膀胱癌-英文版-精品医学课件.ppt

1、Bladder CarcinomasBladder Carcinomasepidemiology（流行病学）It is the most common tumor of urinary tract in China of your book the second common urinary tract tumor in USA Male:female 2:1Pathogeny（病因学）（病因学）chemical substances:lacquer,benzene(苯)Smoking:affect one third patients chronic inflammation and eye

2、winker stimulation（异物刺激）othersGenetic and environmental factorsPathology（病理学）（病理学）More than 95%are epthelial tumor.Most are TCC(transitional cell carcinoma，移行细胞癌)Squamous cell carcinoma（鳞状细胞癌）2%-3%Adenocarcinoma（腺癌）2%-3%The grade of malignancy is on the basis of differentiation degree(分化程度）20%recurr

3、ent tumors will become invasive Pathology Grade（病理学分级）（病理学分级）Papillary urothelial neoplasms of low malignant potential Papillary urothelial carcinoma:low grade Papillary urothelial carcinoma:high grade WHO 2004Papillary urothelial neoplasms-benigngrowth pattern（生长方式）原位癌 cancer in situ 乳头状癌 papillary

4、 carcinoma 浸润性癌 infiltrating cancer the stage is divided based on the depth of the tumor invadeTis：carcinoma in situTa：no invision papillary carcinomaT1:be confined to intramucosal carcinaomThe path of metastasis（转移途径）derect invade:tissue and organ outside the bladder （直接侵犯）lymphatic metastasis:pelv

5、ic lymph node （淋巴道转移）hematogenous metastasis（血行转移）What may be the symptoms of bladder tumor?Symptoms and signs Gorss hematuria is common,some with microscopic hematuria （肉眼或镜下血尿）Some with urinary frequency and urgency （尿频与尿急）Disuria （尿痛）Ureter obstructed and hydronephrosis （输尿管梗阻与肾积水）Question:Total

6、hematuria or intermittent hematuriaPsysical examination It is worthless for early patients diagnosis.（早期体检多无阳性体征）Palpable mass indicate terminal cancer （可触及肿物多位于晚期）Laboratory findings Microscopic hematuria（镜下血尿）Urinary markers:antigen,growth factors,nuclear matrix proteins.not accurate enough to obv

7、iate cystoscopy for diagnosis（不能替代膀胱镜检查）Imaging studies B ultrasonography（0.5cm)IVP:upper urinay change CT MRIB ultrasoundIVPfilling defect CT scanCT scanUrinay cytologic study（尿液脱落细胞）（尿液脱落细胞）Low grade:low sentivity High grade:higher sentivity Sensibility:36%(13%-75%)Specificity:94%(85%-100%)More us

8、eful in checking for recurrence of transitional cell carcinoma May be useful for early diagnosis of recurrenceCystoscopy and random biopsy The scene of bladder tumor by cystoscope How to treat bladder tumor?（Tis Ta T1）Tis:carcinoma in situ well differentiation ones （分化好者）irrigation chemicals 灌注化疗 Ba

9、cille Calmette Guerin 卡介苗 cystectomy 膀胱全切 poor differentiation ones （分化差者）radical cystectomy 膀胱全切Ta,T1 Ta,T1:transurethral resection bladder tumor(TUR-bt)and chemotherapy drugs irrigation postoperation (经尿道膀胱肿瘤切除术及术后膀胱内灌注治疗)About 50%recurrence of the patients accepted TUR-bt in 2 years（T2 T3）Radical cystectomy is the main method T2 stage:well differentiation and localized(分化好、局限者)：TUR-bt partial cystectomy T3 stage：well differentiation:partial cystectomy maybe suitable for some onesT4 T4：lost the chance of radical surgery (多失去根治机会)auxiliary radiotherapy or chemotherapy may do some help 辅助放疗化疗