Department of Medicine, Section of Medical Oncology, Baylor College of Medicine, Houston, TX, USA.
Postgrad Med. 2011 May;123(3):43-55. doi: 10.3810/pgm.2011.05.2283.
Bladder carcinoma is the fourth most common cancer in men and the ninth most common cancer in women in the United States. In 2010, approximately 70,000 new cases of bladder carcinoma (52,000 in men and 18000 in women) and approximately 14000 deaths were expected in the United States. More than 90% of bladder carcinomas are classified as urothelial carcinoma (UC), which arise from the urothelium. This epithelium, also known as transitional cell epithelium, lines the urinary tract, which extends from the renal pelvis through the ureters, bladder, and urethra. Urothelial carcinoma of the bladder may present as a non-muscle-invasive, muscle-invasive, or metastatic malignancy. In noninvasive tumors, treatment by cystoscopic resection and intravesical therapy is directed at reducing recurrences and preventing progression to a more advanced stage. The goal in invasive tumors is a combination of radical cystectomy and perioperative cisplatin-based combination chemotherapy to enhance outcomes by reducing the high risk of distant recurrences. Outcomes in metastatic UC are dismal with current cisplatin-based combination chemotherapy, and progressive disease after frontline chemotherapy is characterized by a short survival. Therefore, clinical trials should be the focus for metastatic UC. It is important for primary care physicians to recognize the early signs and symptoms of bladder carcinoma, initiate the proper work-up, and refer promptly to a urologist to evaluate suspicious signs and symptoms.
膀胱癌是美国男性中第四大常见癌症，女性中第九大常见癌症。2010 年，预计美国将有大约 70000 例膀胱癌新病例（男性 52000 例，女性 18000 例）和大约 14000 例死亡病例。超过 90%的膀胱癌被归类为尿路上皮癌（UC），它起源于尿路上皮。这种上皮组织，也称为移行细胞上皮，覆盖着泌尿道，从肾盂延伸到输尿管、膀胱和尿道。膀胱尿路上皮癌可表现为非肌肉浸润性、肌肉浸润性或转移性恶性肿瘤。在非浸润性肿瘤中，通过膀胱镜切除和膀胱内治疗来治疗，旨在减少复发并防止进展为更高级别。侵袭性肿瘤的目标是结合根治性膀胱切除术和围手术期顺铂为基础的联合化疗，通过降低远处复发的高风险来提高疗效。转移性 UC 的治疗结果较差，目前基于顺铂的联合化疗效果不佳，一线化疗后疾病进展的特点是生存期短。因此，临床试验应是转移性 UC 的重点。初级保健医生识别膀胱癌的早期体征和症状，进行适当的检查，并迅速转介给泌尿科医生评估可疑的体征和症状，这一点非常重要。
