clinical features

Last reviewed 01/2018

Features of the primary urothelial tumour may include:

• painless total haematuria - the classic presentation of bladder cancer, occurring in 70-90% of cases; 20% of patients with haematuria are found later to have a urinary tract tumour. In 10% of patients over 45 years with microscopic haematuria, tumour is responsible.
• ureteric colic - may occur due to clots from an upper tract lesion. Long, stringy clots may be seen in the urine. Heavy bleeding may cause obstruction.
• sterile pyuria, i.e. pus cells without urinary infection. May also occur with calculi, tuberculosis, partially treated infection.
• malignant cystitis - frequency, dysuria and urgency. A common presentation of carcinoma in situ. Haematuria may be absent.
• urinary tract infection in a man, or recurrent UTI in a woman
• palpable suprapubic mass

Secondary features may include:

• bladder outflow obstruction - involvement of bladder neck
• ureteric obstruction - involvement of ureteric orifices. Causes renal pain and hydronephrosis. Uraemia may occur in bilateral occlusion, but is rare.
• perineal and sacral pain - extension of tumour outside the bladder
• enlarged pelvic lymph nodes - lymphatic spread
• hepatomegaly - liver metastases
• bone pain - bony metastases

General effects of malignancy:

• weight loss, anaemia, pyrexia of unknown origin