Bladder cancer differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shanshan Cen, M.D. [2]

Overview

Bladder cancer must be differentiated from renal cancer, renal stones, prostate cancer, and cystitis.

Differential Diagnosis

Bladder cancer must be differentiated from:

• Renal cancer
• Renal stones
• Prostate cancer
• Cystitis
• Glomerulonephritis
• Benign prostatic hyperplasia
• Prostatitis
• Pyelonephritis

Diseases	Symptoms		Signs			Diagnosis		Other Features
	Abdominal pain	Bowel habits	Rebound tenderness	Guarding	Genitourinary signs	Lab findings	Imaging
Colorectal cancer	LLQ	Constipation	-	-	-	Serum carcino-embryogenic antigen  Low Vit b12 Hypercalcemia	CT scan, x-ray and MRI used to show metastasis
Inflammatory bowel disease	LLQ	Bloody diarrhea	-	-	-	Leukocytosis		Colonoscopy and tissue sampling are recommended for differentiating between Crohn's disease and ulcerative colitis.
Diverticulitis	LLQ	Constipation Or Diarrhea	-	+	+	Leukocytosis	CT scan shows evidence of inflammation
Appendicitis	LLQ / RRQ	Constipation	+	+	-	Leukocytosis	Ultrasound shows evidence of inflammation	Nausea & vomiting,decreased appetite
Strangulated hernia	LLQ	-	-	-	-	No specific tests	CT scan used to detect the hernia and to show if it is single or multiple
Urethritis
Neurogenic bladder
Urethrolithiasis
Bladder stones
Cervical cancer
Urethral Cancer
Cystitis	LLQ	-	+	-	Suprapubic tenderness	Pyuria Presence of nitrites and leukocyte estrase	X ray is done to probe the suspicion of emphysematous cystitis. CT scan shows gas in the bladder in cases of emphysematous cystitis.
Prostatitis	LLQ Groin pain	-	-	-	Tender and enlarged	Serum PSA elevated Leukocytosis Elevated CRP	CT scan shows edema and enlarged prostate Abscess may be observed
Pelvic inflammatory disease	Bilateral	-	+	-	Purulent vaginal discharge	Nucleic acid amplification tests is the best laboratory test for PID.	Transvaginal utrasonography
Endometritis	LLQ	-	+	-	+	No specific tests	Ultrasound is helpful to rule out other differential diagnosis such as pelvic abscess, thrombosis and masses	Vaginal discharge Vaginal bleeding
Salpingitis	LLQ/ RLQ		+/-	+/-		Leukocytosis	Pelvic ultrasound	Vaginal discharge