Radiotherapy:
Radiotherapy is a method of killing cancer cells by using high-energy X-rays or other radiation, which is divided into external irradiation and internal irradiation. The radiation generated by the linear accelerator emits external radiation from the body into the cancer tissue; Internal irradiation is to inject radioactive substances directly into cancer tissue or near cancer tissue in the body through instruments such as catheters or needles.
Chemotherapy:
A method of preventing cancer cells from dividing or killing cancer cells with drugs. But because normal cells such as hair and blood cells will also be affected, the side effects are obvious. Chemotherapy can be taken orally or by injection. Chemotherapeutics enter the human blood circulation and act on all cancer cells in the body. If the drug is injected into the spinal canal, bladder or chest and abdomen, the drug mainly works locally. For bladder cancer, intraluminal chemotherapy is usually used.
Biotherapy:
Methods of using patients' own immune system to fight cancer cells. Substances produced in the laboratory or self-produced substances are used to repair, enhance and adjust the patient's natural immune system. This method is also called immunotherapy.
In addition to the above standard methods, other treatments that are still in the clinical trial stage include:
Drug prevention: use vitamins and other drugs or other substances to reduce the occurrence or recurrence of cancer.
Photosensitive therapy: a therapy that uses light energy to stimulate specific drugs to act and kill cancer cells.
What is bladder cancer:
Bladder cancer is one of the most common tumors in the urinary system, which is common in men aged 50-70. The main symptoms are painless hematuria and dysuria. About 3/4 patients' hematuria can be observed with naked eyes, and the rest14 patients' hematuria can only be observed under a microscope. The etiology of bladder cancer is related to the stimulation of aromatic amines, smoking, various chronic stimuli, infection, virus and abnormal metabolism of endogenous tryptophan. The main clinical manifestations are intermittent painless gross hematuria, bladder irritation, dysuria, upper urinary tract obstruction, lower abdominal mass and so on. Systemic symptoms include nausea, loss of appetite, fever, emaciation, anemia and leukemia-like reactions. To prevent this disease, it is necessary to quit smoking and drinking, and not to have frequent sex. Workers exposed to benzidine and other chemical carcinogens for a long time should regularly check their urine and take certain preventive measures. For patients with early bladder cancer, local electrocautery and laser cautery are feasible, and postoperative anti-cancer drugs can be infused and radiotherapy according to the condition to prevent recurrence. Patients who can't be found in the early stage are mainly treated by surgery, and some bladders can be removed by radiotherapy.
This disease is equivalent to "hematuria", "blood stranguria" and "urinary retention" in traditional Chinese medicine. Its symptoms are mostly caused by deficiency of kidney-qi, unstable damp pathogen, spleen and kidney injury, dereliction of transport and transformation, endogenous heat toxicity, bladder stagnation, overheating of meridians, blood-heat rash, hematuria that cannot be cured for a long time, qi stagnation and blood stasis, urinary retention and toxic pathogen. It is characterized by dysuria, dysuria, fever, anemia and failure. Common clinical syndromes are:
1. type of blood stasis: frequent micturition and hematuria, sometimes dysuria, blood clot, abdominal distension and pain, dark purple tongue or ecchymosis, thin tongue coating, string or astringent pulse.
2. Damp-heat downward flow type: intermittent painless hematuria or blood after urine, accompanied by dysuria, frequent micturition, urgent micturition, abdominal distension, backache, sometimes fever and aversion to cold, dark tongue, white or yellow greasy tongue coating and heavy pulse.
3. Yin deficiency and internal heat type: dry mouth and thirst, no desire to drink, feverish sensation in five senses, short and red urine, dry stool, soreness of waist and knees, emaciation, dizziness, tinnitus, hot flashes, red tongue, thin coating and rapid pulse.
4. Spleen and kidney yang deficiency type: painless hematuria, soreness of waist and knees, drooping abdomen, pale complexion, fright of lower limbs, thin stool, pale tongue, white or greasy fur and weak pulse.
First, optional western medicine.
1. Taitepai: 30-60 mg is dissolved in 60ml normal saline and injected into bladder, every 1-2 weeks 1 time, * * * 4-8 times, and then every 4-6 weeks 1 time, at least/kloc-0.
