Bladder Cancer Differential Diagnoses

  • Author: Gary David Steinberg, MD, FACS; Chief Editor: Bradley Fields Schwartz, DO, FACS   more...
 
Updated: Feb 21, 2012
 
 

Diagnostic Considerations

Any patient with gross or microscopic hematuria should be urologically evaluated. Patients with bladder cancer may have spontaneous resolution of gross or microscopic hematuria, which may lull the patient and the clinician into erroneously believing that no significant entity is present.

The presentation in bladder cancer may resemble urinary tract infection (UTI), or the 2 conditions may coexist. Both UTIs and bladder cancer cause hematuria, and bacteriuria occurs in about 50% of patients with squamous cell carcinoma. UTIs are usually associated with irritative voiding symptoms (eg, dysuria, frequency, urgency). Irritative voiding symptoms may also be caused by carcinoma in situ (CIS) or muscle-invasive bladder cancer; patients with CIS may present with irritative voiding symptoms only.

CIS is often misdiagnosed as a bladder infection and treated as such. Patients with irritative voiding symptoms that do not resolve with treatment for UTI require further evaluation. The investigation should include urine cultures for fungi and tuberculosis, as well as cytology studies.

Cystoscopy in patients with CIS may reveal a characteristic red, velvety appearance that resembles an area of inflammation, although, at times, CIS is not visible (see the image below). Diagnostic tests include a urine cytology test and/or one of several available bladder cancer markers. These tests are highly sensitive in detecting CIS. Bladder biopsies are needed to firmly establish a diagnosis. Urinary cytology is highly specific for urothelial bladder cancer, with improved sensitivity for high-grade tumors and cytology obtained by bladder wash or barbotage.

The classic appearance of carcinoma in situ as a fThe classic appearance of carcinoma in situ as a flat, velvety patch. However, using special staining techniques such as 5-aminolevulinic acid, it has been shown that significant areas of carcinoma in situ are easily overlooked by conventional cystoscopy. Courtesy of Abbott and Vysis Inc.

Unfortunately, urinary cytology is not especially helpful in early diagnosis of squamous cell carcinomas. Most of these tumors are not diagnosed until they are at an advanced stage.

With small cell carcinoma, the main differential diagnoses are high-grade urothelial carcinoma, lymphoma, and sarcoma. Additionally, metastatic small cell carcinoma should be ruled out based on the available clinical information. Because small cell carcinoma of the urinary bladder is often mixed with urothelial carcinoma and because any presence of small cell carcinoma is justifiable to render the diagnosis, it is important to thoroughly examine the tumor tissue.

Differential Diagnoses

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Contributor Information and Disclosures
Author

Gary David Steinberg, MD, FACS  The Bruce and Beth White Family Professor and Vice Chairman of Urology, Director of Urologic Oncology, Section of Urology, Department of Surgery, The University of Chicago Medical Center and Cancer Center

Gary David Steinberg, MD, FACS is a member of the following medical societies: American Association for Cancer Research, American College of Surgeons, American Urological Association, Société Internationale d'Urologie (International Society of Urology), Society of Laparoendoscopic Surgeons, and Society of Urologic Oncology

Disclosure: Predictive Biosciences Consulting fee Consulting; Abbott Molecular Consulting fee Consulting; Endo Pharmaceuticals Consulting fee Consulting; Bioniche Consulting fee Consulting; Tengion Consulting fee Consulting; Archimedes Consulting fee Review panel membership

Coauthor(s)

Stanley A Brosman, MD  Clinical Professor, Department of Urology, University of California at Los Angeles Medical School

Stanley A Brosman, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Association for Cancer Research, American Association for the Advancement of Science, American College of Surgeons, American Medical Association, American Society of Clinical Oncology, American Urological Association, Association of Clinical Research Professionals, International Society of Urological Pathology, Société Internationale d'Urologie (International Society of Urology), Society for Basic Urologic Research, Society of Surgical Oncology, Society of Urologic Oncology, and Western Section American Urological Association

Disclosure: Nothing to disclose.

