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Clinical features

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

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

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