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Revision as of 16:15, 5 February 2019

Bladder cancer Microchapters

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Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Bladder cancer from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Staging

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shanshan Cen, M.D. [2]

Overview

Bladder cancer must be differentiated from renal cancer, renal stones, prostate cancer, and cystitis.

Differential Diagnosis

The most common presentation of bladder cancer is hematuria, in the advanced cases, the presentation can be bladder mass. Bladder cancer must be differentiated from other causes of hematuria as in the below table:

Diseases Clinical manifestations Para-clinical findings Gold standard
Symptoms Physical examina
Lab Findings Diagnosi
Low back pain Fever Nausea/

Vomiting

Urinary symptoms Hypertension Pitting edema Other
Dysuria Frequency Oliguria
Glomerular diseases IgA nephropathy[1][2] (Berger nephropathy) + - - - + + + - - Biopsy:

IgA deposited in a diffuse granular patte-rn in the mesangium

Biopsy
Hereditary nephritis[3][4] (Alport syndrome) - - - - - - + -
  • Cataract
  • Hearing loss
 Biopsy:
  • Monoclonal antibodies directed against alpha-3 (IV), alpha-4 (IV), and alpha-5 (IV) chains of typ-e IV collagen
 Genetic analysis
Post-streptococcal glomerulonephritis[5][6] +/- + - - + + + +
  • Edema
  • Anemia
  • Increased Blood Pressure
  • Urine samples for protein and blood

Biopsy

  • Irregularly thin and attenuated GBM
  • Splitting of GBM
  • Scarring
  • Immunoglobulin G and C3 in a diffuse granular pattern
  • Starr-y sky pattern
 Biopsy
Focal segmental glomerular sclerosis[7][8][9] - - - - - - + +
  • Nephrotic syndrome
  • ESRD
  • Pleural effusion
  • Ascites
  • Abdominal pain
  • Urinalysis reveals large amounts of protein, along with hyaline and broad waxy casts
  • Hepatitis B or C infection
  • Antineutrophil cytoplasmic antibody titers, serum protein electrophoresis
 Biopsy
  • Segmental solidification in the perihilar region and peripheral areas, specially the tubular pole
  • Coarsely granular deposits -of IgM and C3
 Biopsy
Rapidly progressive glomerulonephritis[10][11][12] + + + - - - + -
  • Abdominal pain
  • Painful cutaneous nodules
  • Migratory polyarthropathy
  • Sinusitis
  • Cough
  • Hemoptysis.
  • Low iron
  • Eosinophilia
  • Increased serum creatinine level
  • Eleated LDH and CPK
  • Proteinuria
 Biopsy:
  • Diffuse, proliferative, necrotizing glomerulonephritis with cresc-ent formation
 Biopsy
Lupus nephritis[13][14] - + - - - - + +
  • Foamy dark urine
  • Weight gain
 Biopsy,
  • Different pathologies, CLICK HERE for more- information.
 Biopsy
Fabry disease - - - - - - + + -
  • Hematuria
  • Proteinuria
 Biopsy Biopsy
Disease Low back pain Fever Nausea/

Vomiting

Dysuria Frequency Oliguria Hypertension Pitting edema Other Lab Findings Diagnosis method Gold standard
Tubulointerstitial diseases[15][16][17] + + + – – – – – Rash Biopsy:
  • Edema and infiltration by mononuclear cells, (principally lymphocytes)
  • Eosinophils are present, often in large numbers.
 Renal biopsy
Nephrolithiasis[18][19] + ± + ± ± ± – –
  • Radiating pain to groin
  • Hydronephrosis +/- in sonography
  • Abdominal CT scan without contrast
 Abdominal CT scan without contrast
Reflux nephropathy (hydronephrosis) + + - - - - - +
  • Elevated WBC count
  • Elevated BUN
  • Hyperkalemia
  • Ultrasound: Hydronephrosis +/-
  • Biopsy: Kidney scar
 –
Malignancy Renal cell carcinoma (RCC)[20][21] - - - - - - ± ±
  • Flank mass
  • Anemia
  • Hematuria
 –
Nephroblastoma (Wilms tumor)[22][23] - - - - - - - -
  • Abdominal pain

Biopsy:

Biopsy
Bladder cancer[27][28][29] - - - - ± ± - - Suprapubic pain Ultrasound, CT scan, Biopsy Biopsy
Prostate cancer[30][31] ± - - - ± ± - - - Ultrasound, CT scan, Biopsy Biopsy
Disease Low back pain Fever Nausea/