Brendan Curti, MD  Director, Genitourinary Oncology Research, Robert W Franz Cancer Research Center, Earle A Chiles Research Institute, Providence Cancer Center

Brendan Curti, MD is a member of the following medical societies: American College of Physicians, American Society of Clinical Oncology, Oregon Medical Association, and Society for Biological Therapy

Disclosure: Nothing to disclose.

Bagi RP Jana, MD  Assistant Professor, University of Texas Medical Branch, Galveston, TX

Bagi RP Jana, MD is a member of the following medical societies: American Cancer Society, American Medical Association, American Society of Clinical Oncology, and Southwest Oncology Group

Disclosure: Nothing to disclose.

Zhong Jiang, MD  Professor, Department of Pathology, University of Massachusetts, Memorial Medical Center

Zhong Jiang, MD is a member of the following medical societies: College of American Pathologists, International Society of Urological Pathology, and United States and Canadian Academy of Pathology

Disclosure: Nothing to disclose.

J Stephen Jones, MD, MBA, FACS  Chairman, Department of Regional Urology, Cleveland Clinic Glickman Urological and Kidney Institute; Professor of Surgery (Urology), Cleveland Clinic Lerner College of Medicine at Case Western Reserve University School of Medicine

J Stephen Jones, MD, MBA, FACS is a member of the following medical societies: Academy of Medicine Cleveland/Northern Ohio Medical Assn, American College of Surgeons, American Urological Association, International Continence Society, Society of Urologic Oncology, and Southwest Oncology Group

Disclosure: Abbott Honoraria Speaking and teaching; Cook Honoraria Consulting; HealthTronics Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching; GTx Consulting fee Consulting

Mark H Katz, MD  Fellow in Urologic Oncology and Minimally Invasive Surgery, University of Chicago Medical Center

Mark H Katz, MD is a member of the following medical societies: Alpha Omega Alpha, American Urological Association, Endourological Society, and Society of Urologic Oncology

Disclosure: Nothing to disclose.

David A Levy, MD  Assistant Professor of Surgery (Urology), Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation

David A Levy, MD is a member of the following medical societies: American Association of Clinical Urologists, American Urological Association, and Society of Urologic Oncology

Disclosure: Nothing to disclose.

Di Lu, MD  Clinical Associate Professor, Department of Pathology, University of Massachusetts Medical School

Disclosure: Nothing to disclose.

Kush Sachdeva, MD  Southern Oncology and Hematology Associates, South Jersey Healthcare, Fox Chase Cancer Center Partner

Disclosure: Nothing to disclose.

Specialty Editor Board

Martha K Terris, MD, FACS  Professor, Department of Surgery, Section of Urology, Director, Urology Residency Training Program, Medical College of Georgia; Professor, Department of Physician Assistants, Medical College of Georgia School of Allied Health; Chief, Section of Urology, Augusta Veterans Affairs Medical Center

Martha K Terris, MD, FACS is a member of the following medical societies: American Cancer Society, American College of Surgeons, American Institute of Ultrasound in Medicine, American Society of Clinical Oncology, American Urological Association, Association of Women Surgeons, New York Academy of Sciences, Society of Government Service Urologists, Society of University Urologists, Society of Urology Chairpersons and Program Directors, and Society of Women in Urology

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Dan Theodorescu, MD, PhD  Paul A Bunn Professor of Cancer Research, Professor of Surgery and Pharmacology, Director, University of Colorado Comprehensive Cancer Center

Dan Theodorescu, MD, PhD is a member of the following medical societies: American Cancer Society, American College of Surgeons, American Urological Association, Medical Society of Virginia, Society for Basic Urologic Research, and Society of Urologic Oncology

Disclosure: Key Genomics Ownership interest Co-Founder-50% Stock Ownership; KromaTiD, Inc Stock Options Board membership

Liang Cheng, MD  Professor of Pathology and Urology, Department of Pathology and Laboratory Medicine, Indiana University School of Medicine; Chief, Genitourinary Pathology Service, Clarian Health Partners

Liang Cheng, MD is a member of the following medical societies: American Association for Cancer Research, American Urological Association, Arthur Purdy Stout Society, College of American Pathologists, International Society of Urological Pathology, and United States and Canadian Academy of Pathology

Disclosure: Nothing to disclose.

