A cauliflower-like mass was found under cystoscopy. Is it bladder cancer? What should I do?

Author: Xu Tao, Chief Physician, Peking University People's Hospital

Reviewer: Song Gang, Chief Physician, Cancer Hospital, Chinese Academy of Medical Sciences

If a cauliflower-like mass is seen in the bladder using a cystoscope, the most common cause is a malignant tumor, namely bladder cancer.

The most typical manifestation of bladder cancer under cystoscopy is often described as a cauliflower-like tumor floating in the water, but this is not completely absolute. In very rare cases, some benign tumors may also have such a manifestation.

For example, there is a relatively common benign bladder tumor called inverted papilloma of the bladder. From the naked eye, it is very similar to bladder cancer and can also appear as a cauliflower-like tumor.

In this case, during the treatment process, we will treat it like bladder cancer, remove it through cystoscopy, and then do a pathological diagnosis, so that we can determine whether it is malignant or benign.

Figure 1 Original copyright image, no permission to reprint

A very powerful function of cystoscopy is the ability to remove bladder tumors.

Before the advent of cystoscopes, if you wanted to remove a bladder tumor, you had to make a large surgical incision in the abdomen, then open the abdominal wall, subcutaneous tissue, and bladder to enter the bladder and remove the tumor. This method is very damaging and can easily cause the tumor to spread.

With the advent of cystoscopes, the cystoscope can be inserted into the bladder through the urethra, and the tumor can be removed very easily without injuring the body surface. This is a great improvement, because it causes less damage, but the view is clearer, and it is easy for doctors to operate, and patients benefit greatly.

Of course, if it is a malignant tumor, it may grow again after cystoscopic removal, because bladder cancer is a very typical multiple or recurrent tumor. After a bladder cancer in one part is removed, about 3/4 of the patients will grow bladder cancer in the same part or other parts, so bladder cancer is a very special type of tumor. But because we have such a good tool as cystoscopy, even though it is easy to recur, we can detect recurrent tumors in time through frequent reexaminations and repeatedly perform surgery to remove the tumor.

Imagine if there were no cystoscope, patients would have to undergo surgery every time bladder cancer recurred, which would cause great pain to patients. Now we have a device called cystoscope, which does not require an incision and can be operated on repeatedly, so it is a great relief for patients.

Moreover, patients will not experience much pain during cystoscopy or treatment.

If it is just a simple examination, it can usually be completed in a few minutes. In the past, surface anesthesia was used. That is, before doing a cystoscopy, some anesthetics would be injected into the urethra, such as tetracaine, lidocaine and other surface anesthetics. The local urethral mucosa will absorb a certain amount, and it will have a certain analgesic effect every three to five minutes, but it is difficult to fundamentally change the painful feeling of cystoscopy.

At present, painless cystoscopy has been carried out in many units, especially abroad. That is to say, through general anesthesia, the patient can complete the cystoscopy process while sleeping.

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Painless cystoscopy is also a very meaningful revolution for doctors. During the cystoscopy, patients are in a relatively painful process. If patients feel pain, it is difficult for them to cooperate with doctors to complete various operations, and it is also difficult for doctors to complete the entire operation calmly in this state.

Patients may say, "Doctor, it hurts" or use body language, such as twisting, to convey their pain. These expressions of pain will affect the doctor's entire operation or the doctor's psychology, making it difficult for the doctor to observe and operate calmly.

If the doctor knows that the patient is not in pain, he can observe, treat and perform operations very calmly and seriously during this period without being restricted by time.

Of course, if the cystoscopy or surgical operation takes a long time, such as half an hour or an hour, in addition to general anesthesia, you can also choose epidural anesthesia, which is the so-called half-body anesthesia. The patient is conscious, but he does not feel pain. For patients, it is also a better way of anesthesia.