Bladder Cancer


Step 1: View clinicals

A 57-year-old man presents following the passage of dark red urine one day ago. He had a similar episode two months ago, for which medical attention was not sought. He denies suprapubic pain, urinary urgency, frequency, or dysuria. No constitutional symptoms are present. His medical history is significant for mild hypercholesterolemia, which is well controlled on atorvastatin 5 mg/day. He is not on any antiplatelet agents or anticoagulants. He is a heavy smoker, with a 30 pack-year history. He only drinks socially. He is retired now, after working as a storekeeper in a large private company for many years. A complete blood count shows a hemoglobin of 14.2 g/dL. All other cell indices, including platelet counts are normal. A random capillary glucose, renal profile, liver profile, and coagulation profile are all normal.

Step 2: Order all relevant investigations

Urinalysis + urine cytology

Urinalysis: 100 RBC/hpf. No cell casts. Dipstick negative for nitrites and leukocyte esterase. Urine cytology: negative for malignant cells.

CT urography

There is a 2.1 cm x 2.2 cm soft-tissue mass on the right lateral bladder wall, protruding into the bladder lumen. There is no evidence of extravesical extension, locoregional lymphadenopathy, or metastatic spread. The upper urinary tracts appear normal.

Flexible cystoscopy

There is a ~2 x 2 cm raised polypoid lesion on the right lateral bladder wall. Both ureteral orifices are visible.

MRI Brain

You realize that magnetic resonance imaging (MRI) of the brain is not indicated here.

Step 3: Select appropriate management

Oncology referral
Transurethral resection of bladder tumor
Immune checkpoint inhibitor therapy

Score: ★★☆