Disease Overview
bladdercarcinomaisurinarysystemthe most commonmalignant tumorone of，accounting forallmalignant tumorof3%-4%，malesincidenceapproximatelyasfemalesof3-4times。peak age of onset50-70years old, UrbanincidencehighinRural areas.bladdercarcinomabased ontumoris否invasionmuscular layerclassified intonon-muscular layerinvasiontypebladdercarcinoma(NMIBC，accounting for75%)andmuscular layerinvasiontypebladdercarcinoma(MIBC，accounting for25%)。NMIBCprognosisrelativelygood，5yearsurvival ratecan达80%-90%;MIBCrelatively poor prognosis，5yearsurvival rateapproximately50%-60%。hematuriaisthe most commoninitialsymptoms，accounting for80%-90%patientsofinitialmanifestation。
Major Causes
Smoking：most importantofrisk factor，approximately50%bladdercarcinomapatientshaveSmokingHistory,increased risk2-3times。
Occupational exposure：long-termExposure to aromaticamineclasscombine(Dyes, rubber, leather, aluminum productsetc.)increasingrisk，approximately20%andOccupationalhaveclose。
chronic inflammatory stimulation：bladderstones、chronicbladderInflammation,long-termIndwelling urinary catheter, Schistosomadiseaseetc.。
drugdue toelement：long-term服usingcyclophosphamidechemotherapy, Abuse ofusingphenacetin、enablingusingDiabetesdrugpioglitazone。
Other factors：High-fat diet, Low water intake,family history、genetictypebladdercarcinoma(rare)。
Common Symptoms
hematuria：the most commoninitialsymptoms，80%-90%patientsappearing，typicallyno痛type、intermittent、entire process肉eyehematuria。
bladderstimulationsign：urinary frequency、urinary urgency、dysuria，approximately10%patientsmanifestationasinitialsymptoms。
dysuria：Tumor invadesbladder颈orprostatecausingUrinationobstruction。
abdominal pain、lumbarpain：advanced-stageorappearingupperUrinary tractobstruction、renalHydronephrosistime。
othersymptoms：body weightunderdecrease、fatigue、food欲decreaseretreat、advanced-stageappearingcachexia。
Classification and Staging
Pathological Classification
urothelial carcinoma(accounting for90%-95%)：transitional cell carcinomamostcommon，squamous cell carcinoma、glandularcarcinomarare。
squamous cell carcinoma(3%-7%)：normalandSchistosomadisease、chronic inflammationrelated。
glandularcarcinoma(<2%)：more源inUrachal remnants.
othertype：small cell carcinoma、neuroendocrine tumorsetc.。
TNM Staging(AJCC8th edition)
Primary Tumor (T)
Ta：non-invasiontypepapillary carcinoma
Tis：Carcinoma in situ(Flattypecarcinoma)
T1：tumor侵andsubepithelial connective tissue
T2：tumor侵andshallowmuscular layer
T2a: Invasion ofandshallowmuscular layer(medial1/2)
T2b: Invasion ofanddeepmuscular layer(lateral1/2)
T3：tumor侵andbladdersurroundingfat肪
T4a: Invasion ofandprostate、uterus、vaginal
T4b: Invasion ofandPelvic wallorAbdominal wall
Regional Lymph Nodes (N)
N0：No regional lymph node metastasis
N1: Solitaryipsilaterallymph nodesmetastasis，≤2cm
N2: Solitaryipsilaterallymph nodesmetastasis>2cmbut≤5cm，ormoreipsilaterallymph nodes≤5cm
N3：lymph nodesmetastasis>5cmorinvasionPelvic wall
Distant Metastasis (M)
M0：No distant metastasis
M1：Distant metastasis present
Clinical Stage Grouping
0astage：Ta N0 M0
0isstage：Tis N0 M0
Ⅰstage：T1 N0 M0
Ⅱstage：T2 N0 M0
Ⅲstage：T3-4a N0-2 M0，T1-4a N1-3 M0
ⅣAstage：T4b N0-3 M0，anyT N3 M0
ⅣBstage：anyTanyN M1
Diagnosis
尿fluidexamination: UrinenormalRoutine, urinecells
Tumor markers: UrineNMP22(Nuclear matrixprotein22)、bladdertumorantigen(BTA)
Imaging studies：
ultrasound：preferredInitial screeningmethod
CTUrography:assessmenttumorsize、depth of invasion
MRI：assessmentmuscular layerinvasion、surroundingorganinvasion
cystoscopy+biopsy：Diagnosisgold standard
precision strikebladdercarcinomaofminimally invasive疗method
bladdercarcinomaisurinarysystemcommonofmalignant tumor，whenpatientsfacingnomethod立namelysurgery、tumorlargeorbodycondition况nottolerancetraditionalsurgeryofconditiontime，interventional therapyAsonetypeminimally invasiveprecise疗method，normalexertmoretomoreimportantofeffect。itcanenoughinto the greatest extentprotectnormal tissueofmeanwhile，precision striketumortissue。
Whatisbladdercarcinomainterventional therapy?
