Bladder cancer differential diagnosis

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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; however 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 pattern in the mesangium

Biopsy
Hereditary nephritis[3][4] (Alport syndrome) - - - - - - + -
  • Cataract
  • Hearing loss
Biopsy: Genetic analysis
Post-streptococcal glomerulonephritis[5][6] +/- + - - + + + +

Biopsy

Biopsy
Focal segmental glomerular sclerosis[7][8][9] - - - - - - + + Biopsy
  • Segmental solidification in the perihilar region and peripheral areas, especially the tubular pole
  • Coarsely granular deposits -of IgM and C3
Biopsy
Rapidly progressive glomerulonephritis[10][11][12] + + + - - - + - Biopsy: Biopsy
Lupus nephritis[13][14] - + - - - - + +
  • Foamy dark urine
  • Weight gain
Biopsy,
  • Different pathologies, CLICK HERE for more information.
Biopsy
Fabry disease - - - - - - + + - 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: Renal biopsy
Nephrolithiasis[18][19] + ± + ± ± ±
  • Radiating pain to groin
Abdominal CT scan without contrast
Reflux nephropathy (hydronephrosis) + + - - - - - +
Malignancy Renal cell carcinoma (RCC)[20][21] - - - - - - ± ±
Nephroblastoma (Wilms tumor)[22][23] - - - - - - - -

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
Ultrasound
Vascular diseases Renal vein thrombosis[34][35] + + + - - - - - Renal venography: Gold standard
Wegner's granulomatosis polyangiitis[36][37][38][39] - - - - - +/- + + CT chest:

Biopsy:

Biopsy
Henoch-Schönlein purpura[40][41] - - - - - +/- +/- + 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] + +/- + + + + - - 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: -
Cystitis[47][48] - - - + + + - - Ultrasound:
  • Presence of 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] -/- + - + + + - -

CT scan:

  • Diffuse, circumferential urothelial wall thickening and contrast-enhancement
  • Periureteric or perinephric fat stranding.
Urine culture
Urogenital trauma Inserted bladder or ureteral catheters - - - + + + - -
  • Retrograde urethrogram (RUG)
  • Retrograde urethrogram (RUG)

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

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