Other clinical manifestations of bladder cancer include urinary disturbances and abdominal pain. However, data from Europe in 2013 showed that when women present to the hospital with this complaint they are more likely to be treated empirically without further diagnosis (women: men 47%:19%). This means that it is more difficult for women to be diagnosed through repeated consultations over time with constant testing and treatment of urinary tract infections.
Why is this important?
While differences in tumor biology such as gender, bladder anatomy, environment, and hormone exposure are strongly associated with prognosis, there is also evidence that timely diagnosis is closely related to prognosis.
A prospective study of 1537 bladder cancers from the UK showed that delayed diagnosis after presentation of associated symptoms or at GP referral increased the incidence of muscle-infiltrating carcinoma by 5% (staging pT2-4). In contrast, the five-year survival rate for women showed a significant decrease after the presentation of myxoid invasive carcinoma.
Although the report did not distinguish between patient delays and GP delays, prolonged delays (less than 14 days: more than 14 days) would result in a higher risk of death and a lower five-year survival rate. Delays caused by patients in the referral process lead to more disease progression and a worse prognosis.
How is it diagnosed?
1. Clinical features The UK National Postgraduate Health Service strongly recommends that the following people are referred to a urologist as soon as possible: those without a urinary tract infection but with visual haematuria; those older than 40 years with recurrent or persistent urinary tract infections; those older than 50 years with unexplained microscopic haematuria; those found to have an abdominal mass originating from the bladder; those younger than 50 years with unexplained microscopic haematuria without an increase in blood creatinine or urine protein (excluding nephritis).
Most primary care hospitals have now begun to focus on hematuria, although there are other clinical signs associated with bladder and urethral cancers based on past medical records. Most patients with bladder cancer present with simple painless hematuria or hematuria in combination with other clinical symptoms.
(1) Haematuria A case-control study in the UK showed that painless carnal haematuria was the strongest predictor of bladder cancer in primary care. National Audit Office data show that 2/3 of patients present to primary care with haematuria as their chief complaint, although secondary care data show that 90% of patients actually referred have haematuria (the degree of haematuria does not correlate with disease severity) and 25% of these are eventually found to have migratory cell carcinoma of the bladder.
(2) Other specific symptoms The above case-control study also showed that some symptoms such as painful urination, abdominal pain, and constipation, and urinary tract infections are also associated with bladder cancer, but their predictive value is much lower than that of hematuria. Patients with progressive bladder cancer often present with pelvic pain or urethral obstruction, but these patients usually have a visible abdominal mass. Importantly, persistent recurrence of these symptoms increases the risk of tumor.
2. Tests and labs (1) Laboratory urinalysis can accurately detect hematuria, proteinuria, nitrite or leukocyte esterase values, followed by microscopy and culture to clarify the infection. Although elevated leukocytes, CRP and blood creatinine are associated with bladder cancer, one of them alone cannot be used as a basis for the diagnosis of bladder cancer. Urine cytology is mainly used for the follow-up of patients with carcinoma in situ, not for the diagnosis of tumor. No effective test for bladder cancer has been reported in primary hospitals, but given that the sensitivity of the test in secondary hospitals is only 38%, it is certainly even lower in primary hospitals.
(2) Test cystoscopy is currently the predominant modality for the diagnosis of bladder cancer. He can allow the physician to visualize the inside of the bladder and remove tissue for biopsy. However, it is not yet possible to use cystoscopy for treatment. Color Doppler ultrasound of the renal tract makes it difficult to determine bladder and kidney cancer. Staging of patients with bladder cancer can be achieved with CT and ECT, and in addition, Pet-CT is being used more and more in the clinic.
How is it treated?
Initial treatment depends on the stage of the disease. Early stage tumors are often treated with transurethral resection of the bladder tumor. If the stage is early, routine cystoscopy review is sufficient; if there is a risk of recurrence or poor tumor type, bladder chemotherapy or immunotherapy will be required. For intermediate to advanced bladder cancer, neoadjuvant chemotherapy followed by cystectomy or radical radiotherapy may be indicated as appropriate.