Health Information

Essentials of diagnosis

• Irritative voiding symptoms.
• Gross or microscopic hematuria.
• Positive urinary cytology in most patients.
• Filling defect within bladder noted on imaging.

General considerations

Bladder cancer is the second most common urologic cancer, occurs more commonly in men than women, and the mean age at diagnosis is 65 years. Cigarette smoking and exposure to industrial dyes or solvents are risk factors for the disease and accounts for approximately 60% and 15% of new cases, respectively.

Clinical findings

Symptoms and signs

Hematuria – gross or microscopic, chronic or intermittent – is the presenting symptom in 85-90% of patients with bladder cancer. Irritative voiding symptoms (urinary frequency and urgency) will occur in a small percentage of patients as a result of the location or size of the cancer. Most patients with bladder cancer will fail to have signs of the disease because of its superficial nature. Masses detected on bimanual examination may be present in patients with large-volume or deeply infiltrating cancers. Hepatomegaly or supraclavicular lymphadenopathy may be present in patients with metastatic disease, and lymphedema of the lower extremities may be present as a result of locally advanced cancers or metastases to pelvic lymph nodes.

Laboratory findings

Urinalysis will reveal hematuria in the majority of cases. On occasion, it may be accompanied by pyuria. Azotemia may be present in a small number of cases associated with ureteral obstruction. Anemia may occasionally be due to chronic blood loss or to bone marrow metastases. Exfoliated cells from normal and abnormal urothelium can be readily detected in voided urine specimens. Cytology may be useful in detecting the disease at the time of initial presentation or to detect recurrence. Cytology is very sensitive in detecting cancers of higher grade and stage (80-90%) but less so in detecting superficial or well- differentiated lesions (50%). Sensitivity of detection using exfoliated cells may be enhanced by flow Cytometry.