Clinically, bladder urothelial carcinoma has three manifestations: non-invasive, invasive and metastatic. Tumors of non-invasive bladder urothelial carcinoma are limited to the bladder epithelium and lamina propria. It includes epithelial carcinoma in situ and non-invasive tumors. The first choice for treatment is transurethral bladder tumors by electrocautery, electrosurgical resection, and laser removal. Tumor, according to the degree of risk of the tumor to decide whether to further treatment to reduce recurrence and delay tumor progression. The main factors affecting the recurrence of non-invasive bladder urothelial carcinoma are the number of tumors at diagnosis, recurrence within 3 months after treatment, the size of the tumor, the grade of cancer cells, and whether it is combined with carcinoma in situ. According to the main factors affecting recurrence, the risk of non-invasive bladder urothelial carcinoma is divided into three degrees: 1) Low-risk tumors: single, Ta, G1 (low-grade urothelial carcinoma), tumor diameter ≤3cm. 2) Intermediate-risk tumors: Ta-1, G1-2 (low-grade urothelial carcinoma-high-grade urothelial carcinoma) tumor diameter> 3cm, multiple. 3) High-risk tumors: T1, G3 (high-grade urothelial carcinoma), multiple, recurrence in the short term after treatment, carcinoma in situ. Note: There are also low-grade urothelial cancers in the classification standard, or G2 and G3 are collectively called high-grade urothelial cancers. Transurethral resection of bladder tumor (TUR-BT) is the preferred treatment for non-invasive bladder urothelial carcinoma. Indications for TUR-BT surgery: 1) Low-grade malignant potential urothelial papilloma or low-grade urothelial carcinoma, single or multiple non-invasive bladder urothelial carcinoma (including bladder papilloma, inverted papillary) Tumors). 2) Unpedicled tumors are mostly classified as high-grade urothelial carcinoma or invasive urothelial carcinoma. Most of them are not suitable for TUR-BT treatment alone, but papillary, well-differentiated, and isolated tumor bases with a diameter of less than 2 cm Patients with stage T2a tumors are the relative indications for TUR-BT. 3) Invasive bladder cancer, can not tolerate the palliative treatment of patients undergoing total cystectomy to resolve symptoms such as hematuria and dysuria.
Bladder epithelial dysplasia is the precursor of carcinoma in situ or invasive bladder cancer. It is a microscopic change of cell morphology, which is different from normal cell morphology, but does not have the characteristics of cancer cells. However, bladder epithelial dysplasia is common in patients with carcinoma in situ or invasive cancer. 50% of bladder cancer patients have bladder epithelial dysplasia, and there are more men than women. Although bladder epithelial dysplasia is not cancer, not even precancerous lesions, it is a criterion for urothelial “instability”, which may continue to develop into cancer. Bladder epithelial dysplasia does not require special intervention, but it is an indicator of the risk of bladder cancer. Current research has found that bladder epithelial dysplasia is not dangerous, and it represents an intermediate state that is neither normal nor cancerous. About 1/3 of patients with simple bladder epithelial dysplasia will have urinary irritation, 1/3 will have hematuria, and the other 1/3 will have no symptoms. Some patients will have abnormal urine exfoliative cytology results. Only about 20% of patients with bladder epithelial dysplasia will develop into carcinoma in situ or invasive carcinoma.
. . . .Wheel lobular carcinoma in situ is eliminated from breast cancer People will be associated with malignant tumors, but breast lobular carcinoma in situ not only does not require the radiotherapy, chemotherapy and other treatments often needed for malignant tumors, even for the classic lobular carcinoma in situ, it does not even require surgery and can be followed up for a long time. No trace of lobular carcinoma in situ can be found in the 2020 NCCN breast cancer diagnosis and treatment guidelines. Why is lobular carcinoma in situ removed from breast cancer and classified as a precancerous lesion, and the treatment measures are very mild? This starts with the characteristics of lobular carcinoma in situ. 1. Lobular carcinoma in situ progresses slowly and the canceration interval is long. Although ductal carcinoma in situ and lobular carcinoma in situ are both carcinoma in situ, the risk of ductal carcinoma in situ developing into invasive cancer is as high as 20% to 50% if not treated within 10 years. Correspondingly, lobular carcinoma in situ develops into invasive carcinoma for a much longer period, usually 15 to 30 years. A 24-year follow-up showed that the probability of lobular carcinoma in situ eventually developing into invasive carcinoma was within 18%, which was significantly lower than that of patients with ductal carcinoma in situ. Therefore, the risk of lobular carcinoma in situ in a single lesion is not great. The reason for the high risk of lobular carcinoma in situ is the second characteristic of lobular carcinoma in situ. Two, lobular carcinoma in situ often occurs in both breasts, and multifocal studies show that about 50% of lobular carcinoma in situ manifest as Focal, 30%-60% of patients are accompanied by carcinoma of the lobe of the contralateral breast in situ. The incidence of breast cancer in patients with lobular carcinoma in situ is 8 to 11 times higher than that of the general population. The probability of developing invasive cancer 15 to 20 years after diagnosis is 26%. It is generally believed that the risk of lobular carcinoma in situ becoming invasive cancer increases by about 1-2% each year. And the ratio of breasts is the same. Because of the characteristics of lobular carcinoma in situ that can occur in both breasts and multiple lesions, the incidence of breast invasive cancer 10 years after the removal of lobular carcinoma in situ is still much higher than that of ordinary people. These invasive carcinomas do not necessarily occur at the site of resection of the original lesion, but can occur at any site on the affected side or the opposite side. For these reasons, compared with ductal carcinoma in situ, lobular carcinoma in situ is currently considered to be a risk factor for infiltrating breast cancer, rather than precancerous lesions. According to the characteristic that the lesion is bilateral and multiple, all treatment and prevention strategies should be based on bilateral, such as prophylactic double mastectomy, not local radiotherapy. I’ll talk about this next time.