Bladder cancer is a malignant tumor that develops on the mucosa of the bladder. It is the most common malignant tumor in the urinary system and one of the ten most common tumors in the body. In China, the incidence of urogenital cancer is the first, and in the west, its incidence is second only to prostate cancer. In 2012, the incidence of bladder cancer in tumor registries nationwide was 6.61/100,000, ranking 9th among malignant tumors. Bladder cancer can occur at any age, even in children. Its incidence increased with age, the high incidence of 50 ~ 70 years old. Bladder cancer is 3 to 4 times more common in men than women. In the past, the bladder mucosal epithelium was referred to as the transitional cell. In 1998, WHO and the international urological society jointly proposed to replace the word "transitional cell" with the word "urothelium", so as to distinguish it from the transitional epithelium in the nasal cavity and ovary and make the urothelium become the proper name of the urinary tract system. The pathological types of bladder cancer included bladder urothelial carcinoma, bladder squamous cell carcinoma and bladder adenocarcinoma in the histological classification of urinary tract tumors in WHO "urology and tumor pathology and genetics of male reproductive organs" in 2004, and other rare bladder clear cell carcinoma, bladder small cell carcinoma and bladder carcinoid carcinoma. The most common one is bladder urothelial carcinoma, accounting for more than 90% of the total number of bladder cancer patients.
The cause of
The etiology of bladder cancer is complex, with both internal genetic factors and external environmental factors. The two risk factors are smoking and occupational exposure to aromatic amines. Smoking is currently the most confirmed risk factor for bladder cancer. 30% ~ 50% of bladder cancer is caused by smoking, and smoking can increase the risk of bladder cancer by 2 ~ 6 times. With the extension of smoking time, the incidence of bladder cancer also increases significantly. Another important risk factor is associated with a range of occupations or occupational exposures. It has been confirmed that aniline, diaminobenzene, 2-naphthylamine and 1-naphthylamine are all carcinogens of bladder cancer. Long-term exposure to these chemicals increases the risk of bladder cancer, and occupational factors account for about 25% of bladder cancer patients. Related to bladder cancer are aluminum products, coal tar, asphalt, dyes, rubber, coal gasification and other industries.
Clinical manifestations of
About 90% of patients with bladder cancer have the initial clinical manifestations of hematuria, which are usually painless, intermittent, whole-course hematuria with the naked eye, and sometimes hematuria under the microscope. Hematuria may occur only once or last for 1 to several days, which can be alleviated or stopped by itself. Sometimes, the coincidence of hematuria and self-stop after medication often gives patients the illusion of "recovery". Some patients may reappear hematuria after some time apart. Hematuria stain from light red to dark brown, often dark red, some patients will be described as washing meat like water, tea. The amount of bleeding and the duration of hematuria are not directly proportional to the malignant degree, size, range and number of the tumor. Sometimes gross hematuria occurs when the tumor has been large or has been advanced; Sometimes a small tumor can produce a lot of hematuria. Some patients were found to have a tumor in the bladder during a physical examination by b-ultrasonography. Bladder irritation can first appear in 10% of patients with bladder cancer, presenting as frequency, urgency, pain and difficulty in urination, while there is no obvious gross hematuria in patients. This is because tumor necrosis, ulcer, bladder tumor is bigger or number is more or bladder tumor diffuses infiltrate bladder wall, make bladder capacity decreases or concomitant infection place causes. Tumors in the trigonal region and neck of the bladder may obstruct the bladder outlet and present with dysuria.
For painless macrohematuria occurring over 40 years of age, the possibility of urinary tract tumors, especially bladder cancer, should be considered. The patient's previous history and family history were combined with symptoms and physical examination to make a preliminary judgment, and further relevant examinations were conducted. Methods of examination included routine urine examination, urine abscissor cytology, urine tumor markers, abdominal and pelvic ultrasonography. Cystoscopy, venous urography, pelvic CT or/and pelvic MRI were used to determine the diagnosis. Cystoscopy is the most important method for diagnosis of bladder cancer.