Hematuria screening for bladder cancer

Article Abstract:

Early detection of bladder cancer can usually predict a favorable outcome. Bladder cancers usually produce hematuria (blood in the urine), even at noninvasive stages. Screening patients at risk for bladder cancer for hematuria could provide a means of early detection, and thereby reduce bladder cancer-related disease and mortality. Most of the bladder cancer in this country is transitional cell carcinoma (TCC), which arises superficially on the surface of epithelial tissue. Hematuria, however, is intermittent and does not occur at each voiding. In 31 consecutive patients with bladder cancer, 26 had microhematuria (more than two red blood cells per high power field) in at least one urine specimen that preceded cystoscopic detection of the lesion by several months. However, hematuria detection is beset with multiple problems, including: the nature of the urine specimen (initial, midstream, or terminal); whether the patient was in bed or walking around; whether the specimen was freshly voided; the aliquot or volume of urine tested; the speed and radius of the centrifuge, and the duration of the centrifugation. Beyond the techniques of screening for hematuria, clinical questions persist. When, how often, and by whom should hematuria be evaluated? Many consider the evaluation of hematuria in the middle-aged or elderly male an essential component in the physical examination, and advise patients with pre-existing or recurring tumors to be re-evaluated frequently. A pilot study was conducted with male patients, 50 years old or older, to assess the feasibility of home screening for hematuria. Although 358 men originally agreed to participate in the study, only 235 completed the one-year testing program. At least 44 men had at least one positive dipstick test during that period, 31 underwent a urologic workup, and 12 had urinary cancers that would respond to treatment following early detection. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Hematuria

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Molecular and cellular biological approaches and techniques in the detection of bladder cancer and enhanced risk for bladder cancer in high-risk groups

Article Abstract:

Bladder cancer is the sixth most prevalent cancer, with 10,000 deaths and 40,000 new cases occurring yearly. As is the case in most malignancies, early detection contributes to substantially reduced morbidity and mortality. An occupational base is estimated to be the cause of 18 to 35 percent of cases of bladder cancer in men. There are two main types of bladder cancer: a severe, invasive, high-grade form that is rapidly life threatening, and a low-grade form that is less threatening. Recent advances have been made in understanding the histobiology, molecular and cellular biology, immunology and toxicology of bladder cancer. Oncogenes (which control the growth and differentiation of tumors), tumor suppressor genes (anti-oncogenes), and tumor associated antigens have been identified. When these factors are integrated and developed into screening tests and assays, they could be of significant importance in the management of high-risk, occupationally exposed groups and other cohorts in the population. Molecular, immunochemical, oncogene and receptor markers are also being studied for their value in screening bladder lesions. Other techniques based on hybridization, the polymerase chain reaction, DNA probes, and restriction fragment length polymorphism techniques are also being researched. The techniques described are being considered for application in the following four screening or evaluation programs: detecting disease in persons with clinically apparent disease; detecting developing disease in a preclinical or treatable condition; detecting genomic changes indicative of initiating events; and detecting persons at higher risk from potential carcinogens due to genetic factors. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Usage, Tumor suppressor genes, Oncogenes

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Advances in screening protocols for the detection of early bladder cancer

Article Abstract:

Screening tests for bladder cancer have produced a low yield of positive cases. Many new techniques have been developed and reported since the 1977 conference on bladder cancer screening, including flow cytometry, quantitative fluorescence image analysis (QFIA), and improved cytologic techniques. A model for screening a high-risk, asymptomatic occupational cohort for bladder cancer is presented. This model has three objectives: maximize case detection, by maximizing sensitivity (identification of positive cases); minimize costly and invasive procedures; and provide efficient evaluation of competing screening tests. Four bladder cancer screening tests are discussed: voided urine cytology, QFIA, routine urinalysis for microhematuria, and home dipstick testing. The author presents a diagnostic protocol and decision process that would minimize invasive procedures and provide a testing schema with a sensitivity of 89 percent and a specificity (identification of negative cases) of 78 percent. The model allows the comparison of specificities, sensitivities, and predictive values of each test to be evaluated in a single cohort. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods

Similar abstracts:

• Abstracts: Historical and modern role of cystoscopy and bladder mucosal biopsy in detecting bladder cancer in a high-risk population

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