What is hematuria: As the name implies, hematuria is bright red with blood in the urine. In the eyes of the general public, hematuria is mainly visual hematuria, i.e., hematuria that can be directly distinguished by the eye. However, in the eyes of doctors, hematuria also includes microscopic hematuria, i.e., hematuria in which blood red cells can be seen under the microscope while the color of the urine is normal when observed with the naked eye. Usually, only when there is 1ml of blood per liter of urine can the urine color appear red to the naked eye. In addition to microscopic hematuria, which can be detected during a physical examination, the majority of patients are seen with no obvious cause for their visit with the naked eye.
Common causes of hematuria: In fact, there are many causes of hematuria, and the cause of most patients’ hematuria is not a tumor, so the sudden onset of hematuria does not need to cause special psychological pressure on oneself, and the causes of hematuria are roughly as follows
1, inflammation (acute and chronic glomerulonephritis, acute and chronic pyelonephritis, acute cystitis, urethritis, urinary tuberculosis, mycobacterial infection of the urinary system, etc.)
2, stones (stones in the renal pelvis, ureter, bladder, urethra, any part of the stone, when the stone moves through the urinary epithelium, it is easy to cause both hematuria and secondary infection.)
3, tumors (malignant tumors in any part of the urinary system or malignant tumors in adjacent organs invading the urinary tract can cause hematuria.)
4.Trauma (It refers to violence and injury to the urinary system.)
5.Congenital malformation and systemic diseases, etc.
Tumors causing hematuria and their treatment: Among the above diseases, the most serious consequences and easy to be missed are often urological tumors, and hematuria without other symptoms often comes from some early tumor lesions. If you or your family members suddenly find hematuria, especially painless whole body hematuria occurring in middle-aged and elderly groups, you should go to a regular hospital as early as possible. Laboratory test indicators such as FISH and NMP (early diagnostic indicators for early bladder cancer and uroepithelial cancer carried out in large hospitals) are also good indicators for tumors. Sometimes, through these examinations, some imaging suspicious lesions of bladder, ureter and renal pelvis will be found. Advanced endoluminal microscopy techniques such as cystoscopy, ureteroscopy and ureteral flexible microscopy can not only visualize the suspicious parts, but also biopsy some parts and observe the tissue structure under microscope, so as to achieve the purpose of preoperative diagnosis and further guide the treatment plan.
Below, two common urological tumors that are most likely to cause hematuria are briefly introduced.
The first culprit of hematuria – bladder tumor: hematuria caused by bladder cancer is usually red hematuria throughout the process of urination, with the following characteristics.
1. Painless: patients have no pain and other discomfort symptoms. However, if the cancer is necrotic, ulcerated and combined with infection, bladder irritation symptoms such as urinary frequency, urinary urgency and painful urination may appear.
2.Intermittent: that is, hematuria occurs intermittently, and the interval between two hematuria can be several days or months, or even half a year, which can easily give people the illusion that there is no more hematuria and fail to check in time. If you can catch the signal of painless hematuria and check it in time, you can achieve early detection, early treatment and better results. If, like some patients, the best time for treatment may be lost.
In addition to conventional imaging tests such as ultrasound and CT, urology has a unique “weapon” – cystoscopy. Cystoscopy is easy and quick to perform, just like the well-known gastroscopy, and can be performed under local anesthesia in an outpatient setting, or pain-free cystoscopy under general anesthesia in an inpatient setting. With such a weapon, the doctor can observe the size, location and growth of bladder tumors under direct vision, and can also use special “pliers” to take suspicious tissues for biopsy to confirm the diagnosis. In conclusion, cystoscopy is the best means to diagnose bladder tumors and can detect lesions that cannot be detected by ultrasound, CT and other imaging examinations.
Early bladder cancer can be treated by minimally invasive means to remove tumor tissues and achieve good therapeutic results, thus avoiding cystectomy and greatly improving the quality of life. Patients with hematuria should not avoid cystoscopy because of fear, which may lead to delay of the disease.
It should also be noted that in addition to uncontrollable factors such as genetics and chemical pollution, studies this year have found a significant relationship between smoking and bladder tumors, with the incidence of bladder cancer four times higher in smokers than in non-smokers. The incidence of bladder cancer is also significantly higher in men than in women. Therefore, men who have been smoking for a long time should be especially alert to bladder tumors and quit smoking as soon as possible for the health of their families and themselves, and have regular medical checkups.
Be alert to back pain and hematuria–kidney tumor
There are various manifestations of kidney tumors, the most common of which are hematuria and lumbar pain. In the past medical books, the classic clinical symptoms of kidney cancer are hematuria, lumbar pain and abdominal mass, which are also called the “triad of kidney cancer”. Since the kidney is located deep in the body and surrounded by other organs in the abdomen, it is not easy to ignore the symptoms of kidney tumor in the early stage. In recent years, with the development of medical technology and the improvement of people’s health consciousness, more and more patients have discovered small and early kidney tumors by chance due to health checkups or other systemic diseases. Smaller tumors in early stage also do not cause hematuria and back pain.
