Zusammenfassung
Die Heterogenität von Blasenkarzinomen bei Invasion und Metastasierung und deren häufigen Rezidive stellen eine Herausforderung für den Arzt dar, der Blasenkarzinompatienten behandelt, und für den Forscher, der die Diagnose, die Rezidive und das Behandlungsumfeld von Blasenkarzinomen untersucht. In der Mehrzahl neuer Blasenkarzinomfälle beginnen die Untersuchungen, wenn der Patient Symptome zeigt (z. B. Hämaturie oder Blasenentleerungsstörungen). Dieser Modus der Entdeckung ist bei 15–30% der neu entdeckten Fälle inadäquat, weil die Patienten zum Zeitpunkt der Diagnose bereits einen invasiven Tumor haben.
Bei Blasenkarzinompatienten ist eine 3- bis 6-monatige Nachsorge unumgänglich, da Blasentumoren häufig rezidivieren. Zum Nachweis eines Blasentumors ist eine Zystoskopie erforderlich, die invasiv und relativ teuer ist. Die Spontanurinzytologie, der Goldstandard der nicht invasiven Marker, ist sehr tumorspezifisch und hat eine gute Sensitivität bei High-grade-Tumoren. Die Sensitivität für Low-grade-Tumoren ist dagegen gering. Die Genauigkeit der Zytologie hängt von der Erfahrung des Untersuchers ab und ist nicht überall verfügbar. Uringebundene Marker können zwar überall eingesetzt werden, aber ihr Nutzen muss noch weiter diskutiert werden.
Abstract
The heterogeneity of bladder tumors in their ability to invade and metastasize and their frequent recurrence pose a challenge for physicians who treat bladder cancer patients and for the researchers who work on bladder cancer diagnosis, recurrence, and treatment-related areas. For most new bladder cancer cases, investigation begins when patients are symptomatic (i.e., hematuria or irritative voiding). This mode of detection is often inadequate for nearly 15–30% of these new cases with high-grade bladder cancer, since the tumor is already in the invasive stage at the time of diagnosis.
Bladder cancer patients are on a mandatory 3-month to 6-month surveillance schedule because bladder tumors frequently recur. The current mode of detecting bladder cancer involves cystoscopy, which is an invasive and relatively expensive procedure. Voided urine cytology, the standard noninvasive marker, is highly tumor specific and has good sensitivity for detecting high-grade tumors. However, its sensitivity for detecting low-grade tumors is low; its accuracy depends on the examiner’s expertise; and it is not available everywhere. Marker systems are readily available for use in practice. Their utility remains under discussion.
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Hautmann, S., Lokeshwar, V. & Juenemann, K. Uringebundene Diagnostik. Urologe 48, 619–624 (2009). https://doi.org/10.1007/s00120-009-1991-7
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DOI: https://doi.org/10.1007/s00120-009-1991-7