Tuesday, February 2, 2016

New advice for evaluating blood in the urine for signs of cancer

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CANCER DIGEST – Feb. 2, 2016 – Physicians are being advised to take a second look at blood in the urine, or hematuria, for signs of cancer, by a new report from the American College of Physicians’ High Value Care Task Force.

The Task Force issues advice for physicians on how to detect and evaluate hematuria. The report stems from research at the University of North Carolina Lineberger Comprehensive Cancer Center. 

"Blood in the urine can have many causes, and may be associated with urinary tract cancers including bladder cancer and cancer of the upper urinary tract," said Matt Nielsen, MD, MS,co-director of the Multidisciplinary Urologic Oncology Program at Linberger Cancer Center "But, given how common this finding is in clinical practice, we need to ensure that follow-up testing is done in a way that properly balances all of the potential harms and benefits of testing."

The ACP advises that all adults with visible blood in the urine should be referred for further urologic evaluation, even if the symptoms have stopped, given the relatively high risk this symptom has for underlying cancer. 

A more controversial advice is for suspicion of hematuria based on the findings of what is known as a “dipstick” test, the ACP advises that physicians confirm that finding using a microscope before further evaluation. The report suggests that physicians should consider referring adults with microscopically confirmed hematuria for evaluation by a urologist using cystoscopy and imaging in the absence of another possible, demonstrable and benign cause for the hematuria.

At the same time, the task force  pointed to potential harms associated with cystoscopy, which uses a camera attached to a tube inserted through the urethra into the bladder to inspect the walls of the bladder. In addition, they also noted potential harms linked to CT imaging, noting evidence linking radiation doses associated with CT scans to increased cancer risk. 

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