Bladder cancer is most often a urothelial carcinoma that arises from the lining of the bladder. Smoking is the biggest risk factor, and the classic first sign is painless visible blood in the urine in an older adult.
Key symptoms
- Painless visible blood in the urine
- Frequent, urgent or painful urination
- Pelvic or flank pain in advanced disease
- Weight loss and fatigue in late stages
What you find on exam
- Usually normal in early disease
- Pallor if bleeding has caused anemia
- Bimanual pelvic exam for a fixed mass
- Smoking and workplace chemical exposure history
Tests
- Urinalysis and urine culture to exclude infection
- Cystoscopy: the key test to see the tumor
- CT urography to check the kidneys and ureters
- Urine cytology; biopsy by transurethral resection
Treatment basics
- Transurethral resection of the bladder tumor (TURBT)
- Intravesical BCG or chemotherapy for high-risk non-muscle-invasive disease
- Radical cystectomy after cisplatin-based chemotherapy for muscle-invasive disease
- Stop smoking and follow up with regular cystoscopy
Red flags
- Clots with inability to urinate
- Heavy bleeding with anemia
- Flank pain with hydronephrosis or rising creatinine
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.