作者：Laura Nathan-Garner

　　這一年有近7萬5千人將被診斷為膀胱癌，根據(jù)美國癌癥協(xié)會(huì)統(tǒng)計(jì)。絕大多數(shù)人被診斷出這種疾病的人是55歲以上的白人，但是膀胱癌的發(fā)病不限男女，不分種族和年齡。

　　對(duì)于大多數(shù)患者，尿中帶血是膀胱癌癥狀的第一個(gè)警示。但是很多病人沒有來MD安德森癌癥中心，知道他們癌癥已經(jīng)到了晚期階段，膀胱癌已經(jīng)擴(kuò)散。Arlene Siefker-Radtke博士—泌尿生殖器內(nèi)科腫瘤學(xué)副教授說，這意味著治療會(huì)更加的困難。

　　在此Siefker-Radtke博士希望膀胱癌患者和護(hù)理人員知道一些知識(shí)，使得他們能夠得到最好的治療，增加他們打敗這種疾病的機(jī)會(huì)。

　　什么因素使得人們更容易患上膀胱癌?

　　煙草的使用對(duì)于膀胱癌是最大的危險(xiǎn)因素之一。包括吸煙和其他種類的煙草使用，包括鼻吸，浸泡，咀嚼。

　　化學(xué)制品暴露也能增加罹患膀胱癌的風(fēng)險(xiǎn)。工作在大量化學(xué)物質(zhì)的人群同樣容易發(fā)展成膀胱癌。

　　慢性泌尿道感染和腎結(jié)石也會(huì)增加你患膀胱癌的風(fēng)險(xiǎn)。

　　最常見的膀胱癌癥狀有哪些?

　　最常見的膀胱癌癥狀是尿中帶血。

　　其他膀胱癌癥狀包括尿頻或者排尿時(shí)疼痛。

　　雖然其他的疾病—例如：前列腺肥大，尿道感染或腎結(jié)石—也會(huì)導(dǎo)致相似的癥狀。馬上去就診泌尿科醫(yī)生非常重要，如果你確實(shí)得了膀胱癌，你能夠得到正確的診斷并馬上開始正確的治療。

　　膀胱癌特有的確診手段都有那些?

　　當(dāng)泌尿科醫(yī)生通過膀胱鏡在膀胱中發(fā)現(xiàn)異常病變時(shí)，可以作為膀胱癌典型的確診標(biāo)準(zhǔn)。

　　許多患者的病變非常小，也很容易切除，低惡性程度的腫瘤和肉贅或者結(jié)腸息肉相比。

　　但是少數(shù)的膀胱癌患者有更具有侵犯性的腫瘤，這些腫瘤會(huì)快速地侵入和擴(kuò)散到其他地方，需要更加積極的治療方案。

　　典型的膀胱癌治療選擇有哪些?

　　經(jīng)尿道德切除術(shù)，外科手術(shù)切除腫瘤是標(biāo)準(zhǔn)的膀胱癌治療方案，但是許多病人也需要其他種類的治療。

　　具有表層腫瘤的病人能夠通過外科手術(shù)和膀胱內(nèi)治療—醫(yī)生通過病人尿道插入一根管，逐步灌注化療藥物通過該管道進(jìn)入病人體內(nèi)?；瘜W(xué)治療藥物通過導(dǎo)管直接灌注進(jìn)入膀胱。

　　病人如果所患腫瘤類型是更加具有侵犯性（復(fù)發(fā)可能性大，高惡性程度，或者侵犯肌層）腫瘤，通常需要進(jìn)行膀胱全切除術(shù)。

　　MD安德森癌癥中心在開研的最具前景的新的膀胱癌研究項(xiàng)目是什么?

　　我們區(qū)別那些風(fēng)險(xiǎn)較高在外科手術(shù)前確定必須進(jìn)行化療患者和那些不需要進(jìn)行化療的患者。這是非常重要的，因?yàn)榛熆梢援a(chǎn)生許多的副作用，對(duì)心臟，神經(jīng)，聽覺和腎臟都會(huì)產(chǎn)生不良影響?；熆赡懿粫?huì)使每個(gè)病人受益，所以我們必須確定哪些是必須給予化學(xué)治療的患者。其他醫(yī)院不能夠真正做到這個(gè)，因?yàn)樗枰粋€(gè)團(tuán)隊(duì)的泌尿外科腫瘤學(xué)家以及緊密合作為識(shí)別大多數(shù)侵犯性的癌癥的影響因素的專家。

　　我們也致力于免疫療法，免疫療法旨在激活病人的免疫系統(tǒng)以幫助抗擊癌癥。一些研究用免疫療法增進(jìn)了病人對(duì)于化學(xué)治療的響應(yīng)，防止膀胱癌進(jìn)展過快。另一項(xiàng)工作包含發(fā)展蛋白酶體抑制劑與化療聯(lián)用，特別是對(duì)于那些不能忍受化學(xué)治療藥物順鉑的病人。它使得化療更加有效。我有一些病人一直在使用該藥，并且一直有效。

　　我們也有許多臨床試驗(yàn)，這些臨床試驗(yàn)顯示基因治療可以治療癌癥并殺死腫瘤細(xì)胞。

　　一名剛剛被診斷為膀胱癌的患者應(yīng)該向他/她的醫(yī)生提什么樣的問題？

　　第一，弄清楚你的腫瘤是惡性的還是良性的，是表面上的還是侵入肌膜的，因?yàn)檫@將會(huì)影響你的膀胱癌的治療。

　　如果是惡性的，你需要摘除你的膀胱，想腫瘤學(xué)家詢問，你是否需要術(shù)前化療。在MD安德森癌癥中心，我們有多學(xué)科的臨床會(huì)診，腫瘤學(xué)家將和泌尿科醫(yī)生一起決定什么時(shí)候病人需要進(jìn)行化學(xué)治療。

　　如果你需要化療，也請(qǐng)問你的醫(yī)生，是否你是一個(gè)適用順鉑（至今最有效膀胱癌藥物）的人。

　　Any other advice for對(duì)于剛剛被診斷為膀胱癌的患者其他一些建議?

　　去想MD安德森這樣的多學(xué)科癌癥中心，你得到包括內(nèi)科腫瘤學(xué)家，外科腫瘤學(xué)家，放療科腫瘤學(xué)家一起密切合作已找到治療你膀胱癌和腫瘤的最佳方法。以便你能夠利用最新的膀胱癌治療研究成果和臨床試驗(yàn)。

　　馬上去做，你的第一個(gè)治療方案對(duì)你的癌癥治療影響最大。所以，你要盡早獲得一個(gè)第二醫(yī)學(xué)意見，而不是等癌癥擴(kuò)散到無法治療的地步。

　　預(yù)約MD安德森泌尿生殖中心會(huì)診，請(qǐng)致電：400-666-7998或者登錄http://www./

　　本文來源于美國MD安德森癌癥中心官方網(wǎng)站，作者：美國MD安德森癌癥中心Laura Nathan-Garner.，由全球腫瘤醫(yī)生—環(huán)宇達(dá)康醫(yī)療編譯，轉(zhuǎn)載必須注明出處！未注明出處轉(zhuǎn)載，全球腫瘤醫(yī)生—環(huán)宇達(dá)康醫(yī)療保留追究法律責(zé)任的權(quán)利！

　　全文內(nèi)容：關(guān)于膀胱癌需要了解的，MD安德森這種頂級(jí)醫(yī)院中多學(xué)科會(huì)診對(duì)于癌癥治療的重要性，盡早獲得第二醫(yī)學(xué)意見的重要性。

　　英文原始網(wǎng)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.