Staging of bladder cancer treatment

1. Superficial bladder cancer (Tis, Ta, T1)

(1), transurethral resection of bladder tumor, cut / fulguration (TURBt): bladder function could be retained and repeated, the patient and rapid recovery. Reviewed every 3 months after a cystoscopic examination, 2 years and no recurrence can be changed to 6-month review time. Transurethral laser resection surgery can be applied.

(2) local resection of bladder tumor / bladder partial nephrectomy: lack of surgical instruments during transurethral incision of bladder tumor resection feasible, not suitable for line TURBt of superficial bladder cancer patients should also be OK to open surgery bladder.

(3) intravesical instillation therapy
Objective: ① to eliminate cancer; ② relapse prevention; ③ prevention and treatment of superficial tumors developed carcinoma.
Drug choice: common drugs for the Bacillus Calmette-Guerin (BCG), mitomycin C (MMC), epirubicin (ADM), hydroxy-camptothecin, / cisplatin (CDDP), interferon, interleukin -2 and so on.
Usage: BCG 80 ~ 120mg, mitomycin C 40mg, epirubicin 40mg, cisplatin 120mg, dissolved in 40-50ml saline via catheter instillation of drug in the bladder to retain two hours, every half-hour to replace position , so that the wall of the bladder full access to medicine. Infusion once a week, 4-8 was later changed to once a month, a total of 1-2 years.

(4), photodynamic therapy (PDT): commonly used hematoporphyrin derivative (HPD) as a light sensitizer, with a certain wavelength (630nm) laser irradiation treat superficial bladder cancer and carcinoma in situ, adverse reactions, including skin photosensitive reactions , patients in the dark need 6-8 weeks after treatment, while the majority of patients with bladder irritation symptoms, sustainable 10-12 weeks, some patients with bladder contracture.

2. Invasive bladder cancer (T2, D 3, T4)

(1), partial cystectomy
1) Indications: ① a single, limited to invasive carcinoma; ② tumors more than 3cm away from the bladder neck; ③ open interior cancer; ④ urachal cancer.
2) Contraindications: ① multiple or recurrent carcinoma; ② tumor near the bladder neck; ③ bladder capacity is too small; ④ have done radiotherapy.

(2) + radical cystectomy urinary diversion: In addition to the above-mentioned partial resection of the bladder for invasive bladder cancer, the majority of patients with invasive bladder cancer should be performed radical cystectomy including pelvic lymph node dissection. Male patients, such as tumor invasion and prostate urethra, urethral resection of the whole should be OK. Female patients, before surgery to remove pelvic organs, including the bladder, urethra, uterus, fallopian tubes, ovaries combined anterior vagina. Urethral resection should be performed routinely, because women's easy for invasive bladder cancer involving the urethra. Note that the situation of intraoperative ureteral stump, rapid frozen section examination to determine whether there was residual cancer, if found to have cancer, should be removed as far as possible to the cutting edge of ureteral tumor-free.

(3), transurethral resection of bladder tumor (TURBt): a simple transurethral resection of tumors with myometrial invasion for the majority of bladder cancer, said mining is not enough, only applies to shallow myometrial invasion of low-grade small tumors, or not suitable for an open line of bladder surgery.

(4) Radiation Therapy
1) Indication: can not, or is not suitable for surgery for invasive bladder cancer, or invasive bladder cancer with radiotherapy.
2) Dose :50-70Gy.
3) Regional: bladder and pelvic lymph nodes.
4) Impact of prognostic factors: including high-grade and high-stage tumors, anemia, kidney water and so on.
5) complications: gastrointestinal and urinary tract complications, such as radiation enteritis, radiation cystitis.

(5) Chemical treatment: Chemical treatment for lymph node metastasis and distant organ metastasis of bladder cancer, commonly used in joint program for the M-VAC (methotrexate, vinblastine, doxorubicin, / ares platinum), greater toxicity (bone marrow suppression, renal insufficiency, mucous membrane Yandeng).

3. Palliative treatment of advanced bladder cancer

(1), palliative radiotherapy: patients with bone metastases of the total dose of 3 000-3 500cGy radiotherapy can effectively alleviate the pain caused by bone metastases. Local tumor measurement can be used a total of 4 000 ~ 4 500cGy palliative radiotherapy can control hematuria, urgency, dysuria,, shaking urinary difficulties.

(2) Chemical treatment: see above.

(3) intervention (iliac arterial chemotherapy and embolization): iliac arterial chemotherapy and embolization can reduce the tumor bleeding, slow tumor growth, prolong survival and improve quality of life.

(4) alum or formalin intravesical therapy: l% of the alum solution and l% ~ 10% formalin solution bladder infusion for the treatment of advanced bladder cancer or radiation cystitis caused by bleeding, a negative reaction of alum aluminum intoxication. Formalin negative reactions include pain, bladder mucosal fibrosis, ureteral obstruction and so on.

Other bladder epithelial tumor

1. More with bladder squamous cell carcinoma of bladder stones, long-term indwelling catheter or bladder diverticula causing chronic stimuli, due to the time of diagnosis most patients have advanced, the prognosis is poor, treatment with radical cystectomy with postoperative radiotherapy as the first choice, blood At first glance embolization treatment or intravesical alum or formalin can be used as palliative care approach.

2. Bladder cancer, including primary bladder adenocarcinoma, urachal adenocarcinoma and metastatic adenocarcinoma of three, usually poor prognosis.