Bladder tumor

Introduction to bladder tumor Bladder tumor is the most common tumor in the urinary system, and it is also one of the more common tumors in the whole body. Most of them occur in the triangle area, the two side walls and the neck. The incidence of tumors in some cities in China shows that the incidence of bladder cancer has increased. Bladder tumors are currently the first in urinary male germline tumors. The incidence of bladder cancer in men is 3-4 times that of women. basic knowledge The proportion of illness: the incidence rate is about 0.004%-0.006% Susceptible people: no special people Mode of infection: non-infectious Complications: cervical lymph node metastasis

Bladder tumor cause

(1) Causes of the disease

The etiology of bladder tumors is complicated, although it has not been fully understood after much research.

1. Chemical carcinogens: Beta naphthylamine, benzidine, 4-aminobisbiphenyl, etc. are now recognized as bladder cancer. These substances are widely used in dyes, textiles, printing, rubber and plastics industries, and have long-term exposure to such carcinogens. It is easy to develop bladder cancer, but the individual is very different, the incubation period is very long, smoking is 1.5 to 4 times higher than that of non-smokers, and benzopyrene in tobacco is a carcinogen.

2. Oncogenes and tumor suppressor genes: Molecular biology studies suggest that certain factors can cause oncogene activation or inactivation of tumor suppressor genes, which can lead to cancer.

3. Others: abnormal metabolism of tryptophan and niacin may be the cause of bladder cancer, parasitic schistosomiasis in the bladder, bladder leukoplakia, cystitis glandularis, urinary tract, urinary retention, etc. may also be the cause of bladder cancer.

(two) pathogenesis

1. Tumor growth mode: divided into carcinoma in situ, papillary carcinoma and invasive carcinoma, carcinoma in situ is confined to the mucosa, transitional cell carcinoma is mostly papillary, squamous cell carcinoma and adenocarcinoma often infiltrate, the depth of tumor invasion is Clinical (T) and pathological (P) staging, clinical can be divided into: carcinoma in situ (Tis); papillary infiltration (Ta); limited to the lamina propria (T1); infiltrating superficial muscle layer (T2); infiltration Deep muscle layer or penetrating bladder wall (T3); infiltrating prostate or adjacent bladder tissue (T4), pathological stage (P) with clinical stage.

2. Pathology: Bladder tumors are mostly derived from epithelial cells, accounting for more than 95%, and more than 90% of them are transitional cell carcinoma. Squamous cell carcinoma and adenocarcinoma are rare, but the degree of malignancy is much higher than that of transitional cell carcinoma. Epithelial-derived tumors such as rhabdomyosarcoma are rare. The pathological changes of bladder tumors are based on cell size, morphology, staining depth, nuclear changes, and division are equally divided into four grades. One or two grades are well differentiated and are low-grade malignant; The quaternary differentiation is poor, and it is highly malignant. The morphology of papilloma cells is not significantly different from that of normal transitional cells, but there is a tendency to relapse and malignant transformation. Therefore, it is still treated as a cancer treatment in the treatment. The bladder tumor is in the growth mode. There are three types of cancer, papillary carcinoma and invasive carcinoma. It is rare in the clinical combination of the three. In the case of cystoscopy or living specimens, it can be seen that the tumor is often low-grade, broad-based. Non-tidal patients are highly malignant, and ulcer-infiltrating tumors are always highly malignant. Clinically, the depth of bladder tumor growth infiltration is divided into four stages according to the Jewett-Marshall staging method.

Stage O: The tumor is limited to the mucosa.

Stage A: The tumor affects the submucosa but does not invade the muscle layer.

Stage B1: The tumor involves the superficial muscle layer.

Stage B2: The tumor affects the deep muscle layer, but it still invades the extramuscular tissue.

Stage C: The tumor invades the whole muscle layer and the adipose tissue around the bladder.

Stage D1: The tumor invades the tissues surrounding the bladder and the organs in the pelvic cavity, and local lymph node metastasis.

Stage D2: distant metastasis of tumors.

Bladder tumors are most distributed in the bladder wall and posterior wall, followed by the triangle and the top, which can be multifocal, or accompanied by renal pelvis, ureter and urethra tumors. The spread of bladder tumors is mainly deep Infiltration, followed by distant metastasis, the metastasis route is mainly axillary lymph nodes and abdominal aortic lymph nodes. In the late stage, a small number of patients can be transferred to the lungs, bones, liver and other organs through blood flow. The metastasis of bladder cancer occurs later and spreads slowly. .

Bladder cancer prevention

Strengthen labor protection, reduce exposure to exogenous carcinogens, drink plenty of water, and urinate in time, which may play a preventive role. For patients who have undergone surgery, intravesical drug infusion, regular follow-up cystoscopy to prevent recurrence important.