2.VMF regimen: vincristine sulfate was administered at a dose of 0.75mg per square meter of body surface area, with intravenous injection every day 1 time; The dose of mitomycin is 8mg per square meter of body surface area, and it is injected intravenously 1 day/time. The dosage of fluorouracil is 0.4g per square meter of body surface area, and it is injected intravenously on day 1-5/time. Repeat the course of treatment in the fourth week.
3.FAP scheme: the dosage of fluorouracil is 0.6g per square meter of body surface area, and it is given 1 time on the first day and the eighth day respectively; Intravenous injection of adriamycin (30mg per square meter of body surface area) was given every day 1 time; Cisplatin per square meter of body surface
Bladder cancer recurrence:
The most worrying problem for cancer patients after operation is postoperative recurrence and metastasis, especially for bladder cancer patients. Because a significant difference between bladder cancer and other cancers is that it is easy to recur after surgery, for example, most patients who have bladder-preserving surgery will recur within two years.
The most common sites of postoperative recurrence of bladder cancer are local lymph nodes nearby and distant lung, liver and bone. If local lymph nodes metastasize or adjacent tissues are invaded, patients may have discomfort or pain in the lower abdomen, while patients with bladder preservation may have recurrent symptoms such as hematuria, frequent urination and dysuria, and some may have dysuria or urinary retention. Because of diseases such as urinary tract infection and urinary calculi, the above symptoms may also occur. So postoperative discomfort or hematuria is not necessarily a recurrence of bladder cancer. Further examination can confirm whether there is local recurrence or metastasis of bladder cancer.
In fact, in order to find signs of recurrence as early as possible, patients should go to the hospital regularly after surgery even if they have no symptoms. Regular review is usually once every three months. If there is no recurrence after one year, the examination time can be appropriately extended. The contents of the review include:
Cystoscopy is mainly suitable for patients with bladder preservation. Because the recurrence of bladder cancer may also occur in the renal pelvis, ureter and urethra. Therefore, negative cystoscopy can not completely rule out the possibility of bladder cancer recurrence.
Urine exfoliative cytology is simple, cheap and painless, and can be used as the main means of regular review.
B-ultrasound examination of liver and local lymph nodes can find liver metastasis.
X-ray examination, mainly chest film, can find out whether there is metastasis in the lungs.
Blood test of carcinoembryonic antigen (CEA) and other tumor markers is helpful to know whether bladder cancer has distant recurrence and metastasis.
Patients with bladder cancer can receive some treatments to prevent postoperative recurrence besides going to the hospital for regular reexamination. Patients with bladder preservation can receive intravesical instillation of BCG or other drugs after operation to prevent recurrence. Urine should be emptied before intravesical instillation of BCG, and urination should not be allowed for two hours after instillation, and the body position should be changed every 15 minutes. BCG is injected six times as a course of treatment, and then once a month for two years. Its adverse reactions include frequent micturition, dysuria and low fever. A few patients may have tuberculous cystitis and need anti-tuberculosis treatment if necessary. Interleukin -2 and chemotherapy drugs can also be used for bladder perfusion, and the specific use should be in accordance with the doctor's advice. Whether patients with total cystectomy need systematic treatment to prevent recurrence should be decided by doctors according to specific conditions.
If it recurs unfortunately, it is still possible for bladder cancer patients to be cured after treatment. In patients with bladder preservation, the recurrence of bladder cancer is still mainly treated by surgery. The principle is the same as the initial treatment, that is, the tumor is confined to mucosa or submucosa, and only local resection or electrocautery is performed. This operation can be repeated. In view of the fact that most patients have been infused with BCG before, other drugs, such as mitomycin and adriamycin, are usually needed after reoperation. The tumor invaded the local muscle layer, so partial cystectomy can be considered. If the tumor is large, total cystectomy is necessary.
What if the curative effect of bladder cancer is poor? If bladder cancer has invaded the surrounding organs or has distant metastasis, systemic chemotherapy with anticancer drugs such as methotrexate, vindesine, adriamycin and cisplatin has a certain effect. In order to improve the curative effect, chemotherapy drugs can be administered through arterial intubation. Patients with advanced stage or patients who can't operate due to other circumstances can be treated with laser to relieve the symptoms of bladder cancer and control bleeding.
Of course, radiotherapy can also be considered for patients with pain and dysuria caused by pelvic local lymph nodes or bladder adjacent organs metastasis.
