Assessment

HISTORY. Gross, painless, intermittent hematuria is the most frequently reported symptom. Occult blood may be discovered during a routine urinalysis. Dysuria and urinary frequency are also reported. Burning and pain with urination are present only if there is infection. The patient may not seek medical attention until urinary hesitance, decrease in caliber of the stream, and flank pain occur. Other symptoms may include suprapubic pain after voiding, bladder irritability, dribbling, and nocturia.

PHYSICAL EXAMINATION. The physical examination is usually normal. A bladder tumor becomes palpable only after extensive invasion into surrounding structures.

PSYCHOSOCIAL. Diagnosis of cancer and treatment of cancer with radical cystectomy and creation of a urinary diversion system can threaten sexual functioning of both men and women. The procedure can cause impotence in men and psychological problems similar to those that accompany a hysterectomy and oophorectomy in women. In addition, a portion of the vagina may be removed, thus affecting intercourse. The psychological impact of a stoma and external urinary drainage system can cause changes in body image and libido.

128 Bladder Cancer

Diagnostic Highlights

Test

Normal Result

Abnormality with Condition

Explanation

Cystoscopy/biopsy

Normal view of bladder, free of growths

Suspicious growths are seen; a small piece is removed and biopsied

Biopsy confirms the malignancy

Serum carcinoem-bryonic antigen (CEA) level

<2.5 ng/dL in non-smokers; <5.0 ng/mL in smokers

Approximately 50% of patients with late-stage bladder cancer have moderately elevated CEA levels

Useful in monitoring response to treatment and extent of disease

Urine cytology

Normal type and amount of squamous and epithelial cells of urinary tract

Abnormal cells are seen under the microscope (tumor and pretumor cells)

Evidence of urinary tract neoplasm

Other Tests: Intravenous pyelogram (IVP); ultrasonography; pelvic computed tomography (CT) scan; magnetic resonance imaging (MRI); bone scan; complete blood count (CBC)

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