Bladder tumor complications Complications of cervical lymph node metastasis

Bladder tumors can be metastasized by lymph or blood, with local lymph node metastasis, and distant metastasis in the late stage, more common in the liver, lungs, bones and skin.

Bladder tumor symptoms Common symptoms Abdominal mass urinary frequency Bladder volume reduction Urinary urgency bladder stimulation Bladder bulging pelvic mass urinary pain Bladder fibrosis edema

The early and most common symptoms of bladder tumors are intermittent, painless, and the whole process of gross hematuria. Hematuria often occurs intermittently and can stop or reduce by itself. It is easy to cause the illusion of "cure" or "return", generally the whole process of hematuria. At the end of the aggravation, there are also some patients with microscopic hematuria or only a small amount of terminal hematuria, hematuria and tumor size, number, degree of malignancy is inconsistent, non-epithelial tumor hematuria is light, bladder tumors such as necrosis, ulcers, co-infection or tumor Larger body, especially in the triangle area, may have bladder irritation symptoms, frequent urination, urgency, urinary pain, etc. The tumor may be located near the bladder neck or when the tumor is large, dysuria may occur, urinary retention, and the pelvic cavity is extensively infiltrated. Ankle pain, lower extremity edema, squamous cell carcinoma and adenocarcinoma are highly malignant, and the course of disease is short. Children with rhabdomyosarcoma often have dysuria as the main symptom, and most of the patients who have a lower abdominal mass have been in the advanced stage of the disease.

Tumors occur in the two side walls and the posterior wall, followed by the triangle and the top. The tumor is often single-shot, and the multiple tumors account for 16% to 25%. Bladder tumors may be accompanied by renal pelvis, ureter, and urethra tumors.

Bladder tumor examination

1. Urine examination of hematuria or terminal hematuria, urine P53 determination was positive.

2. Urinary exfoliative cytology is simple and easy to perform. It is an important screening method. The tumor is highly malignant and the cell differentiation is high. It is also an effective method for monitoring tumor recurrence and screening for high-risk population. Quantitative fluorescence image analysis More sensitive.

3. Nuclear matrix protein 22 (NMP22) is an examination that has appeared in recent years, mainly to check the content of nuclear matrix proteins in tumor exfoliated cells in urine.

4. Determination of hyaluronic acid (HA) and hyaluronidase (HAase) Increased HA and HAase in urine.

5. Bladder tumor and ABO antigen, flow cytometry, tumor chromosome, salivary enzyme and oncogene, tumor suppressor gene determination can have a deep understanding of the biological characteristics of tumor malignancy, infiltration tendency and prognosis.

6. Cystoscopy: It is the most important method for diagnosing bladder tumors. It can directly observe the tumor growth site, size, number, morphology, basal condition, relationship with ureteral orifice and bladder neck, and can simultaneously perform tumor biopsy and random biopsy of bladder mucosa. To determine the tumor differentiation and the presence or absence of carcinoma in situ.

7. X-ray examination: Excretory urography can understand the renal pelvis, ureter with or without tumor and renal function. If the urinary tract has a tumor, the bladder tumor can be implanted, kidney, ureteral or undeveloped, indicating tumor. Infiltrating into the ureteral orifice caused obstruction, cystography showed filling defects, bladder wall stiffness and irregularity showed deep tumor infiltration, CT, MRI examination can show the depth of tumor invasion and pelvic metastasis.

8. B-type ultrasound: It is increasingly valued and can display bladder tumors above 0.5cm. It can be observed dynamically. Transurethral ultrasound scan can accurately show the depth and extent of tumor infiltration of bladder wall. The direct sound image of bladder tumor can be expressed as bladder. The cavity is raised or infiltrated into the bladder wall.

(1) papilloma, well-differentiated transitional papillary carcinoma, the tumor protrudes into the bladder cavity, showing a cauliflower-like or papillary echo in the anechoic region of the bladder, no sound shadow, and good bladder wall continuity. The echo of the muscular layer is not damaged, and the strong echo group can be shaken in the urine when changing the body position or slamming the bladder.

(2) Papillary carcinoma with poor differentiation, the base is wide, part of the tumor protrudes into the bladder cavity, and the other part infiltrates the muscle layer or bulges outward. The echo of the bladder wall at the tumor growth site is unclear.

Diagnosis and diagnosis of bladder tumor

Painless hematuria is the main symptom of urinary tumors. Once it appears, it should be thought of the possibility of urinary tumors, especially those over 40 years old, or terminal aggravation. Bladder tumors are the most common. If hematuria is accompanied by bladder irritation, it is easy. Misdiagnosed as cystitis, the latter is the simultaneous symptoms of bladder irritation and hematuria. When the "carrion" sample is discharged from the urine, it is easier to diagnose. The lower abdominal mass or bladder double examination and pelvic mass are late manifestations. The main symptoms can be diagnosed by combining laboratory and auxiliary examinations.

It should be differentiated from hematuria and lower abdominal masses for other reasons.

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