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How to diagnose bladder cancer

By Editorial Team

September 14, 2017

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Diagnosing bladder cancer is a process that involves multiple steps. Many patients diagnosed with bladder cancer experience symptoms related to urination— visible blood in the urine is the most common symptom—and visit their primary healthcare provider to have their symptoms checked. Other patients have not noticed symptoms, but their healthcare provider finds a sign of bladder cancer during a routine check-up and carries out further testing.

Should I be screened for bladder cancer?

Screening involves testing a patient for a condition even if the patient has no symptoms. 1 Bladder cancer screening is not routinely recommended for the general public. However, some healthcare providers may recommend screening for patients who have a high risk of bladder cancer, such patients who have already had bladder cancer, who have certain bladder-related birth defects, or who are exposed to specific types of toxic substances in the workplace.

What are first steps in diagnosing bladder cancer?

The first step in diagnosing bladder cancer usually involves a visit to a primary healthcare provider about symptoms a patient has had, such as blood in the urine. 2 The healthcare provider will typically ask about the patient’s symptoms and general health habits, as well as asking about risk factors for bladder cancer, such as smoking or a family history of bladder cancer.

The healthcare provider usually performs a physical examination to check the patient’s overall health and to find out if some other health condition may be causing the symptoms. The physical exam may include a digital rectal exam (for men and women) or a pelvic exam (for women) to check for signs of cancer or other health conditions.

How are urine tests used to detect cancer?

Patients with symptoms that may be caused by bladder cancer are usually asked to provide a urine sample for testing in the laboratory. 3 The results of the test can indicate if there is blood or other contents in the urine (urinalysis testing), as well as indicating if the symptoms may be caused by a urinary tract infection (urine culture testing). Other types of urine testing can be used to check for the presence of cancer or pre-cancer cells (urine cytology testing), or for the presence of substances that are often associated with cancer cells (urine tumor marker testing).

What procedures are used to diagnose bladder cancer?

Based on the results of the physical examination and urine laboratory testing, healthcare providers may recommend that patients undergo procedures that can be used to help make a diagnosis of bladder cancer or to rule out bladder cancer as the cause of the patient’s symptoms. 2

Some of these procedures include physical examination of the patient’s bladder while the patient is under anesthesia, cystoscopy, and transurethral resection of bladder tumor (TURBT). Cystoscopy involves inserting a very thin, flexible tube, with a tiny camera on the end of it, into the patient’s bladder to examine the bladder’s inner lining.

If signs of cancer are found, then a procedure called transurethral resection of bladder tumor can be used to take samples of tissue from the bladder to be further analyzed in the lab to confirm a diagnosis of bladder cancer.

How are imaging tests used to diagnose and detect cancer spread?

If the results of the diagnostic examinations, tests, and procedures have resulted in a diagnosis of bladder cancer, then healthcare providers may recommend different types of imaging tests to learn more about the patient’s bladder cancer and to help find out if the cancer has spread to other parts of the body. 2-4

Imaging tests use technology to capture images of the inside of the body. Imaging techniques that can be used to help diagnose and stage bladder cancer include:

  • Intravenous pyelogram (IVP)
  • Retrograde pyelogram
  • Computed tomography (CT/CAT) scan
  • Magnetic resonance imaging (MRI)
  • Ultrasound

Imaging tests can also be used together with biopsies to find out if a patient has bladder cancer that has spread to other parts of the body, such as the liver, bones, or lungs.

What are the stages of bladder cancer?

A process called staging is used to describe a patient’s specific type of bladder cancer after diagnosis. 5 This provides detailed information about the cancer and helps the patient’s cancer care team to determine the best possible treatment options.

There are five stages used to describe bladder cancers. The earliest stage is Stage 0 and the most advanced stage is Stage IV:

  • Stage 0: cancer cells have grown in the bladder lining
  • Stage I (1): cancer cells have grown through the bladder lining into connective tissue
  • Stage II (2): cancer cells have grown into the muscle layer of the bladder wall
  • Stage III (3): cancer cells have spread beyond the bladder muscle
  • Stage IV (4): cancer cells have spread beyond the bladder and into other areas

Diagnosis is the process of finding out the cause of a health problem. Diagnosing bladder cancer usually begins with a visit to your family doctor. Your doctor will ask you about any symptoms you have and may do a physical exam. Based on this information, your doctor may refer you to a specialist or order tests to check for bladder cancer or other health problems.

The process of diagnosis may seem long and frustrating. It’s normal to worry, but try to remember that other health conditions can cause similar symptoms as bladder cancer. It’s important for the healthcare team to rule out other reasons for a health problem before making a diagnosis of bladder cancer.

The following tests are usually used to rule out or diagnose bladder cancer. Many of the same tests used to diagnose cancer are used to find out how far the cancer has spread (the stage). Your doctor may also order other tests to check your general health and to help plan your treatment.

