Bladder Cancer Initial Assessment

Clinical Presentation

Signs and Symptoms  

Microscopic or gross, painless hematuria is the most common presenting complaint in bladder cancer patients. It must be noted that gross hematuria is associated with a higher disease stage than microscopic hematuria. Urinary frequency from irritation or a reduced bladder capacity can also develop. Carcinoma in situ (CIS) may be suspected in patients with lower urinary tract symptoms (eg irritative voiding). Dysuria and urgency are other complaints, and less commonly, urinary tract infection (UTI). Upper tract obstruction or pain may occur in more advanced tumors.

Physical Examination

Rectal and vaginal bimanual palpation should be done in patients suspected of bladder cancer. In patients with locally advanced tumors, a palpable pelvic mass can be found. To assess whether there is a palpable mass or if the tumor is fixed to the pelvic wall, a bimanual examination under anesthesia should be done before and after transurethral resection of the bladder tumor (TURBT).

Diagnosis or Diagnostic Criteria

Non-muscle invasive disease may be diagnosed by initial cystoscopy and cytology. Once suspected, imaging of the upper tract collecting system is required. CIS is diagnosed by a combination of cystoscopy, urine cytology, and histological evaluation of multiple bladder biopsies. Patients should be assessed for the presence of regional or distant metastases. Tests like cystoscopy, chest radiograph/computed tomography (CT) scan, bone scan in patients with symptoms or high alkaline phosphatase, and imaging of the upper tracts with a CT/magnetic resonance imaging (MRI) scan of the abdomen and pelvis can be done.