Dry mouth and throat caused by radiotherapy
There are three salivary glands in human mouth, namely parotid gland, submandibular gland and sublingual gland. In addition, there are many small salivary glands on the oral mucosa, which constantly produce saliva and lubricate the oral mucosa. Patients with nasopharyngeal carcinoma can't avoid salivary glands because of the light range, and radiation damages glandular cells, which leads to the gradual atrophy and shedding of glandular cells. Therefore, in the process of radiotherapy (hereinafter referred to as radiotherapy), patients often have symptoms such as dry mouth and cleft lip. It is very difficult to swallow when eating, which leads to insufficient nutrient intake and even affects the treatment plan in severe cases.
The duration and severity of dry mouth and throat after radiotherapy are related to the area and dose of radiotherapy. The larger the area, the higher the dose, the heavier the injury and the longer the duration of dry mouth and throat. Most patients' dry mouth improved after radiotherapy for half a year, and it improved obviously after 1 year. In severe cases, it takes 1-2 years or more to recover. Therefore, under the premise of not affecting the therapeutic effect, try to avoid salivary glands, and the dose should not be too large to avoid serious damage to salivary glands.
When the patient has dry mouth and throat, careful nursing of family members can alleviate or delay the above injury reaction.
1. During radiotherapy, avoid tobacco and alcohol, eat less sugar, and often rinse your mouth with normal saline or shellfish solution.
2. Bring your own tea or drink, drink it when it is dry, and swallow it with a warm mouth; Or mouth containing ebony, watermelon frost, American ginseng, golden scorpion treasure, vitamin C tablets to quench thirst and promote fluid production. When the oropharynx is dry and painful, double grams of Houfeng powder can be sprayed locally.
3. Chinese medicine treatment: 20g of honeysuckle, 20g of forsythia suspensa, 20g of Sophora Tonkinensis 15g, 0g of platycodon grandiflorum 15g, 0g of Radix Rehmanniae 15g, 20g of Radix Scrophulariae, 20g of Radix Ophiopogonis 15g, and 10g of Radix Asparagi 15g. Or10g ebony and 5g licorice instead of tea.
4. One week before radiotherapy, take Shu Yale, 25mg each time, twice a day. Take it three times a day until one week after radiotherapy, which can relieve dry mouth symptoms. In addition, you can also choose pilocarpine 2.5 mg tablets, 2-3 tablets at a time, 3-9 times a day for 90 days, which can better improve dry mouth, but it is forbidden for patients with gastrointestinal ulcer, hypertension or cardiovascular disease recently.
Combined detection of two markers to predict the recurrence of bladder cancer
At present, after tumor resection, it is generally known whether it is benign or malignant, but it is not necessarily known whether the tumor has recurred. In the face of multiple and recurrent bladder cancer, people are concerned about whether there is a way to predict the recurrence frequency. One day in mid-August, the reporter learned from Hangzhou Cancer Hospital (Fourth Hospital) that the scientific research team composed of urology and pathology departments of the hospital had found a scientific and simple method to predict whether bladder cancer recurred. The research result named "Relationship between Matrix Metalloproteinase MMP9 and Cell Adhesion Molecule CD44V6 and the Recurrence of Superficial Bladder Cancer" passed the expert technical appraisal in mid-August.
"What is the direct impact of the findings of this study on patients?" On August 2 1, the reporter interviewed Dr. Li Zhenyong, the host of the study, again.
Dr. Li Zhenyong told reporters that the purpose of this study is to find a simple method to predict the recurrence of bladder cancer. The results of previous studies confirmed that MMP9 and CD44V6 are two reliable markers for predicting recurrence, and the combined use of them has higher accuracy in predicting recurrence. If the combined markers are all positive, a more positive attitude should be taken in the further treatment, review and follow-up after operation, while those with negative combined markers should be adopted.
It suggests a good prognosis.
In order to make it easier for reporters to understand the clinical effect of this study, Dr. Li introduced the situation of two patients with positive joint markers: one was a patient in Cixi City, Zhejiang Province. After learning that his tumor is easy to recur, he insisted on perfusion chemotherapy and reexamination, and he was still alive after 8 years of operation. Another farmer in Taizhou, although the postoperative examination clearly showed that his tumor recurrence rate was high, did not receive any chemotherapy, and as a result, he relapsed and died more than one year after operation.