Vomiting

Dysuria Frequency Oliguria Hypertension Pitting edema Other Lab Findings Diagnosis method Gold standard
Familial diseases Polycystic kidney disease[32][33] + - - - - - + + Ultrasound:
  • Unilateral or bilateral cysts

CT:

  • Hyperdense appearance,
  • Septations
  • Calcifications

Genetic testing demonstrates:

  • Frame insertions/deletions
  • Non-canonical splice site alterations
  • Combined missense changes

Biopsy:

  • Interstitial fibrosis
  • Tubular atrophy
  • Thickening and lamellation of tubular basement membranes
  • Microcysts
 Ultrasound
Vascular diseases Renal vein thrombosis[34][35] + + + - - - - -
  • Asymptomatic
  • Abdominal pain
  • Acute in onset
  • Elevation in serum lactate dehydrogenase
  • Cholesterol levels for hypercholesterolemia
  • Albumin levels for hypoalbuminemia
  • Serum complement levels
  • Ultrasound,
  • Venography
 Renal venography: Gold standard
Wegner's granulomatosis polyangiitis[36][37][38][39] - - - - - +/- + +
  • URTI
  • CNS involvement
  • Ophthalmic involvement
  • Proteniuria
  • Microscopic hematuria
  • RBC casts
 CT chest:

Biopsy:

Biopsy
Henoch-Schönlein purpura[40][41] - - - - - +/- +/- +
  • Abdominal pain
  • Rash
  • Hematuria
  • Proteniuria
  • Microscopic hematuria
  • RBC casts
 Biopsy:

IgA deposited in a diffuse granular pattern in the mesangium

Renal biopsy, and clinical syndrome
Disease Low back pain Fever Nausea/

Vomiting

Dysuria Frequency Oliguria Hypertension Pitting edema Other Lab Findings Diagnosis method Gold standard
Lower urinary tract diseases Benign prostatic hyperplasia +/- - - + + - - -
  • Nocturia
  • Other voiding symptoms
    • Slow urinary stream
    • Splitting or spraying of the urinary stream
    • Intermittent urinary stream
    • Hesitancy
    • Straining to void
    • Terminal dribbling
  • Urinalysis to rule out UTI
  • Elevated BUN/Cr
  • High PSA values
  • Urine cytology to screen for bladder cancer
  • Biopsy to rule out cancer
 Biopsy
Urolithiasis[42][43][44] + +/- + + + + - - Flank, groin pain
  • Urine analysis
  • High Cr
 Abdominppelvic CT scan without contrast Abdominppelvic CT scan without contrast
Disease Low back pain Fever Nausea/

Vomiting

Dysuria Frequency Oliguria Hypertension Pitting edema Other Lab Findings Diagnosis method Gold standard
Infectious diseases Pyelonephritis[45][46] + + + + + + - - CT and ultrasound:
  • Enlarged kidneys
  • Round swollen kidneys
  • Hypodense appearance
  • Abscesses may not be present
 -
Cystitis[47][48] - - - + + + - -
  • Ultrasound:
  • Presence of a gas in the bladder wall.
  • Also help to detect the presence of a tumor or a stone.
 Urine culture
Prostatitis[49][50] - + - + + + - -
  • Body aches
 Ultrasound:
  • Focal hypoechoic region located in the peripheral part of the prostate

CT scan:

-
Urethritis[51][52] -/- + - + + + - -
  • Urethral discharge

CT scan:

  • Diffuse, circumferential urothelial wall thickening and contrast-enhancement
  • Periureteric or perinephric fat stranding.
 Urine culture
Urogenital trauma Inserted bladder or ureteral catheters - - - + + + - -
  • History of truma
 Hematuria Retrograde Urethrography Retrograde Urethrography

Lower abdominal mass can be classified to the gynecological and non-gynecological causes. Bladder cancer in the advanced cases can present as a bladder mass. Below table discusses lower abdominal mass causes:

References

  1. ↑ Donadio JV, Grande JP (2002). "IgA nephropathy". N Engl J Med. 347 (10): 738–48. doi:10.1056/NEJMra020109. PMID 12213946.
  2. ↑ Suzuki H, Kiryluk K, Novak J, Moldoveanu Z, Herr AB, Renfrow MB; et al. (2011). "The pathophysiology of IgA nephropathy". J Am Soc Nephrol. 22 (10): 1795–803. doi:10.1681/ASN.2011050464. PMID 21949093.
  3. ↑ McCarthy PA, Maino DM (2000). "Alport syndrome: a review". Clin Eye Vis Care. 12 (3–4): 139–150. PMID 11137428.
  4. ↑ Bodziak KA, Hammond WS, Molitoris BA (1994). "Inherited diseases of the glomerular basement membrane". Am J Kidney Dis. 23 (4): 605–18. PMID 8154501.
  5. ↑ Yoshizawa N, Yamakami K, Fujino M, Oda T, Tamura K, Matsumoto K, Sugisaki T, Boyle MD (July 2004). "Nephritis-associated plasmin receptor and acute poststreptococcal glomerulonephritis: characterization of the antigen and associated immune response". J. Am. Soc. Nephrol. 15 (7): 1785–93. PMID 15213266.
  6. ↑ Oda T, Yoshizawa N, Yamakami K, Tamura K, Kuroki A, Sugisaki T, Sawanobori E, Higashida K, Ohtomo Y, Hotta O, Kumagai H, Miura S (September 2010). "Localization of nephritis-associated plasmin receptor in acute poststreptococcal glomerulonephritis". Hum. Pathol. 41 (9): 1276–85. doi:10.1016/j.humpath.2010.02.006. PMID 20708459.
  7. ↑ Kwoh C, Shannon MB, Miner JH, Shaw A (2006). "Pathogenesis of nonimmune glomerulopathies". Annu Rev Pathol. 1: 349–74. doi:10.1146/annurev.pathol.1.110304.100119. PMID 18039119.
  8. ↑ Reidy K, Kaskel FJ (March 2007). "Pathophysiology of focal segmental glomerulosclerosis". Pediatr. Nephrol. 22 (3): 350–4. doi:10.1007/s00467-006-0357-2. PMC 1794138. PMID 17216262.
  9. ↑ D'Agati VD, Fogo AB, Bruijn JA, Jennette JC (2004). "Pathologic classification of focal segmental glomerulosclerosis: a working proposal". Am J Kidney Dis. 43 (2): 368–82. PMID 14750104.
  10. ↑ Couser WG (1998). "Pathogenesis of glomerular damage in glomerulonephritis". Nephrol Dial Transplant. 13 Suppl 1: 10–5. PMID 9507491.
  11. ↑ Atkins RC, Nikolic-Paterson DJ, Song Q, Lan HY (1996). "Modulators of crescentic glomerulonephritis". J Am Soc Nephrol. 7 (11): 2271–8. PMID 8959617.
  12. ↑ Jennette JC (March 2003). "Rapidly progressive crescentic glomerulonephritis". Kidney Int. 63 (3): 1164–77. doi:10.1046/j.1523-1755.2003.00843.x. PMID 12631105.
  13. ↑ Schwartz N, Goilav B, Putterman C (September 2014). "The pathogenesis, diagnosis and treatment of lupus nephritis". Curr Opin Rheumatol. 26 (5): 502–9. doi:10.1097/BOR.0000000000000089. PMC 4221732. PMID 25014039.
  14. ↑ Giannico G, Fogo AB (2013). "Lupus nephritis: is the kidney biopsy currently necessary in the management of lupus nephritis?". Clin J Am Soc Nephrol. 8 (1): 138–45. doi:10.2215/CJN.03400412. PMID 22977215.
  15. ↑ Baker, R. J.; Pusey, C. D. (2004). "The changing profile of acute tubulointerstitial nephritis". Nephrology Dialysis Transplantation. 19 (1): 8–11. doi:10.1093/ndt/gfg464. ISSN 0931-0509.
  16. ↑ Kelly C, Tomaszewski J, Neilson E. Immunopathogenic mechanisms of tubulointerstitial injury. In: Tisher C, Brenner B, eds, Renal Pathology: With Clinical and Functional Correlations, 2nd Edn., Vol. 1. J. B. Lippincott & Co, Philadelphia, PA, 1994; 699–722
  17. ↑ Dharmarajan TS, Yoo J, Russell RO, Boateng YA. Acute post streptococcal interstitial nephritis in an adult and review of the literature. Int Urol Nephrol 1999; 31:145
  18. ↑ Hochreiter W, Knoll T, Hess B (February 2003). "[Pathophysiology, diagnosis and conservative therapy of non-calcium kidney calculi]". Ther Umsch (in German). 60 (2): 89–97. doi:10.1024/0040-5930.60.2.89. PMID 12649987.
