(Disclaimer: This article is only for popular science purposes. In order to protect patient privacy, the relevant information in the following content has been processed)
The protagonist of the story, Lao Fang, is 76 years old. After retirement, he can be said to be a local "social expert". After sending his grandchildren to school every day, he would dance, ride bikes, and play ball with his relatives and friends... Retirement life can be said to be rich and colorful.
If this continues, Lao Fang’s life can be said to be the ideal life for many elderly people. However, since he was diagnosed with diabetes , coronary heart disease , chronic renal insufficiency , Lao Fang’s life has changed. As he kept running between the hospital and home, Lao Fang became thinner and lost weight every day. He was also listless, and what made matters worse was that Lao Fang had blood in his urine a year ago.
1. First meeting the patient
1 years ago, Fang found a small amount of blood in his urine when urinating. At first, he didn't care about it, thinking that it might be caused by renal insufficiency, and he should be fine with a day or two of rest. However, after a day or two of rest, the blood in the urine not only did not disappear, but symptoms such as difficulty urinating and painful urination also appeared. For this reason, he realized the seriousness of the problem and came to see me for treatment.
When I saw Lao Fang for the first time, he was very haggard. I asked him some basic information. It can be said that he was plagued by diseases. He had suffered from diabetes for 20 years and chronic renal insufficiency for 3 years. He was cured in 2008. He underwent heart bypass surgery for coronary heart disease and underwent cardiovascular stent surgery again in 2012.
's physical condition was poor, and he also had symptoms such as hematuria and poor urination. Therefore, I first suggested that the patient complete abdominal CT , urine routine and other related examinations. It didn't take long for the examination results to come back. Among them, the cardiac color ultrasound showed: old myocardium. Infarction (left ventricular posterior septum, inferior wall), extensive myocardial ischemia. Whole-abdominal CT showed: the bladder wall was unevenly thickened and a mass formed, protruding into the cavity, with a size of 27.9x29.1mm. Cystoscopy biopsy showed bladder cancer . Therefore, based on Lao Fang’s symptoms, signs and related examination results, the patient was admitted to the outpatient clinic as “bladder cancer”.
2. The patient’s treatment process
For Lao Fang, everyone thinks it is very difficult because the patient is older, has many underlying diseases, cannot tolerate surgery and chemotherapy...there are many disadvantages. Moreover, Lao Fang’s children also told me: “The old man is very old and has had many surgeries, so the family hopes to improve the quality of life of the old man and prevent him from suffering too much.” What to do with
? At that time, I kept asking myself how to formulate an old prescription treatment plan, considering on the one hand the patient's difficult physical condition, and on the other hand the needs of the patient and his family for prognostic quality of life. Therefore, we decided to conduct a multidisciplinary consultation for the patient. After discussing with colleagues from the Department of Cardiology and Endocrinology, we decided to treat Lao Fang’s underlying disease first, adjust blood sugar, kidney function, heart function and other indicators to normal, and then conduct 12 courses of treatment. Heavy ion radiotherapy.
2 weeks later, through adjustments to hypoglycemic, anticoagulation and other programs, the patient's blood sugar, renal function, cardiac function and other indicators were at normal levels. Therefore, he started a course of radiotherapy on August 28, 2020, with a total radiation dose of 17.6Gy. The treatment plan is 12 times/26 days (that is, 3 times a week, a total of 12 treatments, each radiation dose is 1.47Gy). After multiple courses of radiotherapy, the patient's symptoms were improved. The visible hematuria gradually disappeared and returned to normal light yellow color. The review CT also showed that the cancer was significantly smaller than before, achieving partial remission.
3. Precautions for patients during treatment
1. If you experience sweating, fever, diarrhea, frequent urination, pain and other discomforts after radiotherapy, you should notify the doctor in time and deal with it as soon as possible to avoid these side effects from affecting the condition and delaying treatment.
2. Mucosal damage may occur during radiotherapy, which can easily lead to inflammation in the patient. Therefore, the patient needs to drink a lot of water to flush the necrotic tissue out of the body, thereby reducing urinary system infection.
3. Pay attention to keep the skin in the radiotherapy field in a dry and ventilated state. After radiotherapy, you still need to protect the skin in the treatment field to avoid vigorous friction and contact with irritating substances.
4. Protect the radiation field mark. If the mark is not obvious or is accidentally washed away, it must be repainted by the doctor in charge before radiotherapy can be carried out, because the line mark on the body surface is the positioning mark for radiotherapy.
5. Metal objects such as mobile phones, watches, pens, etc. are not allowed into the radiotherapy room. Patients with metal dentures must be removed first.
4. The patient's therapeutic effect
After receiving 12 times of heavy ion radiotherapy, Laofang's symptoms such as hematuria and frequent urination were improved. A review of the urine routine showed that the red blood cell value dropped significantly (from 14653/ul to 31/ul). CT prompt: The mass shrank to 7.6x17.7mm, and the maximum diameter of the tumor shrank by 39.1%, which was significantly smaller than before.
During the follow-up visit 3 months after radiotherapy, the patient reported that there were no more symptoms of hematuria or complications related to bladder cancer. A follow-up CT scan showed that the tumor had completely disappeared and the bladder wall thickening had returned to normal. Moreover, because the bladder was not removed and the normal function of the bladder was preserved, the old man's quality of life has recovered, and he has become more optimistic and full of hope for life.
5. Precautions for patients in daily life
1. The diet should be light. It is recommended to consume high-protein, high-nutrition, and high-vitamin foods and avoid spicy and stimulating foods.
2. Pay attention to rest. Lying quietly for half an hour after each exposure is helpful in preventing systemic reactions. You should avoid fatigue and maintain a regular life in daily life.
3. Maintain a good attitude. When patients are fighting against disease, mental factors are a very powerful assistant. Maintaining a positive and optimistic attitude is helpful for disease treatment and recovery.
4. Follow the doctor's instructions for regular check-ups. After radiotherapy is completed, you should also return to the hospital for regular check-ups. If you experience hematuria or other discomforts again, inform the doctor in time to find out the cause and deal with it as soon as possible.
6. Doctors’ insights
In most cases, the presence of blood in the urine (called hematuria) is the first sign of bladder cancer. If possible, enough blood will change the color of urine to orange, pink, or even less commonly, deep red. However, because the blood in the urine may appear and disappear in the early stage, people tend to ignore the symptoms like the old doctor, thereby delaying the opportunity for treatment.
In addition to not paying attention to the symptoms of hematuria, Lao Fang also suffers from a variety of underlying diseases, which will not only have a serious impact on the patient's physical condition, but also make treatment difficult for doctors. Fortunately, through multidisciplinary consultation and active treatment, Lao Fang's basic condition was effectively improved, and his blood sugar, heart function, and kidney function were maintained at a good level, which also laid a good foundation for the subsequent radiotherapy.
Through a precise and personalized radiotherapy plan, Lao Fang’s prognosis is better, and because he has retained his bladder function, Lao Fang has become more positive and optimistic. But from my communication with Lao Fang, I very much hope that he can return to his newly retired state. Not only will his mentality be optimistic, but his life will also be colorful. Fang's psychological condition requires the participation of Lao Fang himself, his family, the community and other parties in order to cure the disease and "heart".
Name: Jin Wenjun
Unit: Gansu Wuwei Cancer Hospital
Department: Department of Urology
Title: Deputy Chief Physician
