A prompt and accurate diagnosis of bladder cancer is critical for the successful management of patients with bladder cancer. Delays in the diagnosis and treatment of bladder cancers result in poorer outcomes. Several studies have shown that intervals of greater than 3 months from the time of diagnosis of muscle invasion until cystectomy directly correlate with a higher pathologic state and lower survival. The diagnosis of bladder cancer is often delayed due to the similarity of symptoms to those of benign disorders (e.g., urinary tract infection, interstitial cystitis, prostatitis, and the passage of renal calculi). Furthermore, symptoms are often intermittent.
However, for more than fifty years, blood in the urine (hematuria) has been recognized as "the most important single painless warning signal of disease". As a result, it is generally accepted that the presence of otherwise unexplained blood in the urine denotes a urothelial cancer in individuals over the age of 40 until proven otherwise.
A full urologic evaluation of the entire upper and lower urinary tract is indicated in such patients unless there is clear evidence of glomerular bleeding[1]. Such an evaluation should consist of cystourethroscopy, urinary cytology, and an evaluation of the upper tracts, since urothelial malignancy can be multifocal, with lesions at any site(s) between the renal pelvis and proximal urethra. Cystoscopy forms the mainstay of diagnosis and staging of bladder cancer. Urinalysis should include a microscopic and gross examination, as well as a dipstick chemical test. Nonrefrigerated urine should be examined within 30 minutes of collection. Radiographic imaging of the upper tract can consist of either a helical computed tomography (CT) scan of the abdomen/pelvis with urography or intravenous pyelography (IVP) plus renal ultrasound (US) to evaluate both the collecting systems and the renal cortex. The goal of the diagnostic evaluation is to determine the diagnosis, site, and extent of cancer, and the presence or absence of muscle-invasive disease. The most important prognostic determinant to be derived from staging is whether the tumor is organ-confined (T2 or less) or nonorgan-confined (T3 or greater).
Once invasion outside the bladder or nodal disease is documented, outcomes without systemic therapy are poor, with overall five year survival rates ranging from four to 35 percent. A similar bleak prognosis is also apparent for patients with distant metastases (e.g., lung, liver, bone), whose median survival rates range from six to nine months; few patients survive five years when metastatic disease is present.
When a health care provider's malpractice causes a delay in the diagnosis and treatment of bladder cancer and that delay results in a poorer prognosis for the patient, the health care provider may be held liable for the resulting damages.
[1] Glomerular bleeding refers to a tiny structure in the kidney that filters the blood to form urine