  19. ↑ Trinchieri A (February 2013). "Diet and renal stone formation". Minerva Med. 104 (1): 41–54. PMID 23392537.
  20. ↑ Cohen HT, McGovern FJ (2005). "Renal-cell carcinoma". N Engl J Med. 353 (23): 2477–90. doi:10.1056/NEJMra043172. PMID 16339096.
  21. ↑ Leveridge MJ, Bostrom PJ, Koulouris G, Finelli A, Lawrentschuk N (June 2010). "Imaging renal cell carcinoma with ultrasonography, CT and MRI". Nat Rev Urol. 7 (6): 311–25. doi:10.1038/nrurol.2010.63. PMID 20479778.
  22. ↑ Jolly RD, Stellwagen E, Babul J, Vodkaĭlo LV, Titov VL, Moldomusaev DM, Maianskiĭ AN (November 1975). "Mannosidosis of Angus Cattle: a prototype control program for some genetic diseases". Adv Vet Sci Comp Med. 19 (23): 1–21. PMID 1978.
  23. ↑ Stefanowicz J, Sierota D, Balcerska A, Stoba C (2004). "[Wilms' tumour of unfavorable histology--results of treatment with the SIOP 93-01 protocol at the Gdańsk centre. Preliminary report]". Med Wieku Rozwoj (in Polish). 8 (2 Pt 1): 197–200. PMID 15738594.
  24. ↑ Hartman DS, Sanders RC (April 1982). "Wilms' tumor versus neuroblastoma: usefulness of ultrasound in differentiation". J Ultrasound Med. 1 (3): 117–22. PMID 6152936.
  25. ↑ De Campo JF (1986). "Ultrasound of Wilms' tumor". Pediatr Radiol. 16 (1): 21–4. PMID 3003660.
  26. ↑ Cahan LD (1985). "Failure of encephalo-duro-arterio-synangiosis procedure in moyamoya disease". Pediatr Neurosci. 12 (1): 58–62. PMID 4080660.
  27. ↑ Pons F, Orsola A, Morote J, Bellmunt J (2011). "Variant forms of bladder cancer: basic considerations on treatment approaches". Curr Oncol Rep. 13 (3): 216–21. doi:10.1007/s11912-011-0161-4. PMID 21360040.
  28. ↑ Metts MC, Metts JC, Milito SJ, Thomas CR (June 2000). "Bladder cancer: a review of diagnosis and management". J Natl Med Assoc. 92 (6): 285–94. PMC 2640522. PMID 10918764.
  29. ↑ Rom M, Kuehhas FE, Djavan B (2007). "New findings in bladder and prostate cancer: highlights of the 22nd annual congress of the European association of urology, march 21-24, 2007, berlin, Germany". Rev Urol. 9 (4): 214–9. PMC 2199502. PMID 18231618.
  30. ↑ Chung SD, Liu SP, Lin HC (2013). "Association between prostate cancer and urinary calculi: a population-based study". PLoS ONE. 8 (2): e57743. doi:10.1371/journal.pone.0057743. PMC 3581486. PMID 23451265.
  31. ↑ Rom M, Kuehhas FE, Djavan B (2007). "New findings in bladder and prostate cancer: highlights of the 22nd annual congress of the European association of urology, march 21-24, 2007, berlin, Germany". Rev Urol. 9 (4): 214–9. PMC 2199502. PMID 18231618.
  32. ↑ Gabow PA (July 1993). "Autosomal dominant polycystic kidney disease". N. Engl. J. Med. 329 (5): 332–42. doi:10.1056/NEJM199307293290508. PMID 8321262.
  33. ↑ Adeva M, El-Youssef M, Rossetti S, Kamath PS, Kubly V, Consugar MB, Milliner DM, King BF, Torres VE, Harris PC (January 2006). "Clinical and molecular characterization defines a broadened spectrum of autosomal recessive polycystic kidney disease (ARPKD)". Medicine (Baltimore). 85 (1): 1–21. doi:10.1097/01.md.0000200165.90373.9a. PMID 16523049.
  34. ↑ U. Kuhlmann, J. Steurer, A. Bollinger, G. Pouliadis, J. Briner & W. Siegenthaler (1981). "[Incidence and clinical significance of thromboses and thrombo-embolic complications in nephrotic syndrome patients]". Schweizerische medizinische Wochenschrift. 111 (27–28): 1034–1040. PMID 7268357. Unknown parameter |month= ignored (help)
