Is bladder cancer related to smoking? Its typical symptoms are...

Author: Zhou Liqun, Chief Physician, Peking University First Hospital

Honorary President of the Urology Branch of the Chinese Medical Association

Reviewer: Zhang Kai, Chief Physician, Peking University First Hospital

Each of us has many smoking friends.

We know that because cigarettes contain nicotine, a harmful substance, it is related to many tumors, such as lung cancer, oral cancer, nasopharyngeal cancer, bladder cancer, and even gastric cancer.

There is clear research data to confirm that compared with non-smokers, smokers have a two to two and a half times higher chance of developing bladder cancer.

Therefore, for patients with bladder cancer, quitting smoking is very important, or in other words, quitting smoking is the first step in preventing bladder cancer.

In addition to smoking, factors related to bladder cancer include genetic factors and exposure to chemicals containing benzene. Frequent hair dyeing is related to bladder cancer because hair dyes contain benzene chemicals, which can cause bladder cancer.

1. What are the typical symptoms of bladder cancer?

The symptoms of bladder cancer are quite typical, and can be described in a more professional term: "intermittent painless gross hematuria". What does it mean?

Figure 1 Original copyright image, no permission to reprint

In layman's terms, this means that one day the patient suddenly discovered bright red blood in his urine, and the entire urine was red, even with blood clots, but it didn't hurt at all. And this kind of blood in urine often disappears after a few urinations.

Then the patient will think, is it all right? At first, hematuria was a shock, but then it disappeared after a few days, weeks, or even months. But after a while, hematuria suddenly appeared again one day.

Our description is that the urine is red from beginning to end. This kind of hematuria is called whole-course hematuria. It may be self-limiting, that is, the capillaries on the surface of the tumor suddenly break and bleed. It can also heal itself and disappear after a few days, which makes the patient feel that it is cured.

Therefore, clinically, this disease is deceptive, with intermittent hematuria and no pain. Sometimes there is pain when there is infection, but most of the time there is no pain. Once there is such painless hematuria, it must be paid attention to.

2. Does hematuria mean bladder cancer?

No, hematuria does not necessarily mean bladder cancer.

Tumors of the upper urinary tract, such as tumors of the renal pelvis, ureter, or even tumors of the renal parenchyma, are renal cancer. When they develop to the late stage and invade the renal pelvis and calyces, they can also cause hematuria.

In addition, some benign diseases, such as benign prostatic hyperplasia, can sometimes cause the capillaries on the surface of the urethra to rupture and cause blood in the urine.

There are also urinary stones, but most patients with stones will experience pain, and most of them are colic, sometimes rolling on the ground in pain. However, some patients do not feel pain, but have hematuria.

There is also urinary tract infection. In addition to frequent urination, urgency, pain, and increased urination frequency, if the capillaries in the mucosa are broken, there will also be obvious hematuria.

Therefore, the occurrence of hematuria does not necessarily mean bladder cancer. This needs to be analyzed and diagnosed based on the specific medical history, course of the disease, and related auxiliary examinations.

3. To treat bladder cancer surgically, does it mean to remove the entire bladder?

When talking about surgical treatment of bladder cancer, we cannot ignore partial cystectomy.

Partial resection was a surgical treatment method that was used decades ago, especially in primary hospitals. However, it has a major problem. Since tumor cells can fall off and be excreted in the urine, there may be tumor cells in the patient's urine. If the bladder is cut open, since there may be tumor cells in the urine, the tumor may be implanted wherever the urine flows.

So some doctors at the grassroots level said, "We have very good results with partial resection, so why do we have to do total resection?" In fact, it is not that partial resection is very effective, but that patients with poor results go to hospitals in big cities for treatment. This is because after the bladder is cut open, urine flows out, and tumors can be implanted everywhere in the pelvic cavity.

Figure 2 Original copyright image, no permission to reprint

In this way, partial resection turns bladder cancer from a surgery that can be cured to a surgery that cannot be cured, so partial resection is now used less and less.

However, in some special cases, such as elderly and high-risk patients with locally advanced myometrial invasion who cannot tolerate such a major surgery as a radical cystectomy, partial cystectomy is a reasonable option considering the patient's life expectancy.

The most widely used clinical method now is transurethral electroresection or laser resection of bladder tumors, which involves inserting special surgical instruments into the bladder cavity through the urethra, using an electroresection ring or laser to gradually cut the tumor into small pieces and then flush it out of the body.

This is a minimally invasive surgery. It can be used to treat early superficial bladder cancer. It is less traumatic to the patient, with less bleeding and faster recovery. It can preserve the bladder and greatly improve the patient's quality of life. However, it is necessary to regularly instill BCG or chemotherapy drugs into the bladder after surgery to prevent tumor recurrence and to have regular follow-up examinations.

Radical cystectomy remains the most effective treatment for locally advanced bladder cancer with muscle invasion.

With the continuous advancement of modern medical technology, everyone is discussing how to preserve the bladder organ while achieving the goal of radically curing the tumor to improve the patient's quality of life. Currently, chemotherapy and immunotherapy have a good effect on bladder cancer. Sometimes, with the help of radiotherapy, some patients can achieve the goal of having both fish and bear's paw, that is, curing the tumor and preserving the bladder. However, this depends on the specific situation of the patient and cannot be generalized.

Therefore, surgical treatment of bladder cancer in the early stages can use minimally invasive methods to remove the tumor and preserve the bladder; while for patients in the late stages with muscle layer invasion, the entire bladder usually has to be removed to be cured; auxiliary chemotherapy, immunotherapy and radiotherapy, etc., can enable some patients to both cure the tumor and preserve the bladder.

It is very important that if you have painless, visible hematuria, you should go to a regular hospital's urology department for a professional examination as soon as possible. Early detection, early diagnosis, and early treatment can achieve the goal of curing the tumor and preserving the bladder, thereby prolonging life and improving the quality of life.