Which of the following symptoms is the most common clinical finding associated with bladder cancer?
A. Suprapubic pain
B. Dysuria
C. Painless hematuria
D. Urinary retention
Correct Answer: C. Painless hematuria
Painless hematuria is the most common clinical finding in bladder cancer. Other symptoms include frequency, dysuria, and urgency, but these are not as common as the hematuria. Bladder carcinoma (BC) is the most common neoplasm of the urinary system. Urothelial carcinoma (UC) is the most common histologic type of BC (approximately 90%). The definition of UC is the invasion of the basement membrane or lamina propria or deeper by neoplastic cells of urothelial origin.
Option A: Suprapubic pain and urinary retention do not occur in bladder cancer. The WHO has replaced the old term transitional cell carcinoma with urothelial carcinoma. Invasion is referred to as ‘micro invasion’ when the depth of invasion is 2 mm or less. The World Health Organization (2016) classifies bladder cancers based on differentiation as low grade (grade 1 and 2) or high grade (grade 3).
Option B: Other less common symptoms include painful micturition, frequency, constitutional symptoms such as fatigue, weight loss, and a pelvic mass. In developing countries, schistosomiasis infection is an important cause of BC. Schistosoma haematobium ova embedded in the bladder wall leading to irritation, chronic inflammation, squamous metaplasia, and dysplasia, with further progression leading to squamous cell carcinoma of the urinary bladder.
Option D: Complications of UC include symptoms related to the tumor and treatment of adverse effects. Complications related to the tumor include weight loss, fatigue, UTI, metastasis, and urinary obstruction leading to chronic kidney failure. The adverse effects of surgical management include UTI, urinary leak, pouch stones, urinary tract obstruction, erectile dysfunction, and vaginal narrowing.
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