Introduction
Bladder cancer is a kind of cancer that originates in the bladder mucosa, mainly in the bladder trigone, both sides of the wall, and the neck. Bladder transitional cell carcinoma accounts for more than 90% of all bladder cancers, whereas adenocarcinoma, squamous cell carcinoma, and leiomyosarcoma are rare. Bladder cancer is mainly exhibited as lymph node metastasis and local spread, and blood dissemination can be found at the advanced stage.
Painless gross hematuria is the most common symptom and it can appear in more than 80% of patients, 17% of which have severe hematuria, but there are 15% that may begin with only microscopic hematuria. Hematuria mostly occurs throughout the whole process with intermittent seizures and can also be manifested as initial hematuria or terminal hematuria. Urinary frequency, urgency, dysuria, and other irritation signs of the bladder can appear, and urinary tract obstruction, bladder pain, lower limb edema, and other symptoms may also occur in advanced patients. The common sites of distant metastases are liver, lung, and bone.
Treatments
1.Surgery
Bladder cancer treatment focuses on surgical excision. Surgical treatments are divided into transurethral resection of cancer, bladder incision to remove cancer, partial cystectomy, and radical cystectomy. An appropriate surgical approach is chosen according to pathology of the cancer, cancer location, and general condition of the patient. The standard treatment of early cancer is traditional surgery or endoscopic complete resection. Radical cystectomy and colonic bladder replacement can be carried out for cancers that are too big or too difficult for endoscopic resection or recurrent cancers.
2.Radiotherapy
Radiotherapy has been defined as an exact treatment of bladder transitional cell carcinoma or as adjuvant therapy after cystectomy. The main advantage of radiotherapy is that it may retain normal bladder function and sexual function. Furthermore, radiotherapy is also an option for patients who are not suitable for surgical treatment. For patients who select radiotherapy, it is possible to preserve the bladder by combining neoadjuvant chemotherapy and radiotherapy. The purpose of preoperative or postoperative radiotherapy is to prevent local recurrence.
3.Chemotherapy
Chemotherapy is most commonly used in treating metastatic bladder cancer, or locally advanced bladder cancer that cannot rely on surgical resection. Systemic chemotherapy can be applied as neoadjuvant chemotherapy for preoperative bladder cancer, postoperative adjuvant chemotherapy, and palliative chemotherapy for advanced metastatic bladder cancer. For early patients with a tendency toward formation of new lesions in the bladder, preventive or adjuvant intravesical chemotherapy can be applied. Perfusion drug options are bacillus Calmette-Guérin, interferon, sapylin, and Brucea Javanica oil, which are comparatively effective immune agents. For advanced bladder cancer patients with metastasis, systemic chemotherapy may be considered.
4.Hyperthermia
Hyperthermia combined with radiotherapy or chemotherapy has synergistic killing effect on cancer cells. Clinical application has shown that hyperthermia combined with radiation or chemotherapy may further improve efficacy. Heat therapies for bladder cancer are bladder irrigation with hot water, radiation diathermy by intrabladder microwave, surface diathermy by RF, and high-energy focused ultrasound method, in which the latter two are most commonly used.
5.Chelation Detoxification Therapy
Chelation detoxification therapy can improve immune function, has synergistic effect when combined with surgery and intravesical chemotherapy, and has great significance in the prevention of cancer recurrence and metastasis.
6.Medical Ozone Therapy
EBOO is preferred. Medical ozone saline can be used for rinsing the bladder after surgery and with intravesical chemotherapy, which not only can relieve frequent urination, dysuria, and other symptoms after perfusion but also has the effects of directly killing residual tumor cells, sterilization, and inhibition of tumor recurrence. At the same time, medical ozone gas acupoint injection can be implemented. The selection of points is the same as with acupuncture. For patients in poor physical conditions and with coagulation dysfunction, intravenous medical ozone saline or medical ozone major autohemotherapy can be used. At the same time, giving medical ozone saline to rinse bladder and medical ozone gas rectal insufflation have a good effect of controlling bleeding and infection and inhibiting further growth of cancer.
7.Traditional Chinese Medicine
The syndrome differentiation of early bladder cancer belongs to insufficiency of kidney qi, and the prescription recommended is modified ginseng and Clamshell Powder. For the syndrome of stagnation of qi due to depression of the liver, the prescription recommended is modified Chenxiang Powder. For the syndrome of deficiency of spleen qi, the prescription recommended is modified Buzhong Yiqi Decoction. For the syndrome of dampness invasion of lower energizer, the prescription recommended is modified Bazheng Powder. The syndrome differentiation of advanced bladder cancer belongs to deficiency of spleen and kidney. The prescriptions recommended are modified Siwu Decoction plus modified Zuogui Decoction. For the syndrome of internal heat due to yin deficiency, the prescription recommended is modified Zhibai Dihuang Decoction. For the syndrome of blood stasis obstructing in the interior, the prescription recommended is modified Taohong Siwu Decoction.
