# Bladder cancer

- Category: chronic
- Review status: reviewed (every claim checked against a document named on this page)
- Sources: Bladder Cancer - StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK536923/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class UD26 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care
- Verified date: 2026-08

## Verified against

- No dose - referral pathway, no medicine given in primary care

## Treatment metadata

- No drug therapy in primary care (Referral & Advice)

## Complete treatment card

```text
BLADDER CANCER
Sources: Bladder Cancer - StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK536923/ · ICPC-3 (WONCA
         International Classification of Primary Care, 3rd edition) class UD26 - condition scope
         only, no dose · No dose - referral pathway, no medicine given in primary care
Review status: REVIEWED against the source listed above  (2026-08)

IS IT THIS? - reference only, to read alongside your own examination
  SYMPTOMS - what the patient reports (4)
    - Blood in the urine, seen or found only on testing, is the most common first symptom  [blood in
      the urine]
    - Over a third of patients with visible blood in the urine are eventually diagnosed with bladder
      cancer  [blood in the urine]
    - Painful urination, urinary frequency, a pelvic mass, fatigue, or weight loss occur less often
      [burning on passing urine · fatigue · pelvic mass · urinary frequency · weight loss]
    - A smoking history of at least 10 pack-years meaningfully raises bladder cancer risk
  SIGNS - what you find (1)
    - In women, the external genitalia, introitus, and area around the urethra are inspected closely
  TESTS (7)
    - Low-risk status requires urinalysis with 10 or fewer red cells per high-power field and no
      prior hematuria
    - Urinalysis showing more than 25 red cells per high-power field marks high risk
    - CT urogram is the gold-standard imaging test for the upper urinary tract
    - Cystoscopy is the gold-standard initial test, with roughly 98% sensitivity
    - Non-muscle-invasive tumors look like frond-like growths with fine vessels that bleed easily
    - Carcinoma in situ looks like a flat, irregular red patch easily mistaken for plain
      inflammation
    - Urine cytology is only about 44% sensitive despite 96% specificity
  IF NOT THIS - what else fits (5)
    - Benign prostatic hyperplasia or bladder wall thickening from obstruction or infection can look
      similar
    - Interstitial cystitis is on the differential list
    - A urinary tract infection can present with overlapping symptoms
    - Kidney stones or an overactive bladder can produce similar symptoms
    - Radiation cystitis or a renal mass are also part of the differential
  Source  StatPearls "Bladder Cancer" - disease-level clinical article
  Status  traced to the source above

1. NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE)    [1st line]
   Adult    Bladder cancer has a notably higher incidence in Egypt historically linked to
            schistosomiasis; the GP must recognise painless blood in the urine and refer urgently
            for urology work-up. - Refer, with advice
   Peds     Children follow the same pathway: recognise and refer. No primary-care medicine is
            implied.
   Source   No dose - referral pathway, no medicine given in primary care
   Why      Bladder cancer has a notably higher incidence in Egypt historically linked to
            schistosomiasis; the GP must recognise painless blood in the urine and refer urgently
            for urology work-up.
   Caution  RED FLAG - Unexplained weight loss or palpable pelvic mass: assess urgently and refer.
            RED FLAG - Clot retention causing acute urinary retention: assess urgently and refer.
            Painless visible blood in the urine in an adult, especially with a history of
            schistosomiasis, is an urgent referral trigger for bladder cancer.
            No medicine is prescribed for this in primary care - this entry is for recognition and
            referral. Anything given is decided by the service it is referred to.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.
```

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