Oncology / / April 20, 2016
The bladder is the most common site of tumors of the urinary tract.Men frequently sick women (ratio 4: 1).Most often the disease occurs between the ages of 50-70 years.Tumors can be located in all parts of the bladder, but the most common site is on the side and rear walls and pours a triangle.In 95% of bladder tumors are of epithelial origin.They can be benign (papilloma) or malignant, such as bladder cancer (papillary, perehodnokletochny and squamous cell carcinoma, adenocarcinoma).
papillomas of the bladder, in spite of the morphological structure of high quality, should be considered premalignant tumor, because it is prone to frequent recurrence and malignancy.
Benign non-epithelial tumors - fibroma, myoma, fibrosarcoma, hemangioma - are extremely rare.Several more common sarcoma, which give early hematogenous and nodal metastases.
Among etiological factors attach great importance to various chemical agents, including a prominent place is given to aniline dyes.Of great importance in the origin
debated in the literature as the viral theory of the origin of tumors of the bladder.
Symptoms The most common symptoms are dysuria and hematuria.Gross hematuria as the first symptom of the disease was observed in 75% of patients.Dysuria observed in 1/3 of the cases;This frequency increases as the disease stage.
hematuria more often total, with shapeless blobs.When the tumor in the neck may be a terminal hematuria.Hematuria is often intermittent in nature, which can lead to late diagnosis.Less common symptom of bladder cancer is microscopic hematuria.At the complicated outflow from the bladder, as well as the decay of tumors often develop secondary cystitis and pyelonephritis upward, which greatly exacerbates the severity of the clinical course of the disease.
addition to the detection of tumors of the bladder, it is necessary to set the stage of the process.It is important bimanual palpation with bladder emptying and complete relaxation of the abdominal muscles, which is achieved by the use of anesthesia or spinal anesthesia.Urinalysis often finds that microhematuria and leukocyturia.
cytological examination of urine sediment is a valuable tool in the diagnosis, when it is possible to detect tumor cells.Some importance urinary cytology sediment is at mass inspections of workers employed in the chemical industry and other industrial facilities.The leading role in the diagnosis belongs cystoscopy.This method allows detection of the tumor, to get an idea about the nature, size, location, her condition mucosa around the tumor, its relationship with the mouths of the ureters.
Endovezikalnaya biopsy is a valuable auxiliary diagnostic method, but its negative results do not reject the diagnosis of the tumor.At the same time, the purity of the response process and does not always correspond to the true nature of it, because when a biopsy is not always possible to get the necessary parts of the tumor, in particular, from its foundation.
include radiological studies play an important role excretory urography with descending cystography.Thus it is possible to determine not only the location and size of the tumor, but the state of the upper urinary tract.To clarify the degree of infiltration of the bladder wall using cystography.The most demonstrative data are obtained from the use of sediment combined with cystography peritsistografiey.
differential diagnosis must be done with tuberculosis, syphilitic ulcers, endometriosis, secondary tumors grow into the bladder from the prostate, rectum, uterus or appendages.
method of treatment is chosen based on the following factors:
1) anatomical and histological classification;
2) the tumor;
3) the general condition of the patient;
4) the previous treatment.
- Bladder Cancer: Causes, Symptoms, Diagnosis, Treatment
- Incontinence: Causes, treatment, prevention
- Puncture bladder (capillary puncture, puncture trocar)
- Resectionbladder cancer
- Types and causes
- Age-related changes in the urinary bladder
1. Endovezikalnuyu electrocoagulation used for neinfiltriruyuschih papillary bladder tumors on the leg, small size.
2. Transurethral resection of use for large superficial lesions and multiple lesions.
3. Segmental resection is used for large tumors single apex or the side walls.The implantation of the ureter is necessary if the process is close to the mouth.
4. totality cystectomy undertaking in cases where the tumor is large, infiltrates the wall of the bladder and is located in the triangle area, or cervix.Surgery may involve removal of the pelvic lymph nodes, prostate, seminal vesicles and urethra (if indicated).
cystectomy produced in the absence of distant metastases and a satisfactory general condition of the patient.The operation may be undertaken in two stages - urinary diversion cystectomy followed by or simultaneously.The most common methods of diversion are ureterosigmoanastomoz, ureterokutaneostomiya, transplant ureter in an isolated segment of ileum.
radiation therapy used in conjunction with surgical techniques.Preoperative radiation therapy is often shown to achieve operability of the tumor.Postoperative radiotherapy is carried out at multiple papillomatosis, radical surgery is not always possible, as well as the lack of radical surgery for cancer.In inoperable patients, radiation therapy is used as a palliative, to relieve pain and hematuria termination.
antitumour therapy in a separate application is ineffective.However, in combination with surgery and radiation, it can improve the results of treatment.
most favorable prognosis in patients with well-differentiated superficial bladder tumors and timely initiation of treatment.Important conditions are favorable prognosis long dispensary observation, systematic cystoscopic control (the first year, every 3 months for the next 3 years - every 6 months, and then once a year).