Bladder Cancer: Diagnosis and Evaluation: Difference between revisions

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 '''See [[CUA: Muscle-invasive Bladder Cancer (2019)|2019 CUA Muscle-Invasive Bladder Cancer Guideline Notes]]'''
+== Presentation ==
+* '''<span style="color:#ff0000">Hematuria</span>'''
+** '''<span style="color:#ff0000">Gross, painless hematuria is the primary symptom in 85% of patients with a newly diagnosed bladder tumor</span>'''
+*** '''<span style="color:#ff0000">Microscopic hematuria occurs in virtually all patients</span>'''
+*** '''In NMIBC, painless hematuria (gross or microscopic) is most common presenting system'''
+** '''Any episode of gross hematuria should be evaluated even if subsequent urinalysis is negative'''
+** '''<span style="color:#ff0000">A full gross hematuria evaluation includes (4):</span>'''
+**# '''<span style="color:#ff0000">Cystoscopy</span>'''
+**# '''<span style="color:#ff0000">Urine cytology</span>'''
+**# '''<span style="color:#ff0000">Upper-tract imaging</span>'''
+**#* '''<span style="color:#ff0000">For gross hematuria, CT urogram preferred over US</span>'''
+**# '''<span style="color:#ff0000">Serum PSA</span>'''
+**#* '''Recommended because 10% of patients with recurrent gross hematuria will have prostate cancer'''
+*** '''The risk of malignancy in patients with recurrent gross or microscopic hematuria that had a full, negative evaluation is near zero within the first 6 years[https://pubmed.ncbi.nlm.nih.gov/10647670/]'''
+**** Design: prospective cohort study
+**** Population: 1,930 patients with microscopic and macroscopic hematuria attending a clinic
+**** Results:
+***** No disease found in >60%
+***** UTI in 13%
+***** Bladder cancer in 12%
+***** Renal disease in 10%
+***** Stones in 3.5%
+***** Kidney cancer in 0.6%
+***** Prostate cancer in 0.4%
+***** Upper tract urothelial carcinoma in 0.1%
+***** A review of 1,168 patients with no diagnosis (follow-up range 2.5 to 4.2 years) has revealed no subsequent neoplastic disease.
+**** [https://pubmed.ncbi.nlm.nih.gov/10647670/ Khadra, M. H., et al.] "A prospective analysis of 1,930 patients with hematuria to evaluate current diagnostic practice." ''The Journal of urology'' 163.2 (2000): 524-527.
+* '''<span style="color:#ff0000">Storage symptoms (e.g., frequency, urgency, dysuria)</span>'''
+** '''May be associated with CIS''' in patients with no sign of UTI
 == Diagnosis and evaluation of suspected bladder cancer ==
@@ Line 23: / Line 54: @@
 * '''<span style="color:#ff0000">History</span>'''
-** '''<span style="color:#ff0000">Hematuria</span>'''
+**Characterize
-*** '''<span style="color:#ff0000">Gross, painless hematuria is the primary symptom in 85% of patients with a newly diagnosed bladder tumor</span>'''
+***Hematuria
-**** '''<span style="color:#ff0000">Microscopic hematuria occurs in virtually all patients</span>'''
+***Risk factors for bladder cancer
-**** '''In NMIBC, painless hematuria (gross or microscopic) is most common presenting system'''
-*** '''Any episode of gross hematuria should be evaluated even if subsequent urinalysis is negative'''
-*** '''<span style="color:#ff0000">A full gross hematuria evaluation includes (4):</span>'''
-***# '''<span style="color:#ff0000">Cystoscopy</span>'''
-***# '''<span style="color:#ff0000">Urine cytology</span>'''
-***# '''<span style="color:#ff0000">Upper-tract imaging</span>'''
-***#* '''<span style="color:#ff0000">For gross hematuria, CT urogram preferred over US</span>'''
-***# '''<span style="color:#ff0000">Serum PSA</span>'''
-***#* '''Recommended because 10% of patients with recurrent gross hematuria will have prostate cancer'''
-**** '''The risk of malignancy in patients with recurrent gross or microscopic hematuria that had a full, negative evaluation is near zero within the first 6 years[https://pubmed.ncbi.nlm.nih.gov/10647670/]'''
-***** Design: prospective cohort study
-***** Population: 1,930 patients with microscopic and macroscopic hematuria attending a clinic
-***** Results:
-****** No disease found in >60%
-****** UTI in 13%
-****** Bladder cancer in 12%
-****** Renal disease in 10%
-****** Stones in 3.5%
-****** Kidney cancer in 0.6%
-****** Prostate cancer in 0.4%
-****** Upper tract urothelial carcinoma in 0.1%
-****** A review of 1,168 patients with no diagnosis (follow-up range 2.5 to 4.2 years) has revealed no subsequent neoplastic disease.
-***** [https://pubmed.ncbi.nlm.nih.gov/10647670/ Khadra, M. H., et al.] "A prospective analysis of 1,930 patients with hematuria to evaluate current diagnostic practice." ''The Journal of urology'' 163.2 (2000): 524-527.
-** '''<span style="color:#ff0000">Storage symptoms (e.g., frequency, urgency, dysuria)</span>'''
-*** '''May be associated with CIS''' in patients with no sign of UTI
 * '''<span style="color:#ff0000">Physical Exam</span>'''
 ** Rarely reveals significant findings in patients with NMIBC.