Chief Editor

Bradley Fields Schwartz, DO, FACS  Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine

Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Association of Military Osteopathic Physicians and Surgeons, Endourological Society, Society of Laparoendoscopic Surgeons, and Society of University Urologists

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors Hyung L Kim, MD, Edward M Gong, MD, and Sujeet S Acharya, MD, to the development and writing of the source articles.

References

  1. Rous SN. Squamous cell carcinoma of the bladder. J Urol. Nov 1978;120(5):561-2. [Medline].

  2. Trias I, Algaba F, Condom E, Español I, Seguí J, Orsola I, et al. Small cell carcinoma of the urinary bladder. Presentation of 23 cases and review of 134 published cases. Eur Urol. Jan 2001;39(1):85-90. [Medline].

  3. Bessette PL, Abell MR, Herwig KR. A clinicopathologic study of squamous cell carcinoma of the bladder. J Urol. Jul 1974;112(1):66-7. [Medline].

  4. Faysal MH. Squamous cell carcinoma of the bladder. J Urol. Nov 1981;126(5):598-9. [Medline].

  5. Lagwinski N, Thomas A, Stephenson AJ, Campbell S, Hoschar AP, El-Gabry E, et al. Squamous cell carcinoma of the bladder: a clinicopathologic analysis of 45 cases. Am J Surg Pathol. Dec 2007;31(12):1777-87. [Medline].

  6. El-Sebaie M, Zaghloul MS, Howard G, Mokhtar A. Squamous cell carcinoma of the bilharzial and non-bilharzial urinary bladder: a review of etiological features, natural history, and management. Int J Clin Oncol. Feb 2005;10(1):20-5. [Medline].

  7. Heyns CF, van der Merwe A. Bladder cancer in Africa. Can J Urol. Feb 2008;15(1):3899-908. [Medline].

  8. Brennan P, Bogillot O, Cordier S, Greiser E, Schill W, Vineis P, et al. Cigarette smoking and bladder cancer in men: a pooled analysis of 11 case-control studies. Int J Cancer. Apr 15 2000;86(2):289-94. [Medline]. [Full Text].

  9. Fortuny J, Kogevinas M, Chang-Claude J, González CA, Hours M, Jöckel KH, et al. Tobacco, occupation and non-transitional-cell carcinoma of the bladder: an international case-control study. Int J Cancer. Jan 5 1999;80(1):44-6. [Medline]. [Full Text].

  10. Kantor AF, Hartge P, Hoover RN, Fraumeni JF Jr. Epidemiological characteristics of squamous cell carcinoma and adenocarcinoma of the bladder. Cancer Res. Jul 1 1988;48(13):3853-5. [Medline]. [Full Text].

  11. Freedman ND, Silverman DT, Hollenbeck AR, Schatzkin A, Abnet CC. Association between smoking and risk of bladder cancer among men and women. JAMA. Aug 17 2011;306(7):737-45. [Medline].

  12. Stein JP, Skinner EC, Boyd SD, Skinner DG. Squamous cell carcinoma of the bladder associated with cyclophosphamide therapy for Wegener's granulomatosis: a report of 2 cases. J Urol. Mar 1993;149(3):588-9. [Medline].

  13. El-Bolkainy MN, Mokhtar NM, Ghoneim MA, Hussein MH. The impact of schistosomiasis on the pathology of bladder carcinoma. Cancer. Dec 15 1981;48(12):2643-8. [Medline].

