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作者：Laura Nathan-Garner 这一年有近7万5千人将被诊断为膀胱癌，根据美国癌症协会统计。绝大多数人被诊断出这种疾病的人是55岁以上的白人，但是膀胱癌的发病不限男女，不分种族和年龄。 对于大多数患者，尿中带血是膀胱癌症状的第一个警示。但是很多病人没有来MD安德森癌症中心，知道他们癌症已经到了晚期阶段，膀胱癌已经扩散。Arlene Siefker-Radtke博士—泌尿生殖器内科肿瘤学副教授说，这意味着治疗会更加的困难。 在此Siefker-Radtke博士希望膀胱癌患者和护理人员知道一些知识，使得他们能够得到最好的治疗，增加他们打败这种疾病的机会。 什么因素使得人们更容易患上膀胱癌? 烟草的使用对于膀胱癌是最大的危险因素之一。包括吸烟和其他种类的烟草使用，包括鼻吸，浸泡，咀嚼。 化学制品暴露也能增加罹患膀胱癌的风险。工作在大量化学物质的人群同样容易发展成膀胱癌。 慢性泌尿道感染和肾结石也会增加你患膀胱癌的风险。 最常见的膀胱癌症状有哪些? 最常见的膀胱癌症状是尿中带血。 其他膀胱癌症状包括尿频或者排尿时疼痛。 虽然其他的疾病—例如：前列腺肥大，尿道感染或肾结石—也会导致相似的症状。马上去就诊泌尿科医生非常重要，如果你确实得了膀胱癌，你能够得到正确的诊断并马上开始正确的治疗。 膀胱癌特有的确诊手段都有那些? 当泌尿科医生通过膀胱镜在膀胱中发现异常病变时，可以作为膀胱癌典型的确诊标准。 许多患者的病变非常小，也很容易切除，低恶性程度的肿瘤和肉赘或者结肠息肉相比。 但是少数的膀胱癌患者有更具有侵犯性的肿瘤，这些肿瘤会快速地侵入和扩散到其他地方，需要更加积极的治疗方案。 典型的膀胱癌治疗选择有哪些? 经尿道德切除术，外科手术切除肿瘤是标准的膀胱癌治疗方案，但是许多病人也需要其他种类的治疗。 具有表层肿瘤的病人能够通过外科手术和膀胱内治疗—医生通过病人尿道插入一根管，逐步灌注化疗药物通过该管道进入病人体内。化学治疗药物通过导管直接灌注进入膀胱。 病人如果所患肿瘤类型是更加具有侵犯性（复发可能性大，高恶性程度，或者侵犯肌层）肿瘤，通常需要进行膀胱全切除术。 MD安德森癌症中心在开研的最具前景的新的膀胱癌研究项目是什么? 我们区别那些风险较高在外科手术前确定必须进行化疗患者和那些不需要进行化疗的患者。这是非常重要的，因为化疗可以产生许多的副作用，对心脏，神经，听觉和肾脏都会产生不良影响。化疗可能不会使每个病人受益，所以我们必须确定哪些是必须给予化学治疗的患者。其他医院不能够真正做到这个，因为它需要一个团队的泌尿外科肿瘤学家以及紧密合作为识别大多数侵犯性的癌症的影响因素的专家。 我们也致力于免疫疗法，免疫疗法旨在激活病人的免疫系统以帮助抗击癌症。一些研究用免疫疗法增进了病人对于化学治疗的响应，防止膀胱癌进展过快。另一项工作包含发展蛋白酶体抑制剂与化疗联用，特别是对于那些不能忍受化学治疗药物顺铂的病人。它使得化疗更加有效。我有一些病人一直在使用该药，并且一直有效。 我们也有许多临床试验，这些临床试验显示基因治疗可以治疗癌症并杀死肿瘤细胞。 一名刚刚被诊断为膀胱癌的患者应该向他/她的医生提什么样的问题？ 第一，弄清楚你的肿瘤是恶性的还是良性的，是表面上的还是侵入肌膜的，因为这将会影响你的膀胱癌的治疗。 如果是恶性的，你需要摘除你的膀胱，想肿瘤学家询问，你是否需要术前化疗。在MD安德森癌症中心，我们有多学科的临床会诊，肿瘤学家将和泌尿科医生一起决定什么时候病人需要进行化学治疗。 如果你需要化疗，也请问你的医生，是否你是一个适用顺铂（至今最有效膀胱癌药物）的人。 Any other advice for对于刚刚被诊断为膀胱癌的患者其他一些建议? 去想MD安德森这样的多学科癌症中心，你得到包括内科肿瘤学家，外科肿瘤学家，放疗科肿瘤学家一起密切合作已找到治疗你膀胱癌和肿瘤的最佳方法。以便你能够利用最新的膀胱癌治疗研究成果和临床试验。 马上去做，你的第一个治疗方案对你的癌症治疗影响最大。所以，你要尽早获得一个第二医学意见，而不是等癌症扩散到无法治疗的地步。 预约MD安德森泌尿生殖中心会诊，请致电：400-666-7998或者登录http://www./ 本文来源于美国MD安德森癌症中心官方网站，作者：美国MD安德森癌症中心Laura Nathan-Garner.，由全球肿瘤医生—环宇达康医疗编译，转载必须注明出处！未注明出处转载，全球肿瘤医生—环宇达康医疗保留追究法律责任的权利！ 全文内容：关于膀胱癌需要了解的，MD安德森这种顶级医院中多学科会诊对于癌症治疗的重要性，尽早获得第二医学意见的重要性。 英文原始网址：http://www2./cancerwise/2014/08/-what-you-should-know-about-bladder-cancer.html 英文原文：What you should know about bladder cancer ByLaura Nathan-Garner This year, nearly 75,000 people will be diagnosed withbladder cancer, according to the American Cancer Society. The vast majority of people diagnosed with this disease are white men over age 55, but bladder cancer can -- and does -- affect men and women of all ages and races. For many, blood in the urine will be the first tell-tale bladder cancer symptom. But many patients don't come to MD Anderson until their disease is late-stage and the bladder cancer has spread. And that, says,Arlene Siefker-Radtke, M.D., associate professor in Genitourinary Medical Oncology, can make it harder to treat. Here's what Dr.Siefker-Radtkewants bladder cancer patients and caregivers to know so they can get the best treatment possible and boost their chances of beating this disease. What factors make someone more likely to develop bladder cancer? Tobacco useis one of the biggest risk factors for bladder cancer. That includessmoking, as well as every other kind of tobacco use, including snuff, dip and chew. Chemical exposure also can increase a person's risk of bladder cancer. People who work around a lot of chemicals are more likely to develop bladder cancer. Chronic urinary tract infections and kidney stones also can put you at increased risk for bladder cancer. What are the most common bladder cancer symptoms? The most common bladder cancer symptom is blood in the urine. Other bladder cancer symptoms may include needing to urinate more frequently or experiencing pain while urinating. Although other conditions -- such as an enlarged prostate, urinary tract infections or kidney stones -- can cause similar symptoms, it's