The author of this article: Han Hui 丨 Chief Physician of The Department of Urology, Affiliated Cancer Hospital of Sun Yat-sen University
Lao Wang, who is in his 50s, is the boss of a clothing company, at the peak of his career, and the company is well-known in the Guangdong industry. Lao Wang not only has a prosperous career, but also a happy and harmonious family, both daughters have settled in the United States, and his wife and himself jointly manage the company's operations.
Although both daughters are not around, the enrichment of his career dilutes his dependence on the family, Lao Wang feels very satisfied with his life, recalling that when he was young, he went from a remote rural area to the city to work hard, and his life is a realistic history of struggle.
The schedule was full of 300 days a year, 365 days a year, and his wife asked him to go to the physical examination for three years, and he kept delaying it again and again on the grounds of busyness. I thought: When I was in my twenties and thirties, I slept at one o'clock every day, got up at four o'clock, got up early and did business in the dark, and there was no illness in my body, and now there is no problem!
Early diagnosis of early bladder cancer, the prognosis is good
At the end of 2008, he finally couldn't resist his wife's advice, was "kidnapped" by his wife to the physical examination center, walked out of the door of the physical examination center, and both legs were weak: B ultrasound found out the solid position in the bladder, and bladder cancer may be possible!
Lao Wang began to regret it, devoted himself to his career, and ignored the physical examination.
After being introduced by a friend, Lao Wang came to the Cancer Hospital of Sun Yat-sen University to undergo bladder tumor electroresection, and during the hospitalization, he asked the doctor restlessly: How long can I live after this operation? The doctor answered: To see the pathological results of the operation, if it is an early low-grade tumor that does not infiltrate the muscle layer, as long as it is regularly reviewed, the prognosis is generally better.
3 days after discharge, the pathological results came out: low-grade non-invasive urinary intestinal carcinoma, pathological stage of pT1N0M0, belongs to early bladder cancer.
Lao Wang breathed a sigh of relief: The stone in his heart fell to the ground, and the doctor said that as long as the early bladder cancer has a better prognosis as long as it is regularly reviewed, then I can review it regularly. So he took the doctor's advice and came every three months to review it.
Repeated recurrence 13 times, refusal of total bladder removal!
At the end of 2009, Lao Wang's re-examination of the cystoscopy found that the tumor had recurred, and he was admitted to the hospital for another electroresection, and the postoperative pathology was still a low-grade non-invasive tumor. Less than a year later, the tumor recurred and was operated on again.
Lao Wang thought to himself: This disease is repeated and repeated, it is really torturous, fortunately, each time the result is early, and it is a big deal to relapse and then do a second electric cut.
Between 2009 and 2016 alone, Lao Wang's bladder cancer recurred 13 times! During this period, the doctor said to Lao Wang: Lao Wang, your tumor has recurred so many times, I suggest you consider removing the bladder and doing a radical resection, so that you can achieve the best curative effect, and second, you will not always recur and do so many surgeries.
Lao Wang refused every time: I am the boss of the company, I am the top pillar, what is the matter with a urine bag all day? It damages my personal and corporate image, and I'd rather do it thirty times than cut my bladder!
The tumor progresses and the best opportunity to treat is missed
The recurrence in 2016, the pathological result is no longer a low-grade tumor, the medical record list reads: high-grade non-invasive urinary intestinal carcinoma.
The doctor once again suggested that Lao Wang cut the bladder: the possibility of high-grade tumor infiltrating the muscle layer is far greater than that of the low level, if you do not cut it at this time, wait until the infiltrated muscle layer, or even metastasize it is too late!
Lao Wang still refused, and his wife was so anxious that tears came out, but she also knew that this person around her had been this temper all her life.
In 2017, Lao Wang found a recurrence again, he was used to it, smiled and said to his wife: You can go to the hospital for a few days off again.
But the pathological results of the surgery made him laugh again: high-grade urinary urothelial cancer, infiltrating the muscle layer. CT results also show pelvic lymphadenopathy, most likely the tumor has metastasized to the lymph nodes.
Annoyed, looking back, the road was not remorseful
Lao Wang lost the best opportunity for surgery, and after a combination of surgery and chemotherapy, his body is still deteriorating, and the company is also left to others to take care of.
Sometimes when he sits alone, he thinks, what is he really for in this life? The children are not around, the company is not inherited, and I am gone. Whenever he thought about it, he would always regret it, what would happen if he had cut his bladder early? What if you bring a urine bag? I have entered the flower armor for many years, I am no longer young, what is so unseemly?
Revelation -
1 Early low-risk, secondary electrocution
Early bladder cancer like Lao Wang has recurred many times, low-grade transitional epithelial cancer can be closely observed (mainly regular cystoscopy), and recurrence during the observation period can be minimally invasive surgery again.
2 Repeated recurrence is high risk, and it is advisable to cut it completely
However, multiple recurrences may be high-risk non-muscular infiltrative bladder cancer or transformed into high-grade urinary urothelial cancer, which is very easy to metastasize to other organs in the body, and if radical bladder cancer resection is performed immediately, the survival rate of 5 years after surgery can reach 80%.
Once the muscle layer is infiltrated and even transferred to the lymph nodes, even if radical resection is received, the 5-year survival rate drops to 25% to 30%.
What a simple mathematical problem, but unfortunately many patients, like Lao Wang, have repeatedly hesitated and missed the best time for treatment.
3 Carefully consider the doctor's recommendations and treat with caution
As a doctor, all you can do is to inform the patient's condition and scientific diagnosis and treatment plan in as much detail as possible.
Patients need to find the right specialist for their own condition, and work with experts to calmly and objectively analyze their own condition, follow expert advice, and make decisions that are responsible for themselves and their families.
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