  14. Botelho M, Ferreira AC, Oliveira MJ, Domingues A, Machado JC, da Costa JM. Schistosoma haematobium total antigen induces increased proliferation, migration and invasion, and decreases apoptosis of normal epithelial cells. Int J Parasitol. Aug 2009;39(10):1083-91. [Medline].

  15. Ahmad I, Barnetson RJ, Krishna NS. Keratinizing squamous metaplasia of the bladder: a review. Urol Int. 2008;81(3):247-51. [Medline]. [Full Text].

  16. Khan MS, Thornhill JA, Gaffney E, Loftus B, Butler MR. Keratinising squamous metaplasia of the bladder: natural history and rationalization of management based on review of 54 years experience. Eur Urol. Nov 2002;42(5):469-74. [Medline].

  17. Newman DM, Brown JR, Jay AC, Pontius EE. Squamous cell carcinoma of the bladder. J Urol. Oct 1968;100(4):470-3. [Medline].

  18. Faysal MH, Freiha FS. Primary neoplasm in vesical diverticula. A report of 12 cases. Br J Urol. Apr 1981;53(2):141-3. [Medline].

  19. Yurdakul T, Avunduk MC, Piskin MM. Pure squamous cell carcinoma after intravesical BCG treatment. A case report. Urol Int. 2005;74(3):283-5. [Medline].

  20. STUART WT. Carcinoma of the bladder associated with exstrophy. Report of a case and review of the literature. Va Med Mon (1918). Jan 1962;89:39-42. [Medline].

  21. Ribeiro JC, Silva C, Sousa L, García P, Santos A. [Squamous cell carcinoma in bladder extrophy]. Actas Urol Esp. Jan 2005;29(1):110-2. [Medline]. [Full Text].

  22. Gupta S, Gupta IM. Ectopia vesicae complicated by squamous cell carcinoma. Br J Urol. Aug 1976;48(4):244. [Medline].

  23. Rieder JM, Parsons JK, Gearhart JP, Schoenberg M. Primary squamous cell carcinoma in unreconstructed exstrophic bladder. Urology. Jan 2006;67(1):199. [Medline].

  24. Sheldon CA, Clayman RV, Gonzalez R, Williams RD, Fraley EE. Malignant urachal lesions. J Urol. Jan 1984;131(1):1-8. [Medline].

  25. Lin RY, Rappoport AE, Deppisch LM, Natividad NS, Katz W. Squamous cell carcinoma of the urachus. J Urol. Dec 1977;118(6):1066-7. [Medline].

  26. SHAW RE. Squamous-cell carcinoma in a cyst of the urachus. Br J Urol. Mar 1958;30(1):87-9. [Medline].

  27. Chow YC, Lin WC, Tzen CY, Chow YK, Lo KY. Squamous cell carcinoma of the urachus. J Urol. Mar 2000;163(3):903-4. [Medline].

  28. Fujiyama C, Nakashima N, Tokuda Y, Uozumi J. Squamous cell carcinoma of the urachus. Int J Urol. Oct 2007;14(10):966-8. [Medline].

  29. American Cancer Society. Cancer Facts and Figures 2010. Accessed January 5, 2011. Available at http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-026238.pdf.

  30. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics, 2009. CA Cancer J Clin. Jul-Aug 2009;59(4):225-49. [Medline].

  31. Dawson C, Whitfield H. ABC of Urology. Urological malignancy--II: Urothelial tumours. BMJ. Apr 27 1996;312(7038):1090-4. [Medline]. [Full Text].

  32. Abrahams NA, Moran C, Reyes AO, Siefker-Radtke A, Ayala AG. Small cell carcinoma of the bladder: a contemporary clinicopathological study of 51 cases. Histopathology. Jan 2005;46(1):57-63. [Medline].

  33. Lohrisch C, Murray N, Pickles T, Sullivan L. Small cell carcinoma of the bladder: long term outcome with integrated chemoradiation. Cancer. Dec 1 1999;86(11):2346-52. [Medline].

