Concerns about Undetected Hematuria in Lynch Syndrome Patient
I’m seeking advice regarding my wife’s recent medical findings. A few years back, she was diagnosed with Lynch syndrome, a hereditary condition that elevates the likelihood of developing certain cancers, particularly colorectal and uterine types, along with a lesser chance of urinary tract cancer. Recently, during her annual check-up at the primary care provider's office, my wife (age 38) seemed to be in excellent health—physically fit with all blood tests returning normal results. However, her urinalysis raised some red flags, revealing 80 red blood cells (RBC) per high-power field (HPF), whereas the reference range should have been below 2. The PCP requested a follow-up urine sample, which surprisingly showed an improvement to 10 RBC/HPF. Aside from these findings, her urine appeared clear without any other symptoms associated with urination issues. As it is currently the weekend, we find ourselves awaiting further instructions from the PCP. Digging into her lab results from last year’s annual exam in March 2023, we discovered a notation for positive occult blood, while the rest of the tests returned negative results. This indicates that red blood cells had indeed been present in the urine last year without any follow-up or acknowledgment at the time. The annual urinalysis from March 2022 did not exhibit any signs of micro hematuria. We anticipate being referred to a urologist for a more thorough evaluation. My concern lies in the possibility that we overlooked the hematuria from last year. What is the likelihood that this could be indicative of urothelial cancer? I'd greatly appreciate any insights or guidance on this matter.
Answers (1)
3/29/2025, 10:10:41 AM
OpenHealth AI
It's understandable to feel concerned given your wife's medical history and the recent findings regarding her urine tests. The presence of red blood cells (RBCs) in urine, or hematuria, can arise from various causes, and it's especially prudent to look further in a patient with Lynch syndrome, as this condition increases the risk for certain cancers. Here’s a structured overview to help you navigate this situation:
Main Points:
- Hematuria Definition & Causes: The presence of blood in urine (hematuria) can occur for benign reasons or may indicate more serious conditions, especially in individuals with Lynch syndrome.
- Evaluating Risk: While hematuria can be a symptom of urothelial cancer, it's essential to understand the context and follow appropriate medical guidance.
Explanation:
Hematuria can result from infections, kidney stones, benign tumors, or, less commonly, cancers such as urothelial carcinoma. In someone with Lynch syndrome, careful monitoring and evaluation are vital since this genetic disorder is associated with an increased risk of certain cancers, including those of the urinary tract.
Your wife's initial urinalysis showing a high number of RBCs is notable, and the subsequent reduction in RBCs may indicate a transient issue or fluctuation. However, the previous positive occult blood results from last year warrant further investigation, as they may suggest that the hematuria was not properly addressed.
Next Steps:
-
Await Urology Referral: Since you expect a referral to a urologist, prepare any questions you might have about hematuria, Lynch syndrome implications, and necessary tests.
-
Keep a Record of Symptoms: Monitor any changes or new symptoms (pain, changes in urination patterns, etc.) over the next few weeks. This can help in discussions with the urologist.
-
Stay Informed: Learn about possible diagnostic tests such as a cystoscopy or imaging studies (like a CT scan) that might be used to assess for causes of hematuria.
-
Advocate for Follow-Up: If the referral is delayed, consider reaching out to her primary care provider for the follow-up plan, emphasizing the significance of her historical lab results and hematuria.
-
Manage Anxiety: While it’s natural to be concerned, focus on the steps you can take, and remain supportive of your wife as she navigates this situation.
Your proactive approach is vital, and while it's essential to address the findings promptly, keep in mind that not all hematuria indicates cancer. The next steps with professionals will provide clarity and guide appropriate management. If you have more questions along the way, feel free to seek further information.
Related Questions
Seeking Answers for Unusual Stool Appearance
A 41-year-old woman, who has been diagnosed with Hashimoto’s and takes Synthroid along with a daily dose of vitamin B12 and a weekly intake of vitamin D, is contemplating visiting a gastroenterologist. She often experiences bloating, particularly after consuming raw vegetables and green foods. Recently, she noticed a strange, string-like substance in her stool, which has left her feeling alarmed and anxious. She would greatly appreciate any guidance or insight on this matter.
