Delayed Diagnosis of Invasive Bladder Cancer

This case involves a seventy-seven-year-old man who was undergoing treatment for urinary frequency, painful urination, nocturia, and hematuria. The urologist performed a cystoscopy and diagnosed the patient with an overactive bladder, interstitial cystitis, and BPH. The patient was seen every three to four months due to the waxing and waning of symptoms, but he consistently had blood in his urine. The patient got a second opinion from a pathologist who identified cancer cells under the microscope. After the patient told him of the suspicious cells, the original urologist performed a second cystoscopy, which revealed invasive bladder cancer. The patient required a neobladdar reconstruction as a result, and alleged that his care from the first physician had been inadequate.

Question(s) For Expert Witness

1. What is the standard of care in properly ruling out malignancy in this case?

Expert Witness Response E-005320

The physician on this patient’s case should have done a bladder biopsy to rule out malignancy and confirm the diagnosis of interstitial cystitis. It is sometimes difficult to see carcinoma in situ, but it may have been possible to see the cancer at the first cystoscopy. In any event, the differential diagnosis must continue until a reason for the blood in the patient’s urine is discovered. A general rule is to treat such cases as cancer until proven otherwise and to proceed with due diligence. If this had been done, it is more likely that the cancer would have been detected.