureteral orifice and bladder neck orifice of bladder tumors, and preliminarily differentiate between benign and malignant tumors.

　　When abnormalities are found during cystoscopy, it is necessary to take living tissue for examination to clarify the nature of the lesion and understand the degree of malignancy of the tumor. Sampling should also be taken near and far from the tumor to understand the presence of mucosal lesions and in situ carcinoma, which provides important information for determining treatment plans and estimating prognosis.

　　3. Flow cytometry

　　Flow cytometry can quickly quantitatively analyze the relationship between the content of cell nucleic acids, DNA content, or DNA ploidy and the biological behavior of bladder tumors.

　　4. B-ultrasound scan

　　Over 1cm bladder tumors can be found through the abdominal wall or transurethral, and reliable judgments can also be made on the depth of tumor infiltration.

　　5. Intra-venous urography

　　It is mainly to understand whether there is a tumor in the upper urinary tract.

　　6. Cystography

　　Visible tumor-filled defects can be seen, and when the bladder wall is infiltrated, it appears rigid and loses elasticity.

　　7. Bladder double examination

　　It is used when the tumor is large.

　　8. CT and MRI examinations

　　It is the most accurate non-invasive bladder tumor staging method, with strong ability to distinguish lesions, and is of great significance for understanding the extent of bladder tumor, perivesical infiltration, and pelvic lymph node involvement.

　　9. Cystography and lymphography of the bladder artery

　　It has certain value for diagnosis.

　　10. Monoclonal antibody

　　Because of the torment of illness and pain, cancer patients are very weak. Therefore, supplementing nutrition to the body is the most important, otherwise, the effect of treatment will be greatly reduced.

　　A reasonable and scientific diet is needed for every patient, and more high-protein, high-fiber foods should be eaten. High-protein foods include milk, eggs, fish, meat, poultry, and soy products; high-fiber foods include animal livers, carrots, tomatoes, lemons, fruits, etc., especially those with anti-cancer effects such as carrots, mushrooms, black fungus, beans, ergot, cauliflower, asparagus, and turtle meat can be eaten more.

　　Immunity in cancer patients is low, and leukocyte levels below normal values are common. They can eat some warm and nourishing meats, such as lamb, dog meat, deer meat, beef tripe, ejiao, chicken, eggs, pigeon meat, and turtle meat, and the effect of Chinese medicine is better if it can be辅助.

　　The following is a brief description of the treatment methods for elderly bladder cancer:

　　First, treatment

　　The biological characteristics of bladder tumors vary greatly, and there are many treatment methods, but the basic method is still surgical treatment, with radiotherapy, chemotherapy, immunotherapy, and other auxiliary positions. In principle, superficial bladder tumors should undergo bladder-preserving surgery, and invasive cancer should undergo total bladder resection.

　　1. Treatment of superficial bladder cancer

　　(1) Transurethral resection: The superficial bladder tumor is most suitable for transurethral resection. Regular follow-up should be performed in the short term after surgery, and a biopsy should be taken at the surgical site. If there is residual tumor, resection or surgical treatment may be needed again.

　　(2) Transurethral electrocautery: Small bladder papillomas can be treated by electrocautery.

　　(3) Transurethral laser and microwave therapy: Laser penetration is stronger than electrocautery, which can uniformly destroy cancer tissue, cause tumor cells to coagulate, and also has a hemostatic effect.

　　(4) Bladder irrigation therapy.

　　2. Treatment of bladder invasive cancer

　　Early symptoms of invasive bladder cancer are rare, and the progression is fast. If it is a localized lesion, partial cystectomy can be performed, otherwise, total cystectomy should be considered, and radiotherapy and systemic chemotherapy may be needed when necessary.

　　(1) Partial cystectomy: Indicated for single localized invasive cancer, more than 3cm from the bladder neck; deep tumors in diverticula that are difficult to remove by transurethral electrosurgery.

　　Partial cystectomy can preserve bladder function, is safe and reliable, but must be followed up closely, and cystoscopy should be reviewed regularly to detect recurrence early.

　　(2) Cystectomy: The entire bladder is removed, and in males, the prostate and seminal vesicle should also be included, and urinary diversion should be performed at the same time. Cystectomy is suitable for patients with multiple bladder cancers and invasion, large infiltrative cancers located at the bladder neck and trigone, infiltrative tumors without clear boundaries, superficial bladder cancers with severe mucosal lesions that only recur, large tumors, and when the capacity of the bladder is too small after partial resection, due to its large size.

　　Cystectomy is a major surgery with significant trauma, excessive bleeding, and the need for urinary diversion, which has a significant impact on the patient's physical, daily life, and work. A systematic examination of the heart, lungs, liver, and kidney functions must be performed before the operation. Elderly or overweight patients may undergo staged surgery.

　　(3) Radical Cystectomy: It includes the bladder, prostate, seminal vesicle, surrounding fatty tissue, and the peritoneum covering it. In women, it includes the bladder, urethra, and surrounding fatty tissue, and it is often necessary to remove the uterus, fallopian tubes, ovaries, and part of the anterior vaginal wall. This operation is complex and has many complications, so it should be carefully controlled.

　　(4) Radiotherapy: Radiotherapy can be used when bladder cancer surgery is difficult or the patient refuses surgery, which can help the patient retain urinary function and sexual function.

　　(5) Chemotherapy: Chemotherapy is the main treatment for bladder cancer with metastasis. Currently, effective drugs are considered to be cisplatin, doxorubicin (adriamycin), methotrexate, vincristine sulfate (vincristine), fluorouracil, and others.

　　Second, Prognosis

　　The prognosis of elderly bladder cancer patients mainly depends on the degree of tumor cell differentiation, the depth of invasion, and whether there is metastasis. The tumor cells of elderly bladder cancer often have poor differentiation, and more than half of the patients have invasion. When the tumor invades the superficial muscle layer, the chance of metastasis is 12%, and when it penetrates the muscle layer with peripheral invasion, 74% of the patients will have regional lymph node and hematogenous metastasis, with very poor prognosis and a cure rate of only 26%. Therefore, elderly bladder cancer has a high degree of malignancy and poor prognosis. The key to improving prognosis lies in early diagnosis and treatment.