Das Harnblasenkarzinom: Epidemiologie, Pathogenese, Früherkennung
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Erhebliche Fortschritte in der transurethralen OP-Technik des Hambla- senkarzinoms bzw. die daraus resultierende klare Indikationsstellung zur Zystektomie haben in der Behandlung dieses Tumors verbesserte Bedin- gungen geschaffen. So kann bei niedriger T-Kategorie des Hamblasenkar- zinoms dem Patienten Aussicht auf Heilung bei Erhaltung der Hamblase in Aussicht gestellt werden. Bedingung daftir ist jedoch die konsequente Anwendung einer tumoradaptierten Resektionsstrategie, die exakte Aussa- gen zur Ausbreitung und Tiefeninfiltration liefert. Hinzu kommt die Infor- mation uber den Malignitatsgrad. Wenn somit durch verbesserte Opera- tionsmethoden bzw. pathologisch-anatomische Auswertung in den fruhen Tumorstadien TA bzw. Tl die Uberlebensraten bei 80-90% liegen, so wird verstandlich, daB die urologische Onkologie mit groBtem Nachdruck Pro- bleme der Fruherkennung, der Epidemiologie und der Karzinogenese an- geht. Festzuhalten ist hierbei, daB Erkenntnisse zur Karzinogenese des Hamblasenkarzinoms immerhin groBer sind als bei einer Reihe anderer bosartiger Tumoren des menschlichen Korpers. Eine von uns in Tubingen initiierte Arbeitstagung von Arbeitsmedizinem, Pathologen, Statistikem, Onkologen und Urologen hat versucht, den derzeitigen Stand dieses Wis- sensgebietes aufzuzeigen. Die wichtigsten Beitrage hieraus werden in die- sem Buch vorgestellt. Auffallig sind erhebliche Unterschiede in den Sterblichkeitsraten des Hamblasenkarzinomes beim Vergleich auf intemationaler Ebene. Sie sind am hochsten in GroBbritannien und am niedrigsten in den asiatischen Lan- demo Man beobachtet femerhin Unterschiede in der Haufigkeit des Auf- tretens dieses Karzinoms zwischen Frauen und Mannem. Die hohere Rate bei Mannem wird Z. T. durch berufsbedingte Kontakte mit Karzinogenen und durch Rauchergewohnheiten erklart.
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