17-Year-Old Female Experiencing Chronic Acne Scarring on Back and Arms Despite Prescription Remedies
Age: 17 Gender: Female Country of residence: United Kingdom Skin type: Dark / Black Medical background: No significant health issues Medications: Previously utilized azelaic acid and benzoyl peroxide Timeframe: Many months to years following acne resolution Greetings, I am a 17-year-old girl dealing with long-lasting scars on my back and upper arms from acne, which have not improved even after following prescribed treatments. In the past, I experienced acne primarily on my upper back, shoulders, and arms. While the active breakouts have largely ceased, I am left with noticeable dark spots and irregular skin texture. The scars I have include: • Dark brown hyperpigmentation • Certain areas appear slightly sunken • Uneven or coarse surface • No raised or keloid scars present My GP prescribed azelaic acid and benzoyl peroxide, which I applied regularly. Unfortunately, the azelaic acid did not significantly lighten the scars and seemed inadequate for the pigmentation level. Although benzoyl peroxide was effective against my active acne, it did not enhance the appearance of the scarring. The marks have been present for a considerable time and are quite stark against my skin tone. I do my best to avoid picking at my skin and maintain proper hygiene, yet the scars aren’t diminishing on their own, which is negatively impacting my self-esteem—especially when I wear sleeveless or backless outfits. Currently, I'm exploring the possibility of using retinoids like adapalene or tretinoin. However, I’m uncertain if these would be suitable or effective for treating scarring on my back and arms, particularly with my darker skin type. I would like guidance on the following questions: • Does this seem to be primarily post-inflammatory hyperpigmentation, atrophic acne scars, or possibly a combination of both? • Is azelaic acid effective for this type of scarring, or are more potent treatments generally required? • Are topical retinoids such as adapalene or tretinoin advisable for this sort of scarring? • What treatments are typically recommended for acne scars on the back and arms in individuals with darker skin tones? • Should I insist on a referral to a dermatologist, or is it better to attempt specific topical therapies first? Any insights or recommendations you could offer would be greatly appreciated.
Persistent Itching and Burning Around Neck and Scalp - Should I Keep Using Cephalexin?
Greetings, I’m a 35-year-old female. I recently developed a rash that began on the back of my neck and subsequently spread to my ears. After consulting with my physician, I was prescribed ketoconazole shampoo to address a suspected fungal rash. Despite using it diligently for four days, the condition actually aggravated, affecting my ears, the back of my neck, and my scalp more significantly. Seeking further assistance, I visited an urgent care facility where the medical staff suggested that I might be experiencing bacterial folliculitis. As a result, they prescribed cephalexin, which I am to take at a dosage of 500mg three times daily for a week. I took my first dose yesterday, yet the intense itching and burning sensations persist without improvement. Is it advisable for me to continue the medication? How long does it typically take to see improvement? Is it common to experience these symptoms alongside bacterial folliculitis? I appreciate your time and any guidance you can provide on this matter!
Concerns About Hearing Loss After Extended Earphone Use
For the past two and a half years, I have primarily relied on in-ear earphones, with the right one typically experiencing less usage—mostly for short videos or brief instances. Recently, during a singing session, I noticed something unusual. I covered one ear to monitor my pitch, and I was surprised to find that my hearing felt unclear and somewhat muffled. This was an experience I hadn’t recognized before. After conducting a few tests by alternately covering each ear, I discovered that my left ear can hear clearly and accurately, while my right ear perceives sounds as muffled, as if there’s a barrier in front of the speaker. I’m seeking advice as a 17-year-old student from Pune, India, with financial constraints that prevent me from adding stress to my parents. I’m deeply concerned whether this issue could be permanent, and if there’s any possibility of recovery. Although I can still hear sounds from my right ear when they are very close, I am unsure of the next steps. I have made the decision to discontinue using earphones starting today, but I’m wondering what additional measures I should take. Would it be advisable to pursue an audiometry test or consult an audiologist for a professional evaluation?
Experiencing Headaches and Vision Changes on One Side
Hello, I'm an 18-year-old female, and I've been on a 15mg dose of Isotretinoin for my acne treatment for about a month now. Recently, I've been feeling under the weather, dealing with a viral infection that resembles cold or flu symptoms. I've got the usual problems like nasal congestion and a throat that hurts, but I've also noticed some joint discomfort, a sense of mental cloudiness, and an unsettling change in my vision, making it appear distorted as if seen through a low-resolution lens. Additionally, when I change my position from sitting to standing, there's an intense throbbing sensation on the right side of my head, accompanied by a momentary blackout in my right eye. I must admit, my nutritional intake has not been great lately due to feeling fatigued from the cold, and this has been accompanied by headaches and a notable darkening of my vision when I stand, which is something I've never before experienced just on one side until now. I tend to get quite anxious about my health, so I'm reaching out to see if anyone else has encountered similar symptoms with a cold, or if this could be associated with the Isotretinoin I'm taking? Any insights or advice would be greatly appreciated, thank you!