The other day I operated on a man with a very nasty looking bladder cancer. He was obviously very upset and wanted me to speculate if the cancer could have been there when he first saw blood in urine
The other day I operated on a man with a very nasty looking bladder cancer. He was obviously very upset and wanted me to speculate if the cancer could have been there when he first saw blood in urine nearly eighteen months ago and whether it could have progressed in this time. It is anybodyâ€™s guess but it cannot be denied that the answer to both questions may well be â€˜yesâ€™. It is possible that he had cancer when he first saw blood in urine and that it could have become more extensive in the time he waited for surgery.
The sight of blood in urine (haematuria in medical jargon) or blood from anywhere in the body can be scary and people run to seek help at once. Moreover, let alone doctors, even lay people are quite often aware that blood from any orifice of the body should be taken seriously as it can be a sign of cancer.
Why should then there have been such a long delay in this manâ€™s diagnosis? The reason lies in the common tendency on the part of doctors to prescribe antibiotics as soon as someone presents to them with haematuria. And not wrongly so either. After all, a urinary infection is indeed the commonest cause of haematuria. So, the patients get antibiotics and haematuria more often than not stops lending credence to the belief that it must have been an infection. But herein lies a clinical trap. Haematuria would probably have stopped anyway because, even in the presence of cancer, blood in urine is usually seen only intermittently. By the time it has been â€˜treatedâ€™ repeatedly with antibiotics, it may be quite late.
So, how do doctors and patients avoid falling into this trap? They do so by being aware of the intermittent nature of haematuria, by remembering that haematuria associated with infection should usually be painful as opposed to cancer-haematuria which is usually painless, by sending a sample of urine to lab for culture before starting the antibiotic and questioning their diagnosis if the result shows no infection, by being open to considering many different possibilities.
Patients should challenge their doctors and should not hesitate to seek a second opinion when things do not seem right. We welcome your questions atÂ www.secondmedic.com.
Dr. Vibhash Mishra,
Second Medic CMO
Speciality:Â Urology / Kidney/Bladder/Prostate/Stones
Qualification:Â MBBS with Honours,MS General Surgery,FRCS Edinburgh,FRCS UROLOGY, UK FEBU