Can Bladder Cancer Be Mistaken For Interstitial Cystitis?

Interstitial cystitis (IC) is a chronic inflammatory disease of the bladder.(1)

Inflammation of the bladder causes pain, urinary disorders, and sexual disorders, outside any infectious context.

Probably underdiagnosed, it is difficult to know the exact number of people affected by this disease.(2)

In about 1% of cases, bladder cancer may be mistaken for IC(3,4)

There is no specific treatment for interstitial cystitis till date and symptomatic management is the primary option(5)

Can Bladder Cancer Be Mistaken For Interstitial Cystitis?

In 1% of cases, bladder cancer may be diagnosed wrongly as interstitial cystitis. Often symptoms of bladder cancer are similar to interstitial cystitis leading to the misdiagnosis. These include irritating symptoms of urination resembling IC may be due to bladder cancer. This is also true for people who have no usual risk factors for bladder cancer.(3, 4)

Since the exact causes and pathological mechanisms of interstitial cystitis remain unknown, no specific treatment could be developed. Medical management thus aims to relieve patients’ symptoms as much as possible, based on several elements:

Pain medication (analgesics, anti-inflammatory drugs, antispasmodics, antihistamines in allergic patients); sodium pentosan polysulfate (a derivative of heparin) which acts to repair the bladder wall; a hydrodistension of the bladder that works for most patients; instillation into the bladder with heparin; hyaluronic acid, Di-methyl-sulfoxide.

Surgery is reserved for the most severe cases and only as a last resort. Several surgical techniques can be used depending on the case of each patient.(5)

The interstitial cystitis is a rare bladder condition that causes pain in the lower abdomen with repeated urges for urination at any time of the day. This can be intense, often intolerable, leading to problems in socializing for the patient as he or she finds it difficult to leave home.

The pain may also involve the urethra and the vagina (in the case of women). Urinating partially or completely relieves the pains in most cases. It primarily affects the elderly, but can happen to any adult person. There is currently no cure for this chronic condition.(1)

Causes Of Interstitial Cystitis

The causes of interstitial cystitis remain unknown to this day and this disease has long been associated with psychological or even psychiatric disorders. Currently, specialists assume that this pathology would group several diseases with multiple origins.

Several factors have been implicated to explain the development of a chronic inflammatory condition of the bladder:

  • Impaired permeability of the bladder wall (found in 70% of patients);
  • Anti-proliferative factor presents only in the urine of patients with interstitial cystitis;
  • Having any neurological problem;
  • Having allergic reactions;
  • Having autoimmune disorders because many affected patients also suffer from an autoimmune pathology (rheumatoid arthritis, systemic lupus erythematosus, etc.);
  • A genetic predisposition (existence of family cases);
  • Environmental factors(2)

Symptoms Of Interstitial Cystitis

The first symptoms of the disease can appear spontaneously or following an event (gynecological surgery, childbirth, a bacterial infection of the bladder). Symptoms of interstitial cystitis vary from person to person, but there are several characteristic symptoms:

  • Abnormal urges to urinate, pressing and / or frequent urges;
  • Pelvic pain (in the lower abdomen, bladder, urethra and / or vagina) often more severe when the bladder is full;
  • Difficulty urinating and emptying the bladder;
  • Pain during intercourse (50% of cases);
  • More rarely – joint and muscle pain, headaches, and digestive disorders.(2)

Diagnosis Of Interstitial Cystitis

Several relatively frequent pathologies can cause symptoms similar to those of interstitial cystitis or interstitial cystitis.

The doctor will therefore first try to exclude all of these pathologies before being able to confirm the diagnosis of IC by various examinations:

  • A bacteriological examination of the urine makes it possible to search for a possible infection (bacterial cystitis).
  • A cystoscopy with hydro-distension of the bladder (visualization of the wall of the bladder thanks to a cystoscope introduced into the urethra, coupled with a filling of the bladder) under general anesthesia.
  • In the case of interstitial cystitis, micro-hemorrhages revealing cracks in the bladder wall can be observed. In severe forms, the bladder wall can even ulcerate.
  • Cystomanometry (urodynamic examination to determine the ability of the bladder to hold urine). Generally, in interstitial cystitis, this capacity of the bladder is reduced.(2)

References:

  1. Giusto LL, Zahner PM, Shoskes DA. An evaluation of the pharmacotherapy for interstitial cystitis. Expert opinion on pharmacotherapy. 2018;19(10):1097-1108.
  2. Patnaik SS, Laganà AS, Vitale SG, et al. Etiology, pathophysiology and biomarkers of interstitial cystitis/painful bladder syndrome. Archives of gynecology and obstetrics. 2017;295(6):1341-1359.
  3. Popović VB, Šitum M, Chow C-ET, Chan LS, Roje B, Terzić J. The urinary microbiome associated with bladder cancer. Scientific reports. 2018;8(1):1-8.
  4. Skove SL, Howard LE, Senechal J, et al. The misdiagnosis of interstitial cystitis/bladder pain syndrome in a VA population. Neurourology and urodynamics. 2019;38(7):1966-1972.
  5. Garzon S, Laganà AS, Casarin J, et al. An update on treatment options for interstitial cystitis. Menopausal Review/Przeglad Menopauzalny. 2020;19(1).

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