  34. Gouda I, Mokhtar N, Bilal D, El-Bolkainy T, El-Bolkainy NM. Bilharziasis and bladder cancer: a time trend analysis of 9843 patients. J Egypt Natl Canc Inst. Jun 2007;19(2):158-62. [Medline]. [Full Text].

  35. Felix AS, Soliman AS, Khaled H, Zaghloul MS, Banerjee M, El-Baradie M, et al. The changing patterns of bladder cancer in Egypt over the past 26 years. Cancer Causes Control. May 2008;19(4):421-9. [Medline].

  36. Elsobky E, El-Baz M, Gomha M, Abol-Enein H, Shaaban AA. Prognostic value of angiogenesis in schistosoma-associated squamous cell carcinoma of the urinary bladder. Urology. Jul 2002;60(1):69-73. [Medline].

  37. Pycha A, Mian C, Posch B, Haitel A, Mokhtar AA, El-Baz M, et al. Numerical chromosomal aberrations in muscle invasive squamous cell and transitional cell cancer of the urinary bladder: an alternative to classic prognostic indicators?. Urology. May 1999;53(5):1005-10. [Medline].

  38. Shaaban AA, Javadpour N, Tribukait B, Ghoneim MA. Prognostic significance of flow-DNA analysis and cell surface isoantigens in carcinoma of bilharzial bladder. Urology. Mar 1992;39(3):207-10. [Medline].

  39. Ghoneim MA, Ashamallah AK, Awaad HK, Whitmore WF Jr. Randomized trial of cystectomy with or without preoperative radiotherapy for carcinoma of the bilharzial bladder. J Urol. Aug 1985;134(2):266-8. [Medline].

  40. Cheng L, Pan CX, Yang XJ, Lopez-Beltran A, MacLennan GT, Lin H, et al. Small cell carcinoma of the urinary bladder: a clinicopathologic analysis of 64 patients. Cancer. Sep 1 2004;101(5):957-62. [Medline].

  41. Shahab N. Extrapulmonary small cell carcinoma of the bladder. Semin Oncol. Feb 2007;34(1):15-21. [Medline].

  42. Mackey JR, Au HJ, Hugh J, Venner P. Genitourinary small cell carcinoma: determination of clinical and therapeutic factors associated with survival. J Urol. May 1998;159(5):1624-9. [Medline].

  43. Choong NW, Quevedo JF, Kaur JS. Small cell carcinoma of the urinary bladder. The Mayo Clinic experience. Cancer. Mar 15 2005;103(6):1172-8. [Medline].

  44. van Rhijn BW, Burger M, Lotan Y, Solsona E, Stief CG, Sylvester RJ, et al. Recurrence and progression of disease in non-muscle-invasive bladder cancer: from epidemiology to treatment strategy. Eur Urol. Sep 2009;56(3):430-42. [Medline].

  45. Fernandez-Gomez J, Solsona E, Unda M, Martinez-Piñeiro L, Gonzalez M, Hernandez R, et al. Prognostic factors in patients with non-muscle-invasive bladder cancer treated with bacillus Calmette-Guérin: multivariate analysis of data from four randomized CUETO trials. Eur Urol. May 2008;53(5):992-1001. [Medline].

  46. Cha EK, Tirsar LA, Schwentner C, Christos PJ, Mian C, Hennenlotter J, et al. Immunocytology is a strong predictor of bladder cancer presence in patients with painless hematuria: a multicentre study. Eur Urol. Jan 2012;61(1):185-92. [Medline].

  47. Lotan Y, Roehrborn CG. Cost-effectiveness of a modified care protocol substituting bladder tumor markers for cystoscopy for the followup of patients with transitional cell carcinoma of the bladder: a decision analytical approach. J Urol. Jan 2002;167(1):75-9. [Medline].

