[Fat Bear Science] Frequent urination and urgency may be bladder cancer? Whether you are a man or a woman, the doctor said you should go to the hospital for a check-up if you have this symptom.

Mr. Wang is 72 years old this year. Two days ago, he heard that Mr. Li, who used to go fishing with him, had bladder cancer and had to undergo surgery. His wife found an opportunity to say to him, "I told you not to go fishing. Mr. Li must have had bladder cancer because you two sat for too long while fishing. You sit and play with him every day, so you should go see a doctor."

"You're talking nonsense. It's not that I sat for too long. They said it was because old man Li smoked too much. And I heard him say there was blood in his urine a long time ago. My urine is not red. Why does he need to be checked?"

"You went when you were asked to go. During your last community checkup, your urine was checked for occult blood and they recommended that you go to the urology department for a checkup, but you didn't go."

"Okay, if you want it, go and take a look."

Friday morning was the outpatient visit of Dr. Xian Peng from the Urology Oncology Department. After listening to Mr. Wang's situation, Dr. Xian told him that the urine routine test showed occult blood and red blood cells, which was indeed considered hematuria. Mr. Wang did not have a urinary tract infection, so there was a possibility of bladder cancer. He suggested that he first do a urinary system color Doppler ultrasound to check.

Uncle Wang finished the color Doppler ultrasound. It was almost 12 noon. He just happened to see Dr. Xian before the clinic ended. "Your color Doppler ultrasound did not show any bladder tumors. There are some small stones in the left kidney, which may be the cause of microscopic hematuria. There is no major problem for the time being."

"Then I feel relieved." said Uncle Wang.

Expert Profile

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Xian Peng

Deputy Chief Physician of the Department of Urological Oncology, Affiliated Cancer Hospital of Chongqing University, and Master’s Supervisor.

Expert in laparoscopic minimally invasive surgery and tumors of the urinary system. Proficient in various complex laparoscopic/robotic surgeries for urinary system tumors. Rich experience in the formulation and adjustment of targeted drug treatments for kidney cancer and comprehensive treatment plans for bladder cancer.

Clinic time: Friday morning (Urinary tumor targeted therapy clinic)

I understand. It must be because men love to smoke that bladder cancer is more common, right?

Dr. Xian Peng:

Many people do ask why men have more bladder cancer. Is it because men smoke? Or do men like to hold their urine? Or is it because of occupational factors? Or is it because men's physiological structure is more susceptible to bladder cancer? These factors may be related to a certain extent, but the huge difference in the incidence of bladder cancer between men and women cannot be completely attributed to smoking habits, lifestyle and occupational factors. In fact, sex hormones may be an important reason for this result.

In other words, androgens may play a certain role in promoting the occurrence of bladder cancer, or estrogen may have a certain protective effect on bladder cancer.

The occurrence of bladder cancer is a complex, multi-factor, multi-step pathological process, which involves both internal genetic factors, that is, bad genes, and external environmental factors. The two most obvious risk factors for bladder cancer are smoking and long-term exposure to industrial chemical products.

Smoking is currently the most confirmed risk factor for bladder cancer. About 30%-50% of bladder cancers are caused by smoking. Smoking can increase the risk of bladder cancer by 2-4 times, and the risk is proportional to the intensity and duration of smoking.

Another important risk factor is long-term exposure to industrial chemical products, that is, occupational factors. This is the earliest known risk factor for bladder cancer. About 20% of bladder cancer is caused by occupational factors, including textile, dye manufacturing, rubber chemistry, pharmaceutical preparations and pesticide production, paint, leather and aluminum, iron and steel production. In our daily life, many people worry that hair dyeing will cause cancer. It is true that the chemical ingredients contained in hair dyes may induce cancer, but it is rogue to talk about the hazards without considering the dosage. We don’t have to change color when talking about hair dyeing. Nowadays, hair dyes are much safer than before. As long as we don’t choose inferior products that cost more than ten yuan and don’t dye our hair frequently, it will not cause much harm to our body.

Where can you find hair dye for 10 yuan now? By the way, to prevent bladder cancer, is it better to drink more water or less water?

