Hematuria may be an early sign of bladder cancer? If you find hematuria, you need to do these further tests!

Author: Yang Yong, Chief Physician, Peking University Cancer Hospital

Reviewer: Lu Wenhong, Researcher, Institute of Science and Technology, National Health Commission

Once bladder cancer metastasizes, the average life expectancy is only about one and a half years, and the mortality rate is very high.

Fortunately, bladder cancer will show corresponding signs in the early stage, such as hematuria. If patients seek medical attention promptly when hematuria occurs, a considerable number of patients can detect bladder cancer in the early stage.

Why can early bladder cancer be detected through hematuria? The bladder is not a static organ. It is always in a state of storing and excreting urine, and it will constantly expand and contract. If a tumor grows in the bladder cavity, it will also rupture and bleed as the bladder continues to expand and contract. The tumor will also rupture and bleed when it is very small, which will manifest as red blood cells in the urine. If there is more bleeding, it will manifest as macroscopic hematuria. Therefore, the presence of hematuria, microscopic hematuria or macroscopic hematuria can detect bladder cancer early.

It should be noted that the most common cause of hematuria is not bladder cancer, but often benign diseases such as renal papillary calcification and urinary stones. However, bladder cancer is a cause that cannot be ignored.

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Urinalysis is the most effective way to detect hematuria. Urinalysis is a must-do item in health checkups. The age of onset of bladder cancer is generally around 40 years old. It is recommended to have regular health checkups and urine routine tests after the age of 40. If there are no red blood cells in the urine routine test, bladder cancer can basically be ruled out. Once red blood cells are found, further detailed examination of the urinary system is required to determine the source of the red blood cells.

First, an ultrasound examination of the urinary system is performed. If hematuria is related to a tumor, it may originate from the bladder, ureter, or renal pelvis. Therefore, when hematuria occurs, an ultrasound examination of the entire urinary system is required to rule out the presence of tumors in the bladder, ureter, or renal pelvis. The kidneys can also be examined accordingly.

Ultrasound is a relatively rough examination item. In many cases, ultrasound examination does not find any problems, but there is hematuria, and further enhanced CT examination is required. If enhanced CT also does not find any problems, cystoscopy is recommended. Cystoscopy can observe the bladder under direct vision and can basically diagnose bladder cancer 100%, but the final diagnosis still requires biopsy for pathology.

When doing cystoscopy, you may find a tumor in the bladder, but it does not mean that there is no tumor in the ureter or renal pelvis. Therefore, when doing cystoscopy, you should also observe whether there is any abnormality in the ureteral orifices on both sides and whether the urine is clear. If you find that the urine from one ureteral orifice is turbid or even bloody, you should consider whether there is a problem with the renal pelvis and ureter on this side. At this time, you should use a ureteral catheter to collect renal pelvic urine to see if there are tumor cells in the urine, and even do a ureteroscopy to see if there are tumors in the ureter or renal pelvis.

The bladder is a thick muscle organ. The bladder wall is composed of three layers of tissue, from the inside to the outside, namely the mucosal layer, the muscular layer, and the serosa layer. The outermost layer of the bladder wall is the mucosal layer, which belongs to the urothelium. When the urothelium becomes cancerous, the tumor is confined to the mucosal layer in the early stage. The instrument enters the bladder through the urethra and uses energy such as electric knife, plasma or laser to remove the tumor. This is a minimally invasive surgery. After the operation, various drugs should be instilled into the bladder to prevent tumor recurrence.

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In the past decade or so, the demand for painless surgery has become higher. Cystoscopy may be performed under general anesthesia. If a tumor is seen in the cavity under the cystoscope, whether it is benign or malignant, it can be directly removed. This is called diagnostic electrosurgical resection.

Diagnostic electroresection has certain requirements. After the tumor is removed, a pathological examination must be performed to determine whether it is benign or malignant. In addition, the mucosa around the tumor, that is, the base of the tumor, must also be removed and sent for biopsy to see if the tumor has invaded the surrounding area and how deep the tumor is. If the tumor is relatively large, a random biopsy of the surrounding mucosa that appears normal must also be performed. Diagnostic electroresection must not only determine whether it is bladder cancer, but also the stage of bladder cancer, so as to determine the risk of lymph node metastasis or distant metastasis and whether other auxiliary treatments are needed.