In the TV series, there is an episode in which Geng’s old comrade Chu Jian falls ill and is confirmed to have advanced bladder cancer after examination and expert consultation, and the hospital eventually fails to save the life of Geng’s old comrade and friend. As a clinical laboratory worker, I noticed that the episode mentioned that Chu went to the hospital because of hematuria, and the test results showed that a large number of red and white blood cells were found in the urine. In this regard, I associated the urine test with bladder cancer, which has sensitive diagnostic value for middle-aged and elderly patients with sudden onset of hematuria in high-risk groups. It suggests to doctors and patients that they should not ignore this risk factor for bladder cancer.
Malignant tumors of the urinary system
Bladder cancer is the most common malignant tumor in the urinary system, ranking 8th in the incidence of malignant tumors, and is more common in patients over 50 years of age, with a higher incidence in smokers than non-smokers, and a male to female ratio of about 4:1.
Bladder cancer refers to all kinds of malignant tumors from the bladder, which means that there are abnormal cells proliferating in the bladder. The most common type of bladder cancer cells are from the mucosal epidermis within the bladder and are formally known as metastatic epithelial cell carcinoma (TCC). Early superficial tumors (including those invading the superficial bladder muscle) can be completely removed by transurethral resection and electrocautery with a low mortality rate. Patients with deep lesions invading the bladder muscle have a low survival rate, but adjuvant chemotherapy may improve these outcomes. Squamous cell carcinoma of the bladder is often highly infiltrative, progresses rapidly, and has a poor prognosis. Therefore it is crucial whether bladder cancer can be detected early, diagnosed early and treated early. So what are the symptoms of bladder cancer? How to check and confirm it?
Most patients with bladder tumor mostly have painless carnal hematuria or microscopic hematuria as the first and typical symptoms. About 85% of patients will have hematuria, which may appear intermittently or throughout, and sometimes blood clots appear in the urine. Patients may present with complete hematuria, especially when the urine is about to be finished and the color of the urine deepens. It can also begin as hematuria and gradually turn clearer. There are also cases where the urine starts out clearer and gradually turns into hematuria. Visual hematuria is easy to detect, with a cloudy appearance of urine ranging from pink to red. Microscopic hematuria, on the other hand, must be confirmed in the laboratory by instrumentation and microscopic examination.
The size and duration of the hematuria bleeding is related to the malignancy of the tumor, its size, extent and number, but not necessarily proportional. When the patient only shows microscopic hematuria, it is not detected because there are no other symptoms, and often it will not be noticed until the appearance of meatus hematuria.
One of the differences between bladder cancer hematuria and hematuria caused by other diseases is that when hematuria occurs, the patient does not have any pain or other uncomfortable symptoms, which is called painless hematuria, which is obviously different from stone hematuria. This is obviously different from stone hematuria. Patients with stones mostly have significant pain in the kidney and ureter, which is also different from hematuria caused by cystitis that is mostly accompanied by frequent, urgent and painful urination. Another characteristic is intermittency, that is, hematuria appears intermittently and can stop or reduce on its own, and two hematuria can be separated by days or months, or even six months. When the hematuria stops, it is easy to be ignored or mistaken that the hematuria has been cured. If hematuria occurs only once or twice, it is not taken seriously, and it is thought to be caused by exertion or cold, which is not a big problem, and often makes people think that the problem of hematuria has been cured by itself, and they do not make timely further examination, which causes delay and thus lose the best time for treatment.
Pay attention to urine examination
Since painless hematuria is almost the main sign of bladder cancer, if we can seize this feature and conduct timely examination, we can achieve early detection and early treatment and obtain better treatment effect.