important to see an urologist immediately so you can get the correct diagnosis and start treatment right away if you do in fact have bladder cancer. How is bladder cancer typically diagnosed? Bladder cancer is typically diagnosed when the urologist looks inside the bladder by doing a cystoscopy and sees an abnormality. For many patients it's a small, easily removed, low-grade tumor that could be compared to a wart or colon polyp. But a small number of bladder cancer patients have a more aggressive tumor, which can invade and spread more rapidly to other areas, requiring more aggressive treatment. What are the typical bladder cancer treatment options? Transurethral resection, surgery to remove the tumor, is the standard bladder cancer treatment, but many patients also need another type of treatment as well. Patients with superficial tumors can be treated with surgery and intravesical therapy, where doctors inserts a tube across the urethra and instill the chemo across the tube through the patient's urine. Chemotherapy is instilled directly into bladder with a catheter. Patients who have more aggressive (either recurrent high-grade or muscle-invasive) tumors typically need to have the bladder completely removed. What is some of the most promising new bladder cancer research being conducted here at MD Anderson? We identify patients at highest risk who definitely need chemo before surgery and those who don't need chemo. This is important because chemo can have adverse side-effects and be hard on the heart, nerves, hearing, and kidneys. It may not help everyone, so we want to make sure we're only giving chemo to patients who really need it.Other hospitals can't really do this because it requires a team of urologists, oncologists and others who work closely together to identify the factors contributing to the most aggressive cancers. We've also been focusing onimmunotherapy,which activates the patient's immune system to help fight the cancer. Several studies use immunotherapy to improve patients' responses to chemo to keep the bladder cancer from progressing as quickly. Additional work includes developing proteasome inhibitors in combination with chemo, especially for patients who can't tolerate the chemotherapy drug cisplatin. It appears to make the chemo more effective. I've had some patients who've had longer-lasting responses. We've also done a clinic trial that's showed that gene therapy can get to the cancer and kill tumor cells. What questions should a newly diagnosed bladder cancer patient ask his or her doctor? First, find out if your tumor is high-grade or low-grade, superficial or muscle-invasive because that will affect your bladder cancer treatment. If it's high-grade and you need to have your bladder removed, ask to speak to an oncologist to see if you need chemo before surgery. Here at MD Anderson, we have a multidisciplinary clinic where oncologists work with urologists to determine when a patient needs chemo. If you need chemo, also ask your doctor if you're a candidate for cisplatin, the most successful bladder cancer chemo drug to date. Any other advice for someone who's just been diagnosed with bladder cancer? Go to a multidisciplinary cancer center like MD Anderson, so you have a team of medical,\ surgical and radiation oncologists working closely together to develop the best bladder cancer treatment for you and your tumor, and so that you can take advantage of the latest bladder cancer research and clinical trials. And, don't wait to do that. What you do first in terms of treatment makes the biggest impact in your cancer. So go get a second opinion early, rather than when the cancer has spread and may no longer be treatable. |
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