Cancer of the bladder.Diagnosis and staging

Hematuria and frequency of urination not otherwise explained should suggest that a bladder tumor could be present. Excretory urography may increase one's suspicion. Cystoscopy and, when necessary, biopsy prove that a tumor exists. The stage, or microscopic extent, of the tumor largely governs the outlook when treatment appropriate to that stage is used. The stage consists of 5 histologic categories: non-invasion, invasion of submucosa (lamina propria), superficial muscle, deep muscle (with or without perivesical fat), and prostatic stroma or metastases. In general, cure seems probable in the first 2 stages, possible in the third, improbable in the fourth, and impossible in the fifth. Since the treatment selected depends largely on the stage of the tumor, the stage must be determined beforehand. The clinical assessment lacks the preciseness of the pathologic but becomes more accurate with increasing experience. Under general anesthesia bimanual examination and biopsy of the involved bladder wall will yield the most information.