  48. Strittmatter F, Buchner A, Karl A, et al. Individual learning curve reduces the clinical value of urinary cytology. Clin Genitourin Cancer. Sep 2011;9(1):22-6. [Medline].

  49. Grossfeld GD, Litwin MS, Wolf JS Jr, Hricak H, Shuler CL, Agerter DC, et al. Evaluation of asymptomatic microscopic hematuria in adults: the American Urological Association best practice policy--part II: patient evaluation, cytology, voided markers, imaging, cystoscopy, nephrology evaluation, and follow-up. Urology. Apr 2001;57(4):604-10. [Medline]. [Full Text].

  50. Murphy WM, Crabtree WN, Jukkola AF, Soloway MS. The diagnostic value of urine versus bladder washing in patients with bladder cancer. J Urol. Sep 1981;126(3):320-2. [Medline].

  51. Lokeshwar VB, Soloway MS. Current bladder tumor tests: does their projected utility fulfill clinical necessity?. J Urol. Apr 2001;165(4):1067-77. [Medline].

  52. [Best Evidence] Grossman HB, Soloway M, Messing E, Katz G, Stein B, Kassabian V, et al. Surveillance for recurrent bladder cancer using a point-of-care proteomic assay. JAMA. Jan 18 2006;295(3):299-305. [Medline].

  53. Al-Sukhun S, Hussain M. Molecular biology of transitional cell carcinoma. Crit Rev Oncol Hematol. Aug 2003;47(2):181-93. [Medline].

  54. Soloway MS, Briggman V, Carpinito GA, Chodak GW, Church PA, Lamm DL, et al. Use of a new tumor marker, urinary NMP22, in the detection of occult or rapidly recurring transitional cell carcinoma of the urinary tract following surgical treatment. J Urol. Aug 1996;156(2 Pt 1):363-7. [Medline].

  55. [Guideline] Babjuk M, Oosterlinck W, Sylvester R, Kaasinen E, Böhle A, Palou-Redorta J, et al. EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder, the 2011 update. Eur Urol. Jun 2011;59(6):997-1008. [Medline].

  56. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology. Bladder Cancer, v.2.2011. Available with free registration at www.nccn.org. Available at http://www.nccn.org. Accessed May 27 2011.

  57. Greene LF, Page DL, Fleming D, et al. American Joint Committee on Cancer (AJCC) Cancer Staging Manual. 6th ed. New York, NY: Springer-Verlag; 2002.

  58. [Guideline] Stenzl A, Cowan NC, De Santis M, Jakse G, Kuczyk MA, Merseburger AS, et al. The updated EAU guidelines on muscle-invasive and metastatic bladder cancer. Eur Urol. Apr 2009;55(4):815-25. [Medline].

  59. Ploeg M, Kums AC, Aben KK, et al. Prognostic factors for survival in patients with recurrence of muscle invasive bladder cancer after treatment with curative intent. Clin Genitourin Cancer. Sep 2011;9(1):14-21. [Medline].

  60. Serretta V, Galuffo A, Pavone C, Allegro R, Pavone-MacAluso M. Gemcitabine in intravesical treatment of Ta-T1 transitional cell carcinoma of bladder: Phase I-II study on marker lesions. Urology. Jan 2005;65(1):65-9. [Medline].

  61. Sylvester RJ, van der Meijden AP, Witjes JA, Kurth K. Bacillus calmette-guerin versus chemotherapy for the intravesical treatment of patients with carcinoma in situ of the bladder: a meta-analysis of the published results of randomized clinical trials. J Urol. Jul 2005;174(1):86-91; discussion 91-2. [Medline].

  62. Witjes JA, Hendricksen K. Intravesical pharmacotherapy for non-muscle-invasive bladder cancer: a critical analysis of currently available drugs, treatment schedules, and long-term results. Eur Urol. Jan 2008;53(1):45-52. [Medline].

