Internal Medicine

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

Bladder Tumors 239

Bladder Tumors.....................................

MARKLYN J. JONES, MD and KENNETH S. KOENEMAN, MD

history & physical

History

■Tobacco most common cause (>30–50% of cases)

■Fourth leading cause of cancer death

■M > F (2.5X), White > African American

■Incidence increases with age

■Chronic cystitis, especially squamous cell Ca (indwelling catheter,

stones, Schistosoma haematobium)

■Cyclophosphamide, radiation exposure to bladder, or chemical

exposure (aromatic amines; aniline dyes most common)

Signs & Symptoms

■Hematuria, microscopic or gross, often painless in up to 80%

■Irritative voiding symptoms (frequency, urgency, dysuria), with ster-

ile urine

■Flank pain secondary to hydronephrosis/ureteral obstruction

■Bone pain (mets) or pelvic pain (mass)

■Sites of metastasis from transitional cell Ca (most to least): pelvic

lymph nodes, liver, lung, bone, and adrenal gland

tests

■History and Physical – include bimanual examination

■Urine: hematuria (always refer patient to urologist for work-up of

gross hematuria or 2 of 3 UAs with microscopic hematuria [>3

RBCs/hpf]); can have pyuria, but rule out cystitis

➣Cytology, especially positive in high-grade TC Ca or CIS

➣Special tests: BardTM BTA-STAT, NMP-22 (nuclear matrix pro-

tein), hyaluronidase ELISA, FISH, tumors with p53 overex-

pression more likely to progress and less likely to respond to

chemotherapy

■Blood: CBC (anemia), and LFTs to rule out bone or liver mets, and

alkaline phosphatase to rule out bone mets; if gross hematuria, check

PT/PTT, platelets

■Screening – Only for high-risk populations (tobacco), can per-

form UA, urine cytology or special urine tests (BTA-STAT, NMP-22,

hyaluronidase ELISA, or FISH)

■Imaging