  35. ↑ F. Llach, S. Papper & S. G. Massry (1980). "The clinical spectrum of renal vein thrombosis: acute and chronic". The American journal of medicine. 69 (6): 819–827. PMID 7446547. Unknown parameter |month= ignored (help)
  36. ↑ Pagnoux C (2016). "Updates in ANCA-associated vasculitis". Eur J Rheumatol. 3 (3): 122–133. doi:10.5152/eurjrheum.2015.0043. PMID 27733943.
  37. ↑ Lee KS, Kim TS, Fujimoto K, Moriya H, Watanabe H, Tateishi U, Ashizawa K, Johkoh T, Kim EA, Kwon OJ (2003). "Thoracic manifestation of Wegener's granulomatosis: CT findings in 30 patients". Eur Radiol. 13 (1): 43–51. doi:10.1007/s00330-002-1422-2. PMID 12541109.
  38. ↑ Kallenberg CG, Heeringa P, Stegeman CA (2006). "Mechanisms of Disease: pathogenesis and treatment of ANCA-associated vasculitides". Nat Clin Pract Rheumatol. 2 (12): 661–70. doi:10.1038/ncprheum0355. PMID 17133251.
  39. ↑ Jennette JC, Falk RJ (November 1997). "Small-vessel vasculitis". N. Engl. J. Med. 337 (21): 1512–23. doi:10.1056/NEJM199711203372106. PMID 9366584.
  40. ↑ Jennette JC, Falk RJ (November 1997). "Small-vessel vasculitis". N. Engl. J. Med. 337 (21): 1512–23. doi:10.1056/NEJM199711203372106. PMID 9366584.
  41. ↑ Chen JY, Mao JH (February 2015). "Henoch-Schönlein purpura nephritis in children: incidence, pathogenesis and management". World J Pediatr. 11 (1): 29–34. doi:10.1007/s12519-014-0534-5. PMID 25557596.
  42. ↑ Hochreiter W, Knoll T, Hess B (February 2003). "[Pathophysiology, diagnosis and conservative therapy of non-calcium kidney calculi]". Ther Umsch (in German). 60 (2): 89–97. doi:10.1024/0040-5930.60.2.89. PMID 12649987.
  43. ↑ Flannigan R, Choy WH, Chew B, Lange D (June 2014). "Renal struvite stones--pathogenesis, microbiology, and management strategies". Nat Rev Urol. 11 (6): 333–41. doi:10.1038/nrurol.2014.99. PMID 24818849.
  44. ↑ Pereira DJ, Schoolwerth AC, Pais VM (March 2015). "Cystinuria: current concepts and future directions". Clin. Nephrol. 83 (3): 138–46. PMID 25685869.
  45. ↑ Pereira DJ, Schoolwerth AC, Pais VM (March 2015). "Cystinuria: current concepts and future directions". Clin. Nephrol. 83 (3): 138–46. PMID 25685869.
  46. ↑ Rosen DA, Hooton TM, Stamm WE, Humphrey PA, Hultgren SJ (2007). "Detection of intracellular bacterial communities in human urinary tract infection". PLoS Med. 4 (12): e329. doi:10.1371/journal.pmed.0040329. PMC 2140087. PMID 18092884.
  47. ↑ Franco AV (2005). "Recurrent urinary tract infections". Best Pract Res Clin Obstet Gynaecol. 19 (6): 861–73. doi:10.1016/j.bpobgyn.2005.08.003. PMID 16298166.
  48. ↑ Franco AV (2005). "Recurrent urinary tract infections". Best Pract Res Clin Obstet Gynaecol. 19 (6): 861–73. doi:10.1016/j.bpobgyn.2005.08.003. PMID 16298166.
  49. ↑ John N. Krieger, Ulrich Dobrindt, Donald E. Riley & Eric Oswald (2011). "Acute Escherichia coli prostatitis in previously health young men: bacterial virulence factors, antimicrobial resistance, and clinical outcomes". Urology. 77 (6): 1420–1425. doi:10.1016/j.urology.2010.12.059. PMID 21459419. Unknown parameter |month= ignored (help)
  50. ↑ Sharp VJ, Takacs EB, Powell CR (2010). "Prostatitis: diagnosis and treatment". Am Fam Physician. 82 (4): 397–406. PMID 20704171.
  51. ↑ McNagny SE, Parker RM, Zenilman JM, Lewis JS (1992). "Urinary leukocyte esterase test: a screening method for the detection of asymptomatic chlamydial and gonococcal infections in men". J. Infect. Dis. 165 (3): 573–6. PMID 1538163.
  52. ↑ Brill JR (2010). "Diagnosis and treatment of urethritis in men". Am Fam Physician. 81 (7): 873–8. PMID 20353145.

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