Health history and physical exam

Your health history is a record of your symptoms and risks and all the medical events and problems you have had in the past. Your doctor will ask questions about your history of:

  • symptoms that suggest bladder cancer, such as blood in the urine (pee)
  • general symptoms that may suggest cancer, such as fatigue, loss of appetite and sweating at night
  • smoking tobacco
  • working with chemicals, such as in paints, rubber, metals, textiles and dyes
  • radiation therapy to the pelvis
  • long-term (chronic) bladder irritation

Your doctor may also ask about a family history of:

  • bladder cancer
  • other cancers in the urinary tract
  • risks for bladder cancer

A physical exam allows your doctor to look for any signs of bladder cancer. During a physical exam, your doctor may do a pelvic exam or a digital rectal exam (DRE).

Find out more about a physical exam.

Urinalysis and other urine tests

A urinalysis examines your urine. It finds and measures substances in a sample of urine, such as blood, bacteria and cells. It is often one of the first tests done to check for abnormalities in the urine and problems in the urinary tract.

Blood in the urine (hematuria) may mean there is bleeding in the urinary tract, which could be caused by cancer. Nitrites in the urine may mean you have a urinary tract infection (UTI).

A urine culture tests a sample of urine for bacteria and other germs that can cause an infection. In a lab, the urine is placed in a special substance where germs can grow. After a few days, the sample is examined under a microscope to check if bacteria and other germs have grown. A urine culture is done to check if an infection could be the cause of bladder symptoms.

Urine cytology studies the cells in a urine sample or bladder washings (collected during a cystoscopy when the bladder is rinsed with salt water). Urine cytology can be used to look for abnormal cells, including bladder cancer cells.

Find out more about a urinalysis.

Cystoscopy

A cystoscopy uses a thin tube with a light and lens on the end (called a cystoscope) to look inside the bladder and urethra. It is used to look for any tumours or abnormal areas. Biopsy samples and salt water rinses from the bladder (bladder washings) may be taken during a cystoscopy. A cystoscopy is usually done when there is blood or abnormal cells in the urine.

A fluorescence cystoscopy may be done along with a regular cystoscopy. It uses a dye ( contrast medium ) and a special blue light to help make cancer cells easier to see. The doctor injects the dye into the bladder and then uses a cystoscope to shine a blue light in the bladder. The cancer cells that take up the dye will glow in the blue light.

A ureteroscopy may be used if the doctors want to look at the upper parts of the urinary tract. It is done like a cystoscopy, except the doctor will look at the ureters and renal pelvis .

Biopsy

During a biopsy, the doctor removes tissues or cells from the body so they can be tested in a lab. A report from a pathologist will show whether or not cancer cells are found in the sample. Small tumours and biopsy samples from the bladder are usually removed during a cystoscopy.

A transurethral resection of bladder tumour (TURBT) is the most common type of biopsy used to diagnose bladder cancer. It is surgery that removes the tumour and some muscle from the bladder wall near it. A TURBT can show how far the cancer has grown into the bladder wall (depth of invasion). It is also used to treat early stages of bladder cancer.

Find out more about a biopsy and surgery for bladder cancer, which includes a TURBT.

Complete blood count (CBC)

A complete blood count (CBC) measures the number and quality of white blood cells, red blood cells and platelets. A CBC may be done to check for anemia from long-term bleeding from the urinary tract. It may also be used to check for infection.

A CBC is usually done before any cancer treatment starts. This provides a baseline to compare with future CBCs.

Blood chemistry tests

Blood chemistry tests measure certain chemicals in the blood. They show how well certain organs are working and can help find abnormalities. Blood chemistry tests used to staging.

Kidney function tests measure how well the kidneys are working. Higher levels of certain chemicals may mean that there are kidney problems or a blocked urinary tract.

Alkaline phosphatase (ALP) is an enzyme found throughout the body. The highest amounts are found in the cells of the bone and liver. Increased levels of ALP may mean the cancer has spread to bone or the liver.

Liver function tests (including ALP) measure how well the liver is working. Higher levels of certain chemicals may mean that the cancer has spread to the liver.

Intravenous pyelogram (IVP)

An intravenous pyelogram (IVP) is also called an intravenous urography. It makes images of the urinary system, including the kidneys, ureters, bladder and urethra. A dye is injected into a vein and concentrates in the urine. X-rays are taken as the urine (with the dye) moves through the urinary tract. The images can help diagnose tumours and other abnormalities in the bladder and the rest of the urinary tract.

A retrograde pyelogram is like an IVP, but the dye is injected directly into the urinary system (instead of a vein) through a tube placed into the ureter using a cystoscopy. This procedure is sometimes used to find out what is blocking the flow of urine. It can also help diagnose cancer in the inner lining of the ureters or kidneys. It may be used if someone can’t have an IVP.

CT scan

A computed tomography (CT) scan uses special x-ray equipment to make 3D and cross-sectional images of organs, tissues, bones and blood vessels inside the body. A computer turns the images into detailed pictures.

A CT scan of the abdomen and pelvis is used to check the urinary system for any tumours or blockages. It is also used to check if bladder cancer has spread to lymph nodes, the liver or other organs and tissue around the bladder. A CT scan of the chest may be used to check if bladder cancer has spread to the lungs.

CT urography is an IVP that uses a CT scan instead of regular x-rays to make images of the urinary tract. It is used to look for tumours in the urinary tract.