Dr. Li Zhenyong asked the reporter to tell bladder cancer patients that due to many factors affecting tumor recurrence, patients with MMP9 and CD44V6 positive should be highly vigilant, keep close contact with attending doctors, strive to change bad living habits, continue to receive chemotherapy, and check regularly to minimize recurrence.
Scientists at the University of Washington School of Medicine have found that the interval between each recurrence of superficial bladder cancer is getting shorter and shorter. In addition, scientists have found two kinds of protein in tumor cells, which may help to predict the first or second recurrence.
In the United States, every year, doctors diagnose more than 50,000 new cases of bladder cancer, which is the first type of cancer most commonly suffered by men and the ninth type of cancer most commonly suffered by women. Up to 80% of bladder cancer cases are superficial bladder cancer, and its cancer cells have not invaded the deep tissue of bladder. Nearly half of the patients will relapse, and 20% of them will die.
Scientists studied 270 patients with superficial bladder cancer, all of whom were treated between 1994 and 1999, and the treatment time was between/kloc-0 and 54 months ago. Among them, 47% patients relapsed more than once, and 14% patients relapsed more than twice. The average time interval between the first treatment and the first recurrence was 23 months, and the time interval between the second and third recurrence was 13 to 15 months.
Prevention of postoperative recurrence of superficial bladder cancer by intravesical instillation of pirarubicin
Objective To evaluate the efficacy and safety of intravesical instillation of pirarubicin in preventing postoperative recurrence of superficial bladder cancer. Methods 45 patients with superficial bladder cancer were treated with turbt or partial cystectomy, and thp( 40mg/40ml) was instilled into the bladder regularly after operation, and the drug remained in the bladder for 30min each time. Results 45 patients were followed up for 9 ~ 12 months, 44 patients (97.8%) had no tumor recurrence, and 1 patient recurred. There were no systemic adverse drug reactions, only 2 cases had mild bladder irritation symptoms shortly after bladder perfusion. Conclusion thp bladder perfusion can effectively prevent postoperative recurrence of superficial bladder cancer, with good tolerance and few side effects.
Intravesical instillation of chemotherapy drugs is one of the most commonly used treatments to prevent postoperative recurrence of bladder cancer. Pyramycin (thp) is a new generation of semi-synthetic anthracycline antineoplastic drugs, which can spread rapidly in tumor tissues and have strong anticancer activity, and can kill tumor cells effectively and quickly. From1July, 1998 to 1 1 July, 45 patients with superficial bladder cancer were treated with thp to prevent tumor recurrence. After follow-up, the effect is satisfactory. The report is as follows.
Materials and methods
I. General information
45 cases in this group. There were 36 males and 9 females. The age ranged from 38 to 73 years, with an average of 52 years. Among them, there were 37 cases of single tumor and 8 cases of multiple tumors. 6 cases were recurrent tumors (5 cases were infused with mitomycin, 1 case with hydroxycamptothecin). All 45 cases were confirmed by pathology as transitional cell carcinoma of bladder. According to uicc and who evaluation criteria, g 1, g2 and g3 tumors were 13, 24 and 8 respectively. Ptis, pta and pt 1 tumor were 2 cases, 17 cases and 26 cases respectively.
Among 45 cases, 40 cases were treated with transurethral resection of bladder tumor and 5 cases with partial cystectomy. Thp was infused into bladder regularly after operation.
Second, the perfusion method
Thp bladder perfusion was started 1 week after operation, and thp 40mg+5% glucose 40ml was mixed and dissolved. Routine perfusion, changing posture every 5 minutes, and leaving the hospital after 30 minutes. Once a week ***8 times, and then once a month, *** 1 year. Regular blood routine, urine routine, liver and kidney function and cystoscopy were performed to record the systemic and local reactions after each bladder perfusion. All patients underwent cystoscopy every 3 months, and if suspicious lesions were found, biopsy was performed to determine whether there was tumor recurrence.
fructification
45 cases were followed up for 9 ~ 12 months, 44 cases (97.8%) had no tumor recurrence, 1 case recurred 6 months after operation. The pathological grading and staging (g2, pt 1) were the same as those in the first operation.
All patients can tolerate thp bladder perfusion treatment, and no obvious systemic adverse reactions have been found. Only 2 patients had mild frequent urination and dysuria after perfusion, and the symptoms disappeared completely after 2 ~ 3 days. There were no abnormal changes in blood and urine routine before and after thp bladder perfusion.