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