  63. Zaharoff DA, Hoffman BS, Hooper HB, Benjamin CJ Jr, Khurana KK, Hance KW, et al. Intravesical immunotherapy of superficial bladder cancer with chitosan/interleukin-12. Cancer Res. Aug 1 2009;69(15):6192-9. [Medline]. [Full Text].

  64. Islam MA, Bhuiyan ZH, Shameem IA. Intravesical adjuvant therapy using mitomycin C. Mymensingh Med J. Jan 2006;15(1):40-4. [Medline].

  65. Herr HW, Dalbagni G, Donat SM. Bacillus calmette-guérin without maintenance therapy for high-risk non-muscle-invasive bladder cancer. Eur Urol. Jul 2011;60(1):32-6. [Medline].

  66. Mukesh M, Cook N, Hollingdale AE, Ainsworth NL, Russell SG. Small cell carcinoma of the urinary bladder: a 15-year retrospective review of treatment and survival in the Anglian Cancer Network. BJU Int. Mar 2009;103(6):747-52. [Medline].

  67. Ehdaie B, Maschino A, Shariat SF, Rioja J, Hamilton RJ, Lowrance WT, et al. Comparative outcomes of pure squamous cell carcinoma and urothelial carcinoma with squamous differentiation in patients treated with radical cystectomy. J Urol. Jan 2012;187(1):74-9. [Medline].

  68. Hall MC, Chang SS, Dalbagni G, Pruthi RS, Seigne JD, Skinner EC, et al. Guideline for the management of nonmuscle invasive bladder cancer (stages Ta, T1, and Tis): 2007 update. J Urol. Dec 2007;178(6):2314-30. [Medline]. [Full Text].

  69. O'Donnell MA, Lilli K, Leopold C. Interim results from a national multicenter phase II trial of combination bacillus Calmette-Guerin plus interferon alfa-2b for superficial bladder cancer. J Urol. Sep 2004;172(3):888-93. [Medline].

  70. Kamat AM, Dickstein RJ, Messetti F, et al. Use of fluorescence in situ hybridization to predict response to bacillus calmette-guérin therapy for bladder cancer: results of a prospective trial. J Urol. Mar 2012;187(3):862-7. [Medline]. [Full Text].

  71. [Best Evidence] Tilki D, Reich O, Svatek RS, Karakiewicz PI, Kassouf W, Novara G, et al. Characteristics and outcomes of patients with clinical carcinoma in situ only treated with radical cystectomy: an international study of 243 patients. J Urol. May 2010;183(5):1757-63. [Medline].

  72. Davis JW, Castle EP, Pruthi RS, Ornstein DK, Guru KA. Robot-assisted radical cystectomy: an expert panel review of the current status and future direction. Urol Oncol. Sep-Oct 2010;28(5):480-6. [Medline].

  73. Winquist E, Kirchner TS, Segal R, Chin J, Lukka H. Neoadjuvant chemotherapy for transitional cell carcinoma of the bladder: a systematic review and meta-analysis. J Urol. Feb 2004;171(2 Pt 1):561-9. [Medline].

  74. Chang SS, Cookson MS. Radical cystectomy for bladder cancer: the case for early intervention. Urol Clin North Am. May 2005;32(2):147-55. [Medline].

  75. Sánchez-Ortiz RF, Huang WC, Mick R, Van Arsdalen KN, Wein AJ, Malkowicz SB. An interval longer than 12 weeks between the diagnosis of muscle invasion and cystectomy is associated with worse outcome in bladder carcinoma. J Urol. Jan 2003;169(1):110-5; discussion 115. [Medline].

  76. Grossman HB, Natale RB, Tangen CM, Speights VO, Vogelzang NJ, Trump DL, et al. Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer. N Engl J Med. Aug 28 2003;349(9):859-66. [Medline].

  77. Herr HW, Faulkner JR, Grossman HB, Natale RB, deVere White R, Sarosdy MF, et al. Surgical factors influence bladder cancer outcomes: a cooperative group report. J Clin Oncol. Jul 15 2004;22(14):2781-9. [Medline]. [Full Text].

