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Actos Lawyers : The pathologist studies the prepared slides and makes a determination of the grade of cancer. There are a number of criterions that are used: degree of cellularity, nuclear crowding, loss of polarity and differentiation, nuclear pleomorphism, chromatin pattern and mitotic activity. In layman’s terms, the pathologist looks at the size, shape and relationship of the cancer cells. The nucleus is often abnormal since it contains damaged or mutated DNA. Cancer cells look different than normal cells. The greater the difference from normal, the higher the grade will be. These parameters are utilized to reduce the subjective nature of pathology. In the end, the pathologist assigns a grade. Since grading is actually a continuum, many pathologists find that by adding to the grading scale, they can more accurately grade what they are seeing.
The medical history of those with bladder cancer varies. For many patients, the first clue is blood in the urine, while in others, it may be an alteration in urination. Sometimes a tumor is found inadvertently on an X ray or ultrasound exam. In all cases, an initial assessment is implemented by the urologist. In this chapter, we will review the presenting findings of those with bladder cancer and how they are initially “worked up.”
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A sign is a physical finding from an underlying disease or disorder which can be noted by the individual or the physician. A symptom is something the individual feels or experiences from a disease. A clinical sign is a physical finding, while a symptom is something the individual experiences. Approximately three quarters of individuals with bladder cancer initially present with blood in their urine. The blood may be visible to the naked eye (gross hematuria), or seen with a microscope only (microscopic hematuria). In the case of gross hematuria secondary to bladder cancer, it is often total (throughout the entire stream) and may be intermittent. Generally, there is no pain associated with it. I have seen many patients over the years who had gross hematuria months earlier who falsely assumed their condition was not serious since the bleeding stopped and there was no pain, only to come in later with recurrent bleeding, their tumors needlessly more advanced. When an individual experiences gross hematuria, a work up is a must! Gross hematuria at times can become quite severe to the point blood clots can restrict the flow of urine. What could have been an elective assessment then becomes a mad dash to the emergency room for catheterization (passing a tube into the bladder) and irrigation or an emergency procedure. Of course, there are other causes for gross hematuria, such as urinary infections, kidney stones or tumors in the kidney, all of which require assessment.
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If a urine dipstick is positive for blood, it is recommended to check the urine under a microscope. The urine is first spun down to separate out the sediment and is then examined under the high power lens. If there are more than 3 red blood cells per high power field it is felt to be significant. If there are no other reasons for the presence of blood such as a urinary infection, the urine should be rechecked. If there is a persistent presence of significant microscopic hematuria, an assessment is recommended. When there is a large amount of microscopic hematuria, especially in older individuals with risk factors for bladder cancer, there is no need to repeat the urinalysis as a workup should be done.
A small amount of microscopic hematuria in an individual without symptoms (asymptomatic microscopic hematuria) can be found in many healthy individuals. It has been estimated that up to 10% of the population has asymptomatic microscopic hematuria. In brief, the older you are (generally over the age of 40), the more risk factors you have (smoking, occupational exposure), and the more red blood cells present, the more likely serious pathology (disease of the urinary tract including bladder cancer) will be found. If you have persistent microscopic hematuria without a known cause, a urologic assessment is recommended.
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