Bladder Cancer in the Elderly
Introduction
Introduction to bladder cancer in the elderly Bladder cancer is the most common genitourinary tumor. The incidence of bladder tumors increases with age. The data of patients aged 50-79 years account for 67.5% of all bladder cancer patients. Badly differentiated bladder cancer is common in older patients. basic knowledge Sickness ratio: 0.05% Susceptible people: the elderly Mode of infection: non-infectious Complications: urinary retention
Cause
The cause of bladder cancer in the elderly
Chemical carcinogens (30%):
Carcinogenic substances are intermediates of dyes such as -naphthylamine, benzidine, -naphthylamine and 4-aminobiphenyl. The incubation period after exposure to carcinogens is 5 to 50 years, and more than 20 years. Onset.
The above carcinogens are absorbed through the skin, the respiratory tract or the digestive tract, and then the metabolites are excreted from the urine to act on the urothelium to cause tumors. The urine stays in the bladder for the longest time, so the bladder incidence is high.
Relationship between endogenous tryptophan metabolism abnormalities and bladder cancer (20%):
Many patients with bladder cancer have no history of exposure to chemical carcinogens and may be associated with abnormal metabolism of tryptophan in the body. Bladder tumors are associated with chronic infection and irritation. The use of cyclophosphamide can also cause bladder cancer. Others such as radioactive irradiation can also cause cancer.
Adenocarcinoma (30%):
Also known as gelatinous carcinoma, mucinous carcinoma, the entire tumor has adenoid structure, accounting for 1% to 1.8% of bladder cancer, can also be self-limited cystitis.
Bladder squamous cell carcinoma (20%):
Pathological grading and staging: The malignancy of bladder tumors is expressed as "grade". In recent years, the third-grade method is used: the cells of grade I tumors are well differentiated; the grade III is undifferentiated; the grade II is between the two.
The staging of bladder tumors is divided according to the depth of bladder tumor infiltration. The prognosis of tumors can be estimated by staging. There are two main methods: one is Marshall-modified Jewett staging method, and the other is International Anti-Cancer Association (UTCC). The TNM staging method, the two methods are compared as shown in Table 1:
The advantages of TNM method are to determine the clinical stage and pathological stage, to define the concept of carcinoma in situ, and to distinguish the degree of metastasis. The pathway of metastasis: direct metastasis of bladder cancer, lymphatic, menstrual blood and tumor cell planting, etc. Tumor metastasis is related to clinical stage. According to statistics, at the time of diagnosis, T1 is about 10%, T2 is about 29%, and T3 is about 75%.
Prevention
Elderly bladder cancer prevention
The immune function of elderly patients with bladder cancer is low, so enhancing the body's immune function should be part of the treatment.
Complication
Elderly bladder cancer complications Complications, urinary retention
Acute urinary retention, liver, lung and bone metastases.
Symptom
Elderly bladder cancer symptoms Common symptoms Shame area bladder irritation urinary pain urinary frequency urgency nausea prostate hyperplasia edema bone pain lower extremity radiation pain
Hematuria
In particular, intermittent painless gross hematuria is the most common condition of bladder tumors. 80% of patients have hematuria at the time of treatment, and 17% of hematuria is severe. Because hematuria often appears intermittently and aggravates, it is easy to give the patient the illusion of "cure", which delays. time.
2. Bladder irritation symptoms
About 10%, patients with frequent urination, urgency, urinary pain often indicate invasive bladder cancer or primary carcinoma in situ, high malignancy, extensive invasion of the bladder wall, primary carcinoma in situ, bladder irritation Accompanied by pubic or penile pain, the pain is exacerbated after urination.
3. abnormal urination
A small number of patients may have dysuria and discharge abnormal contents. The high degree of malignancy can quickly spread to the prostate and dysuria, even urinary retention. Benign prostatic hyperplasia can also cause dysuria, and should be vigilant.
4. Metastatic symptoms
Patients with advanced bladder cancer may have pubic lumps, anemia, weight loss, edema, nausea and vomiting, such as metastasis to lymph nodes, invasion of most pelvic lymph nodes, pain, lower extremity radiation pain, lower extremity reflux disorder, etc. There is a bone pain in the corresponding part. The common distant metastatic sites are liver, lung and bone.
Examine
Examination of bladder cancer in the elderly
Urine cytology examination: specimens should use fresh urine or saline bladder irrigation solution. The positive rate of urine cytology is closely related to the degree of tumor cell differentiation. Repeated multiple urine specimen examination can increase the positive rate.
Cystoscopy
Cystoscopy can directly see the location, size, number, general morphology, extent of invasion and relationship with the ureteral orifice and bladder neck of the bladder tumor, and initially identify the benign or malignant tumor.
When a cystoscopy is found to be abnormal, a biopsy should be taken to determine the nature of the lesion and to understand the degree of malignancy of the tumor. The tumor should also be taken near and away from the tumor to understand whether there is mucosal lesion or carcinoma in situ. Provide important information for estimating prognosis.
2. Flow cytometry
Flow cytometry can quickly quantitatively analyze the relationship between cellular nucleic acid content, DNA content or DNA ploidy and bladder tumor biological behavior.
3.B type ultrasound scanning
More than 1 cm of bladder tumors can be found through the abdominal wall or transurethral tract, and a reliable judgment can be made on the depth of invasion of the tumor.
4. Venous urography
Mainly to understand whether there is a tumor in the upper urinary tract.
5. Cyst angiography
Visible tumor filling defects, bladder wall infiltration, showed rigidity and loss of elasticity.
6. Bladder double check
It is used when the tumor is large.
7. CT and MRI examination
It is the most accurate non-invasive method for staging tumors. It has strong resolving power for lesions. It is important for understanding the extent of bladder tumors, infiltration around the bladder and involvement of pelvic lymph nodes.
8. Bladder angiography and lymphography
It has certain value for diagnosis.
9. Monoclonal antibodies.
Diagnosis
Diagnosis and diagnosis of bladder cancer in the elderly
diagnosis
The diagnosis should accurately estimate the actual growth of bladder cancer and make a definite clinical stage, and understand the upper urinary tract in order to choose a treatment plan and estimate the prognosis.
Differential diagnosis
Mainly for the identification of hematuria, the diseases that need to be identified are non-specific cystitis, renal tuberculosis, cystitis glandularis, urolithiasis, radiation cystitis, benign prostatic hyperplasia, prostate cancer, cervical cancer, etc. Other medical diseases should also be To be identified.
