Fast Five Quiz: Bladder Cancer Presentation and Diagnosis

Kyle A. Richards, MD


December 29, 2020

Painless gross hematuria is a cardinal symptom of bladder cancer. When patients present with this symptom, a diagnosis of bladder cancer should be presumed until proof to the contrary is found. Spontaneous resolution of gross or microscopic hematuria may occur in patients with bladder cancer, and this may lull the patient and the clinician into mistakenly believing that no significant entity is present. Even if the hematuria resolves, a thorough evaluation should still be performed in the absence of an obvious benign cause.

A palpable mass on physical examination can be an indication of bladder cancer, but it is rarely found in patients with non–muscle-invasive bladder cancer.

Patients with advanced disease can present with lower-extremity edema from iliac vessel compression, as well as pelvic or bony pain or flank pain from ureteral obstruction.

Irritative bladder symptoms (eg, dysuria, urgency, or frequency of urination) occur in 20%-30% of patients with bladder cancer. Although such symptoms can occur in advanced muscle-invasive disease, carcinoma in situ (CIS) is the more likely cause. Thus, when patients present with unexplained or refractory irritative symptoms, cystoscopy and urine cytology should be considered, particularly when patients smoke or have other risk factors.

Learn more about the clinical presentation of bladder cancer.


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