Bladder cancer. Urine tumour markers and hematuria

Sammanfattning: Cancer of the urinary organs is one of the more common cancer forms in Sweden, with bladder cancer as the fourth most common cancer among men, and the seventh most common among women. The bladder cancer incidence is rising with age and is seldom seen before 50 years of age. Bladder cancer should be suspected if patients have blood in the urine (hematuria), but also if they have voiding problems, pain from the urinary tract or upper urinary tract obstruction. The diagnosis is made by cystoscopy and verified by histopatho-logical examinations of the resected tumour.One aim of this thesis is to describe the quantity of malignancies among patients referred to urological investigation with information about hematuria in the referral form. Another aim is to investigate sensitivity and specificity for tumour markers in urine like NMP22, BTA stat, UBC, TPS as well as hematuria and flow cytometry for erythrocyte size determination. A third aim is to investigate the difference between new and recurrent tumours regarding tumour characteristics, and what influence these differences have on sensitivity and specificity of the tumour markers in urine.Patients with macroscopic hematuria were found to have a 25% risk for urogenital malignancies, and if they were asymptomatic it was even higher. Patients with micro-hematuria had a 9% risk for malignancies, and if microhematuria was asymptomatic, the frequency of malignancies was 5%. The sensitivity of NMP22, UBC, TPS and BTA stat was higher for new tumours than for recurrences, due to smaller size and lower grade and stage among recurrences. There was a large decrease in specificity for recurrences for NMP22 and BTA stat, but not for UBC and TPS. Cytology had a lower sensitivity than the other tumour markers but a much higher specificity.Hematuria had just as high sensitivity for new bladder cancer as UBC, NMP22 and BTA stat. The grade of hematuria was correlated with grade, tumour size and stage. NMP22, BTA stat and cytology were correlated to the grade of hematuria, but not UBC and TPS. Both with self-test at home for seven days and with automatic optic scanning of the teststrip on the morning of the day of the operation, 25% of patients with bladder cancer tested negative for hematuria. NMP22, BTA stat and UBC had the same sensitivity among patients with newly detected bladder cancer with macroscopic hematuria as initial symptom, as among those without. Erythrocyte size measurement with flow cytometry as a marker for bladder cancer had a somewhat lower sensitivity and specificity than NMP22, BTA stat and UBC.