On November 12, Chinese news outlets reported that the musician Liu Huan had died, on the basis of a public letter from his wife, Lu Lu, released at her request through the journalist Shui Junyi and reported by 新黄河 on Tencent News. [1] The letter, translated here from the Chinese, says he was diagnosed with bladder cancer in September 2012 and lived with the disease for more than a decade — fourteen years, counting from that diagnosis — and that the death certificate's main cause of death reads septic shock. [1]
Bladder cancer's danger is not a single number; it depends on how far the disease has progressed when it is found. Caught before it reaches the bladder's muscle wall, it can often be cured. [2] Allowed to grow large or spread, it brings symptoms that include the inability to urinate and bone pain. [3] And blood in the urine is the disease's most common symptom — which is why it should never be waited out. [3]
The step to keep comes from the UK's National Health Service: if you ever see blood in your urine, ask for an urgent doctor's appointment — even if it is the first time it has happened, even if there is only a small amount, and even if you are not sure it was blood. [7] The blood may not look like blood at all; the NHS notes that it can color the urine pink, red or brown. [7]
Bladder cancer's danger depends on how far it has progressed
After news like this, the natural question is "how dangerous is bladder cancer, really". The US National Cancer Institute (NCI) lists what decides a prognosis: whether the cancer has reached the muscle wall of the bladder — the distinction between non-muscle-invasive and muscle-invasive disease — together with the cancer's type and grade, and the patient's age and general health. [2]
For cancer that has not reached the muscle wall, the NCI's summary is plain: "Non-muscle-invasive bladder cancer can often be cured." [2] For cancer that has grown large or spread beyond the bladder, the NCI lists symptoms that include being unable to urinate, lower back pain on one side of the body, pain in the abdomen, bone pain or tenderness, unintended weight loss, and swelling in the feet. [3] The letter's account of lung and lymph-node metastases [1] describes bladder cancer at that advanced stage.
The most common symptom is easy to miss
Blood in the urine is the most common symptom of bladder cancer, and it hides well. The NCI describes it as often slightly rusty to bright red in color — seen once, then gone for a while — and sometimes present only in amounts too small to see, discoverable by a test. [3] The NHS makes the same point in plainer words: the blood may be "bright pink, red or dark brown". [7] A symptom that comes and goes invites the wrong conclusion — that whatever it was has passed on its own.
Bladder cancer's other common signs are easy to blame on ordinary life: urinating more often than usual, pain or burning during urination, feeling the need to go even when the bladder is not full, and getting up often during the night. [3] None of these necessarily means cancer. Urinary tract infections, kidney or bladder stones, and other kidney problems could be the cause, "not cancer", as the NCI puts it. [3] That is exactly why the right response is not panic but a proper check. A doctor will most likely ask for a urine sample as the first step in diagnosing what is causing the symptoms. [3] And if the cause does turn out to be cancer, finding it early may mean it is easier to treat. [7]
Septic shock, the word on the certificate, explained
The main cause of death on the medical certificate was 感染性休克 — septic shock. [1] What does that word mean in general medicine?
Sepsis, as the US Centers for Disease Control and Prevention (CDC) defines it, is the body's extreme response to an infection — a life-threatening medical emergency in which an existing infection triggers a chain reaction throughout the body. [5] The infections that lead to sepsis most often start in the gastrointestinal tract, the lung, the skin, or the urinary tract. [5] Without fast treatment, sepsis can quickly lead to tissue damage, organ failure, and death. [5] Septic shock, per the MedlinePlus encyclopedia, is the serious condition that occurs when a body-wide infection leads to excess inflammation, releasing chemicals that cause dangerously low blood pressure. [6]
The documented risk factors for septic shock include diseases of the genitourinary system, indwelling urinary catheters, recent chemotherapy for any type of cancer, and recent infection. [6] Septic shock occurs most often in the very old and the very young, and may also occur in people with weakened immune systems. [6] Read together, those two lists describe the risks a person managing advanced urinary-tract disease and its treatment already carries. This is general medicine, and it stops at the general: the letter describes Liu Huan's own final weeks through a different route — severe diarrhea diagnosed as bacterial and immune enteritis, a worsening infection, then a high fever that would not break [1] — and this article makes no claim about his individual care.
The CDC's signs of sepsis are clammy or sweaty skin, confusion or disorientation, extreme pain or discomfort, fever with shivering or feeling very cold, a high heart rate or weak pulse, and shortness of breath. [5] The MedlinePlus entry for septic shock adds little or no urine, lightheadedness, and low blood pressure to that picture. [6] Signs like these, in a person with an infection, are what the CDC means by a life-threatening medical emergency. [5]
Tobacco is the risk you can change; the urgent rule is the one to keep
A risk factor, as the NCI defines it, is anything that increases the chance of getting a disease — and some risk factors for bladder cancer, like using tobacco, can be changed, while others, like age and family history, cannot. [4] Among the changeable ones, using tobacco, especially smoking cigarettes, is a major risk factor for bladder cancer, and tobacco contains harmful chemicals called carcinogens. [4] In the United States, the disease also occurs more often in men than in women, and the risk increases as a person gets older [4] — facts no reader can alter, but reasons to take the symptom rule seriously rather than casually.
That is what this event leaves with the reader. An illness carried quietly for more than a decade, ending in septic shock, is medically a story about stage: found before it reaches the muscle wall, bladder cancer can often be cured; [2] found late, it announces itself through bone pain, weight loss, and the inability to urinate. [3] Most people cannot change their age or sex. Most can decide not to smoke. [4] And everyone can keep the rule this article opened with: blood in the urine — even once, even a little, even if you are not sure it is blood — deserves an urgent appointment, not a wait-and-see attitude. [7]