Internal Medicine

0521779407-B01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:52

240 Bladder Tumors

■IVP (intravenous urogram) with tomogram, or retrograde urogram

is gold standard to evaluate upper tract for filling defects (tumors),

but CT urogram also useful and popular

■Bladder ultrasound, IVP, abdominal/pelvic CT often not diagnostic,

but can reveal large masses or large polypoid filling defects

■CT scan is useful in metastatic work-up to check for lymph nodes

and liver mets; PET CT useful with indeterminate CT; pelvic MRI can

be used for determination of local invasion

■CXR or CT chest to rule out lung mets

■Bone scan is indicated if alkaline phosphatase is abnormal or osseous

pain is present

Diagnostic Procedures

■Cystoscopy (fluorescent cystoscopy increases sensitivity), transu-

rethral resection of the bladder tumor (TURBT), and site-directed

bladder biopsy to rule out carcinoma in situ

differential diagnosis

■For hematuria or irritative voiding symptoms

➣Intravesical calculi

➣Cystitis (bacterial or fungal, etc.)

➣Interstitial cystitis (noninfectious)

➣BPH or prostatitis

➣Radiation, chemical or exogenous injury

■For Bladder Masses

➣Transitional cell carcinoma, TC Ca >90%

➣Squamous cell, SC Ca, 5% US cases: poorer prognosis except

bilharzial (secondary to schistosomiasis), which are well differ-

entiated

➣Adenocarcinoma, <2%

Most common in exstrophic bladders

Common in urachal tumor, often cystic, poorly differentiated,

poor prognosis

Must be evaluated for other sites of origin – bladder metastasis

(most to least common): melanoma, colon, prostate, lung, and

breast

➣Lymphoma, pheochromocytoma, and small cell carcinoma are

all rare.

➣Leiomyosarcoma in adults, or rhabdomyosarcoma in children

➣Benign Lesion