8 Acupuncture
The main syndrome of early bladder cancer is dampness invasion of lower energizer, and the therapeutic principle should focus on clearing heat and eliminating dampness as well as regulating the lower Jiao.
The main syndrome of medium-advanced bladder cancer is deficiency of both spleen and kidney. The therapeutic principle should focus on invigorating spleen for eliminating dampness, as well as regulating and reinforcing liver and kidneys.
9.Medicated Diet, Nutrition, and so on
Most patients at the early stage have acceptable general conditions, with no significant malnutrition and with normal diet, so it is recommended to give herbal diet therapy as the adjuvant treatment. Appropriately add trace elements and vitamins to improve immunity. For advanced bladder cancer patients with weight loss, poor eating or without eating, intestinal obstruction, and other symptoms, total parenteral nutrition therapy should be considered to enhance physical conditions and disease resistance.
10. Others
Guide early-stage patients to practice qigong, tai chi, and so on, as well as to conduct aerobic exercise with relatively mild exertion, combined with music, psychology, and other therapies to adjust the patients’ states of mind to improve the cure rate. For medium-advanced patients, qigong, music, sports, psychology, and other therapies can complement each other along with the aforementioned integrative treatments, which help to activate or enhance the patients’ own immune systems to monitor and inhibit cancer, stabilize state of mind, improve sleep, and improve survival quality.
Typical Case
A 31 year old male patient. 3 years ago, patient began to have intermittent gross hematuria, with the color of bloody liquid, about once per month, mostly after activities, and with total hematuria. Hematuria may disappear spontaneously, with no further dysuria and no lumbar or abdominal pain and discomfort. Patient came to Clifford Hospital to seek a second opinion on the diagnosis and treatment. Patient was in distress with flank distension and pain. Bladder CT examination showed a cauliflower-life mass of 4.2cm×3.2cm in the left rear wall of the bladder. No pelvic lymph node metastasis was found.
Diagnosis: Bladder transitional cell carcinoma of level 1 to 2.
Integrative treatment prescription: Integrative treatment involving micro-invasive surgery, chelation and detoxification therapy, medical ozone therapy, TCM was adopted after a case conference of a group of specialists. Surgical procedure involved transurethral resection of bladder tumor. Post operative pathology report indicated bladder transitional cell carcinoma of level 1 to 2. Total parenteralnutrition was given on day of surgery and for two consecutive days after surgery. The bladder was irrigated with medical ozone saline after surgery once daily for one week. Patient suffered from hematuria 3 days after surgery with poor sleep. Nutritious herbal cuisine was given to complement treatment. Recipe: Lotus seeds 50g, dried longan 30g; crystal sugar was added to mix paste. Rice added to cook porridge. Herbal cuisine was given before bedtime nightly to nourish kidney and heart, calm nerves and astringe for hemostasis. Alternating treatment of medical ozone saline, chelation and detoxification therapy were conducted once every other day. Hematuria disappeared after one week. Whole body hyperthermia combined with intravesical chemotherapy was conducted in the fifth week after surgery. Mitomycin 40mg each time was administered once a week for a total of 8 times. Whole body medium-high temperature hyperthermia was conducted at the first and the fifth time and local hyperthermia was carried out once every other day. Later, this was changed to whole body hyperthermia and intravesical chemotherapy once a month for a total of 12 times. Alternating treatment of EBOO and chelation and detoxification therapy were conducted continuously once every other day. Patient was prescribed Chinese herbal medicine one dose per day coordinating with herbal cuisine, medical Qigong and tai chi.
Treatment outcome: patient continued with outpatient treatment after two months of hospitalization. He received chelation and detoxification therapy and medical ozone therapy combining bladder chemohyperthermia. Patient remained in stable condition without hematuria. No abnormalities evident from regular cystoscopy. CT examination show no signs of recurrence and metastasis. One year later, patient returned every 3 months for 1 week of integrative treatment. Treatment options were whole body hyperthermia, chelation and detoxification therapy, medical ozone, TCM and acupuncture. Patient continued with Chinese medicine and herbal cuisine, moderate exercise and medical Qigong. His KPS score was 100.