Is a tumor found in the kidney necessarily cancer?
There are two types of kidney tumors: benign and malignant. Although most of the data show that malignant tumors in kidney account for 96-98% of all kidney tumors, and cancer is the main one, there are still some patients suffering from benign tumors such as renal adenoma, renal cyst, renal hemangioma, renal malignant tumor, renal lipoma, etc. Some benign tumors are difficult to distinguish from malignant tumors and need to be treated by experienced oncologists.
Why do tumors grow in human kidney?
So far, the cause of kidney cancer is still unclear, and it may be related to many factors, genetic factors may be one of them, and it is found that kidney cancer has a tendency to run in families, for example, both brothers have kidney cancer, or three or even five people in a family have kidney cancer. Some hereditary diseases such as tuberous sclerosis and multiple neurofibromas can be combined with renal cell carcinoma; there is familial renal cancer with retinal hemangioma, which can be multifocal cancer or intracapsular cancer, and mutation of VHL gene is also one of the reasons for the development of renal cancer. Meanwhile, the prevalence rate of smokers is significantly higher than that of nonsmokers. There is no definite answer to the relationship between kidney cancer and industrial carcinogens, but male smokers who are frequently exposed to cadmium industrial environment have a higher incidence of kidney cancer than the norm. In addition, there are also some reports that certain industrial substances, aflatoxin, hormones, radiation, contrast agents, etc. may cause kidney cancer, and it is also said that coffee may increase the risk of kidney cancer in women, and the risk is not related to coffee dosage.
Why the earlier kidney cancer is detected, the better?
The earlier kidney cancer patients are treated, the greater their survival benefit. Statistically, the survival rate of renal cell carcinoma is 60% for overall 5-year survival, 90~100% for stage I, 65~75% for stage II, 40~70% for stage III, and 10~20% for stage IV. Survival rates for patients with renal cell carcinoma have improved over the last 30 years, thanks in large part to the availability of ultrasound and CT scans, leading to an increase in incidental renal cell carcinoma and more patients being detected and treated early. Surgery is the most effective and fundamental way to treat kidney cancer, and the most classical way is radical nephrectomy. In current large hospitals, most kidney tumors can be treated with minimally invasive laparoscopic surgery, and the trauma and recovery have been significantly improved compared with the previous ones. What is more valuable is that for patients with early stage tumor, small tumor, intact tumor envelope and exophytic type, laparoscopic partial nephrectomy is feasible, i.e. surgery that only removes tumor and preserves normal kidney tissue. Some people may ask rhetorically: compared with total nephrectomy, will the procedure of preserving the kidney be incomplete resection and thus affect the survival rate? In fact, from a large-scale retrospective clinical analysis, there is no significant difference in the five-year survival rate between the two surgical approaches. Urologists in regular hospitals will choose the most suitable surgical procedure according to the patient’s specific situation.
If a kidney with tumor growth is removed, will it be life-threatening due to kidney failure?
The answer is no. Because a person normally has two kidneys, each with 2 million kidney units. And only 1 million normal kidney units are needed to maintain a normal life of an adult, which is 1/2 kidney tissue. Therefore, in most cases, only one normal kidney can still live a normal life without kidney failure, but it is important to pay more attention and protect kidney function in general.
Why do you say that both radiotherapy and chemotherapy have little effect on kidney cancer?
Because, renal cell carcinoma is highly resistant to chemotherapy, therefore, chemotherapy is generally not recommended to treat patients with advanced kidney cancer. Gemcitabine in combination with 5-FU has some effect, but the remission rate is not better than treatment with interleukin-2 or interferon. Radiation therapy has no important role in the treatment of kidney cancer yet. Most scholars do not advocate radiation therapy for kidney cancer, and it can only be used as adjuvant treatment before and after surgery. For those with rapid tumor growth and obvious toxic symptoms in the short term, preoperative radiotherapy can reduce the tumor volume, decrease the spread of cancer cells during surgery and facilitate surgical operation. For stage II or III kidney cancer or cases where the lesion has spread to adjacent organs or tumor resection is incomplete, postoperative radiotherapy can reduce local recurrence. Meanwhile, for advanced renal cancer that cannot be surgically resected, radiotherapy can reduce local pain, hematuria and relieve toxic symptoms of bone metastasis.
As mentioned above, most patients with hematuria do not have tumor, but other benign diseases such as stones and urinary tract infections also need early diagnosis and treatment, so we hope readers can pay attention to clinical symptoms and manage their health well. Even if unfortunately diagnosed with tumor, they should learn about various advanced treatment strategies in urology and actively cooperate with the treatment. Only the mutual cooperation between doctors and patients can make the treatment received by patients more effective. At the same time, we should pay attention to regular medical checkups, which can detect health problems before symptoms appear and get more timely treatment, so that patients and their families can get more effective treatment and spend less cost.