Dr. Xian Peng:

Drinking more water can definitely reduce the risk of bladder cancer. For example, if the water in a teapot is not poured out, is it more likely to cause scale? So drinking more water can reduce urine concentration. It is recommended that healthy adults drink more than 2000ml of water per day. The elderly should reduce the amount according to their physical condition.

In addition, smoking is a clear risk factor for many cancers, including bladder cancer. The incidence of bladder cancer in smokers is four times that of non-smokers, so the sooner you quit smoking, the better you will be at avoiding cancer. We should also avoid long-term exposure to industrial chemical products.

What are the symptoms of bladder cancer? You see, I just don’t know, otherwise I wouldn’t have come.

Dr. Xian Peng:

How can you listen to our popular science talk about bladder cancer if you don’t come?

Hematuria is the most common symptom of bladder cancer, especially intermittent and completely painless hematuria, which means sometimes there is blood and sometimes not, and there is no pain in the back or abdomen when urinating. In this case, bladder cancer should be checked out.

Hematuria may be macroscopic hematuria or microscopic hematuria. That is to say, during our annual physical examination, if the urine routine test is found to be positive for red blood cells or occult blood, we must pay attention and recheck it one or twice. If it is positive for multiple times, we need to further check whether there is bladder cancer.

The time when hematuria appears and the amount of bleeding are not consistent with the malignancy, stage, size, number and shape of bladder cancer. In other words, it depends on luck. Some people are lucky and have a small bladder tumor in the early stage, and they start to have hematuria, and a small operation will completely cure it; some people are unlucky and have several large tumors in the bladder, but they don’t have hematuria until they grow very big, and then they start to have hematuria, which means they are in the late stage.

In addition to hematuria, which is the most common symptom, frequent urination, urgency, dysuria, and pelvic pain are other common manifestations of bladder cancer. These symptoms are often associated with diffuse carcinoma in situ or invasive bladder cancer, while early bladder cancer does not have such symptoms.

Other symptoms include lumbar pain due to ureteral obstruction, lower limb edema, pelvic mass, and urinary retention. Some patients present with late-stage symptoms such as weight loss, renal insufficiency, abdominal pain, or bone pain when they seek medical treatment.

You have said so much. We old men all have frequent urination and urgency. What kind of examination should I have to know if it is bladder cancer?

Dr. Xian Peng:

If the above symptoms occur, bladder cancer is suspected and patients should usually consider physical examination and imaging examination. Currently, color Doppler ultrasound examination is simple and easy to perform clinically, non-invasive, and can detect bladder cancers larger than 5mm. It is the preferred screening method for bladder cancer.

If there is no problem with the color Doppler ultrasound but there is always hematuria, a urinary system CT imaging (CTU) examination should be performed to determine whether there is renal pelvis or ureteral cancer, and it has a higher diagnostic accuracy rate for bladder cancer.

If a bladder tumor is found by color ultrasound or CT scan, a multi-parameter magnetic resonance imaging (MRI) examination is recommended to check the growth of the bladder tumor, understand how deep it is, whether it has grown into the muscle layer of the bladder, etc.

Of course, cystoscopy and biopsy are the most reliable methods for diagnosing bladder cancer. If other examinations highly suspect bladder cancer in a patient, cystoscopy can determine the number of bladder tumors, their size, location, and shape. Most importantly, biopsies can be performed on tumors and suspicious lesions to confirm the pathological diagnosis, which is a 100% confirmation.

I have been talking to you for so long, but the clinic has closed for half an hour. When you go back, you should also tell your friends about what I said. In summary: drink more water, urinate frequently, don't smoke, dye your hair less, and have less contact with chemical raw materials. If you are a high-risk group or have symptoms, come to the hospital for a check-up.

Text/Fat Bear

Picture/partially from the Internet (please contact us to delete if there is any infringement)

Audit/Uro-Oncology

Member of China Medical We-Media Alliance

Science Popularization China Co-construction Base

Chongqing Science Popularization Base/Chongqing Health Promotion Hospital

Chongqing Science and Technology Communication and Popularization Project

Chongqing Grassroots Science Popularization Action Plan Project

National Health Commission National Basic Public Health Service Health Literacy Project