List symptoms of bladder carcinoma.
Painless gross hematuria throughout micturition (most common)
Irritative voiding symptoms (dysuria, urinary frequency, urgency)
Bladder outlet obstruction (rare)
Suprapubic/rectal/perineal pain
Palpable suprapubic mass (advanced cases)
Why is painless gross hematuria one of the clearest features of bladder carcinoma?
Urothelial tumors are friable and tend to bleed easily.
What should be a suspicion of irritative voiding symptoms together with sterile urine?
Irritative voiding symptoms despite sterile urine cultures should raise suspicion of a carcinoma.
Why can there be perineal pain?
Due to tumor infiltration of adjacent nerves; suprapubic pain can also be caused by bladder distention (secondary to bladder outlet obstruction).
List features of advanced/metastatic disease.
Features of uremia
Constitutional symptoms: anorexia, weight loss, fatigue
Metastatic symptoms
Enlarged lymph nodes
Liver: right upper quadrant pain, hepatomegaly, jaundice, ascites
Lungs: dyspnea, cough, chest pain, pleural effusion
Bone: pain in long bones/vertebrae, pathological fractures
Why are there features of uremia?
Bladder outlet obstruction → bilateral hydronephrosis → renal failure
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