Differential diagnosis of bladder cancer

The main manifestation of bladder cancer is hematuria. There are many causes of hematuria. In addition to the urinary system and adjacent organs, various systemic diseases and drugs can cause hematuria. The identification of common diseases is as follows.

1. Kidney and ureteral tumors

The characteristic of hematuria caused by kidney and ureteral tumors is also painless macroscopic hematuria throughout the process, which is similar to bladder cancer and can occur alone or simultaneously with bladder cancer. Hematuria caused by upper urinary tract tumors may present with strip-shaped or earthworm-shaped blood clots. A clear diagnosis requires the results of B-ultrasound, CT, urography, and other examinations.

2. Urinary tract tuberculosis

In addition to hematuria, the main symptoms of urinary tuberculosis are chronic bladder irritation symptoms, accompanied by systemic symptoms such as low fever, night sweats, weight loss, fatigue, etc. It is differentiated from bladder cancer by looking for acid-fast bacilli in the urine, intravenous urography (IVP), cystoscopy, etc.

3. Prostatic hyperplasia

The main symptoms of prostatic hyperplasia are progressive dysuria and frequent urination, and sometimes gross hematuria. In the elderly, bladder cancer can coexist with prostatic hyperplasia, and urine exfoliative cytology, B-ultrasound, CT, cystoscopy and other examinations are needed to differentiate them.

4. Urolithiasis

Urolithiasis hematuria is mostly microscopic hematuria. Upper urinary tract stones may cause renal and ureteral colic, and bladder stones may cause urination interruption. They are differentiated through urinary tract plain film (KUB plain film), B-ultrasound, cystoscopy and other examinations. Bladder stones can stimulate local mucosa and lead to tumors. Therefore, when long-term bladder stones cause hematuria, the possibility of bladder cancer should be considered, and cystoscopy and biopsy should be performed if necessary.

5. Cystitis glandularis

Cystitis glandularis has obvious bladder irritation symptoms and requires cystoscopy and biopsy. Simple cystoscopy can sometimes lead to misdiagnosis.

6. Prostate cancer

Hematuria is a manifestation of tumor infiltration into the bladder, which can be confirmed by rectal examination, B-ultrasound, CT scan, biopsy, etc.

7. Others

Other diseases, such as radiation cystitis, often have a history of pelvic radiotherapy, and radial capillary dilatation, bladder mucosal ulcers and granulomas can be seen under cystoscopy, which require a biopsy for diagnosis. Cervical cancer may cause hematuria after invading the bladder, but usually there is vaginal bleeding first, which can be identified by vaginal examination.