In fact, urine examination is the most convenient and painless routine examination, and it is recommended for middle-aged and above “healthy people”, especially for high-risk groups, such as smokers who have a higher risk of bladder cancer, about 30% to 50% of bladder cancer is caused by smoking, and smoking can increase the risk of bladder cancer by 2 to 4 times, and it is proportional to the intensity and duration of smoking. proportional to the intensity and duration of smoking. The risk of bladder cancer is increased in dyestuffs, textiles, chemicals, rubber, leather, paints, printing, pharmaceuticals and insecticides, steel production and other industries. People with familial genetic factors and those who have taken large amounts of finasteride paroxysms for a long time, and those who have had bladder stones and Schistosoma egypti infection should pay attention to the observation of urination and routine urine tests, and as a regular routine check-up for such high-risk groups. Routine urinalysis should also not be omitted from the routine medical checkups for the general population.
If there is a positive result for red blood cells or a positive result for white blood cells in the test result, you should pay attention to it and use microscopic examination to confirm the result if possible. Microscopic hematuria is defined as red blood cells >3/HP in urine after centrifugal sedimentation, and if quantitative examination is performed, red blood cells >8000/ml (>8×106/L) are called microscopic hematuria. The higher the number of red blood cells, the more serious the degree of hematuria, whose red blood cell morphology is predominantly normal. Patients are advised to always take clean mid-morning urine for testing to avoid unnecessary interfering factors to the test results.
The bladder is one of the largest hollow urinary storage organs. The most common bladder cancer cells come from the mucosal epidermis on the inner surface of the bladder, which are easily shed and excreted from the urine, while the ulceration of the tumor may also lead to local bleeding and cause hematuria. Therefore, urinalysis is a very easy test.
Other auxiliary tests to supplement
Routine urine examination is only a screening test and cannot confirm the occurrence of bladder cancer. Many other urological diseases may also present hematuria, such as kidney disease, urinary tract stones, tuberculosis inflammation, infection, etc., which should be excluded.
If the presence of visual or microscopic hematuria has been confirmed, urine exfoliation cytology, which is a simple and non-invasive test, is also needed. About 85% of patients with bladder cancer have positive urine exfoliative cytology, which is of great value for the diagnosis of bladder cancer, but this test needs to be done by experienced pathologists or examiners and is closely related to their professional skills. Urine exfoliative cytology is a simple, non-invasive and highly specific method, and is the main test for bladder cancer diagnosis and postoperative follow-up.
Some new urinary tumor markers are closely related to bladder cancer diagnosis, treatment and prognosis, such as the application of tests and techniques for bladder tumor antigen (BTA), nuclear matrix protein (NMP22, BLCA-4), telomerase (Telomerase), survivin, hyaluronan and hyaluronidase, fluorescence in situ hybridization (FISH), etc. in urine , the sensitivity and specificity of the diagnosis of bladder cancer are increasing. Elevated urinary β-glucuronidase (β-GRS) can be used as a screening method in bladder tumor screening. Blood group antigens, Lewis A and Lewis X, have a high positive rate in bladder cancer and are diagnostic references for migratory cell carcinoma of the bladder and are useful in the diagnosis of low-grade migratory cell carcinoma. Elevation of traditional tumor marker tests such as carcinoembryonic antigen (CEA) and glycoconjugate antigen 125 (CA-125) can also be used as reference indicators for bladder tumors.
Cystoscopy is the most reliable method
Of course, cystoscopy is currently considered the most reliable method to diagnose bladder cancer. It is an interventional examination method that inserts a cystoscope into the bladder through the urethra to directly observe the lesions in the bladder and urethra. X-ray imaging can also be used to understand the filling of bladder and the scope and depth of tumor infiltration, and combined with pelvic and ureteral imaging, it can understand whether there is hydronephrosis, ureteral infiltration and the degree of infiltration.
Ultrasound examination can measure tumor with diameter above 0.5cm, and can observe its size, location and the extent of mucosal infiltration. If transrectal ultrasound scan is used, the scope of bladder tumor can be determined. When bladder tumor tissues grow into the cavity or outside the wall and appear metastasis, CT and MRI are mostly used for invasive cancer, which can detect the depth of tumor infiltration into the bladder wall and local metastasis of enlarged lymph nodes.
In conclusion, there has been great progress in the examination, diagnosis and treatment of bladder cancer, and currently, surgery and chemotherapy are more effective. If early detection, early diagnosis and early treatment can be achieved, the prognosis and survival period are relatively optimistic.