bladdercarcinomainterventional therapyisonetypethroughinterventionaltechnologywillchemotherapydrugorembolic agentdirectlyDelivered totumorvascular，withcut offtumorNutritiontoSource,improvetumorlocaldrug浓degree, Promotingenablingtumorischemianecrosisoftreatmentmethod。
andtraditionalsystemicchemotherapydifferent，interventional therapyneedlefortypestrong，canenoughenablingtumorlocal达tomorehighofdrug浓degree，meanwhilereduceforsystemicothertissueofdamage，fromwhileinimproveefficacyofmeanwhiledecreaselightadverse reactions。
primaryinterventional therapymethod
bladdercarcinomaofinterventional therapyprimaryhave三typemethod，doctor会based onpatientsofspecific circumstanceschoicemostcombine适ofplan：
1. transarterial chemoembolization
thisisthe most commonbladderinterventional therapymethod。doctorinpatientsinguinal处offemoral arteryperformedlocal anesthesiaposterior, Insert a finesmallofcatheter，inimagingequipmentguidanceunder，willcatheterpreciseInserted into the supplyingbladdertumorofmove脉vascular。
thenthroughcatheterinjectedhigh浓degreeofchemotherapydrug，enablingdrugdirectlyeffectintumortissue;along withposteriorinjectedembolic agent, Blockingtumoroffeeding artery, Reachingto"饿death"tumorcellsof目of。
2. Percutaneouspuncturebladdertumorablation
forrelativelysmallof、localizedoftumor，doctorcancan会adoptedB-ultrasoundorCT-guidedunderPercutaneouspuncturetumor，throughradiofrequency、microwave、cold冻etc.理energy，enablingtumorcellsproteindegeneration, Dehydration,causingtumordeath。thismethoddirectlyeffectintumorlocal，forsurroundingnormal tissuedamagesmall。
interventional therapyofadvantagein
interventional therapymostoutstandingofAdvantagesisprecisehighly effective。throughmove脉directlygivedrug，tumortissueacceptedofdrug浓degreehigh，treatmenteffectsignificantelevating。meanwhile，itforbody整bodydamagesmall，toxintypelow，complicationsMinimal,patientssystemiccondition况recoveryrapidly。foradvanced-stagebladdercarcinomacausingofseverehematuria，interventional embolizationtreatmentcaneffectivecontrolbleeding，meanwhiledecreaselighttumorcompressionsymptoms，significantimprovepatientsquality of life。
in addition，thistreatmentmethodtraumasmall, Procedure is relativelyforsimpleSimple,safeeffective，can缩shortinpatienttime间
Prevention and Follow-up
戒tobacco：mosteffectiveofpreventionmeasures
reduceOccupational exposure：addstrong劳moveprotect
moreWater intake:daily2000mland above, Diluting carcinogeniccarcinoma
regular饮food：moreEat fruits and vegetables,reducepickled、smoked and grilledfood品
regularlybodyExamination:50years and olderrecommendedannually尿normalRoutine,urinary系ultrasound
follow-up：after treatmentfirst 2 yearsevery 3 monthsonce，years 3-5every 6 monthsonce，after 5 yearsannuallyonce