  78. Griffiths G, Hall R, Sylvester R, Raghavan D, Parmar MK. International phase III trial assessing neoadjuvant cisplatin, methotrexate, and vinblastine chemotherapy for muscle-invasive bladder cancer: long-term results of the BA06 30894 trial. J Clin Oncol. Jun 1 2011;29(16):2171-7. [Medline]. [Full Text].

  79. [Best Evidence] von der Maase H, Sengelov L, Roberts JT, Ricci S, Dogliotti L, Oliver T, et al. Long-term survival results of a randomized trial comparing gemcitabine plus cisplatin, with methotrexate, vinblastine, doxorubicin, plus cisplatin in patients with bladder cancer. J Clin Oncol. Jul 20 2005;23(21):4602-8. [Medline].

 
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In an ileal conduit, a small segment of ileum is taken out of continuity with the gastrointestinal tract but is maintained on its mesentery. Ureters are anastomosed to one end of this ileal segment, and the other end is brought out as a stoma to the abdominal wall.
In an Indiana pouch, a urinary reservoir is created from detubularized right colon and an efferent limb of terminal ileum. Terminal ileum is plicated and brought to the abdominal wall. The continence mechanism is the ileocecal valve.
In an orthotopic neobladder, a segment of ileum is used to construct a neobladder, which is connected to the urethra. Orthotopic neobladder most closely restores the natural storage and voiding function of the native bladder.
The classic appearance of carcinoma in situ as a flat, velvety patch. However, using special staining techniques such as 5-aminolevulinic acid, it has been shown that significant areas of carcinoma in situ are easily overlooked by conventional cystoscopy. Courtesy of Abbott and Vysis Inc.
Papillary bladder tumors such as this one are typically of low stage and grade (Ta-G1). Courtesy of Abbott and Vysis Inc.
Sessile lesions as shown usually invade muscle, although occasionally a tumor is detected at the T1-G3 stage prior to muscle invasion. Courtesy of Abbott and Vysis Inc.
Photograph in which fluorescence in situ hybridization centromere staining identifies aneuploidy of chromosome 3. Multiple instances of overexpression of the chromosome (note the multiple red dots, which identify centromeres of this chromosome) prove aneuploidy.
Cross-section through the bladder, uterus, and vagina with squamous cell carcinoma of the bladder infiltrating through the bladder wall into the vaginal wall.
Table 1. Clinical Findings and Recommended Action
Cystoscopy Findings Urine Cytology Findings FISH* Findings Action
NegativeNegativeNegative†Routine follow-up
NegativeNegativePositive‡Increased frequency of surveillance, whether FISH findings are false-positive or anticipatory positive
NegativePositiveNegative or positiveCancer until proven otherwise
  • Upper tract imaging with contrast
  • Cystoscopy with retrograde pyelography, washings, and/or ureteroscopy
  • Evaluate urethra
  • Increased frequency of surveillance upon negative findings
*FISH - Fluorescent in situ hybridization.



†Negative predictive value 95%.



‡Positive predictive value 30%.



Table 2. Recurrence and Progression Rates at 5 Years for Ta, T1, and CIS TCC of the Bladder Treated With BCG
Stage Recurrence, % Progression, %
Ta5511
T16131
CIS4523
G1612-4
G2565-7
G350-7030-40
Table 3. Most Common Complications of Radical Cystectomy
Early Complications Rate, % Late Complications Rate, %
Ileus10Small-bowel obstruction7.4
Wound infection5.5Ureteroenteric stricture7.0
Sepsis4.9Renal calculi3.9
Pelvic abscess4.7Acute pyelonephritis3.1
Hemorrhage3.4Parastomal hernia2.8
Wound dehiscence3.3Stomal stenosis2.8
Bowel obstruction3.0Incisional hernia2.2
Enterocutaneous fistula2.2Fistula1.3
Rectal injury2.2Rectal complications< 1
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