The great majority of bladder cancers are diagnosed at an early stage — when bladder cancer is highly treatable. People who manifest any symptoms of bladder cancer may first see their family doctor or may be recommended to a urologist, a doctor who specializes in diseases of the urinary system. If there is a reason to suspect that a person might have bladder cancer, the doctor will use one or more methods to exclude or confirm a diagnosis more conclusively.
Often, bladder cancer can discovered early. Finding it early improves chances for successful treatment. Screening tests or exams are used to look for a disease in individuals who have no symptoms. One possible way to screen for bladder cancer is to check for blood in the urine (called hematuria). Another way to screen for bladder cancer is to examine the urine for cancer cells (urine cytology). This test does find some cancers, but it is not reliable enough to make a good screening test. Keep in mind that early-stage bladder cancer is likely to recur. For this reason, bladder cancer survivors often undergo follow-up screening tests for years after treatment.
If a person exhibits signs or symptoms that suggest bladder cancer, the doctor may check general signs of health and may order lab tests. During a physical exam, the doctor palpates the abdomen and pelvis for tumors. Furthermore, the physical exam could include a rectal or vaginal exam in order to check if a tumor has already spread to those organs or to palpate the tumor or lymph nodes located in the pelvis through the walls of the rectum or vagina. Some doctors find urine tests useful for diagnosis of bladder cancer, but most feel that cystoscopy is still the best way to find bladder cancer. Doctors may order one or more of the following procedures:
Biopsy - During a biopsy, doctors remove a sample piece of tissue from an abnormal area to see if it contains cancer cells. A biopsy can show if cancer is present and what type of cancer it is (transitional cell carcinoma, squamous cell carcinoma, adenocarcinoma, etc.). It can also show how deeply the cancer has penetrated into the bladder wall, which is very important in deciding treatment. Doctors use two types of biopsies when testing for bladder cancer:
Bladder biopsies - Bladder biopsy samples are most often obtained during cystoscopy. This allows the doctor to be precise in terms what tissue is removed.
Needle biopsies - Another way to take a biopsy sample is to use a needle to take tissue without the need for an operation. Needle biopsies are sometimes done using a CT scan or ultrasound to accurately guide the biopsy needle into the abnormal area.
Cystoscopy – During a cystoscopy, the doctor uses a thin, lighted tube (cystoscope) to look directly into the bladder and to examine the lining of the bladder.
Fluorescence cystoscopy - This test may be done alongside a routine cystoscopy. Substances called porphyrins are put into the bladder during cystoscopy and are taken up by cancer cells, if present. Then, when the doctor shines a blue light through the cystoscope, the cells containing the porphyrins will glow (fluoresce).
Imaging tests – If and when a person is diagnosed with bladder cancer, the doctor may order some of the following tests to see if the cancer has spread to tissues near the bladder, nearby lymph nodes, or to distant organs.
Bone scan – During a bone scan, a small amount of a radioactive substance is injected into a vein. This substance concentrates in areas of bone containing cancer, which are probably metastasis of the primary cancer. A scanner can spot the radioactive deposits.
Chest x-ray – A chest x-ray aims to identify a tumor or a spot on the lungs that might indicate the spread from a bladder cancer.
Computed tomography (CT) - A CT scan is an x-ray procedure that produces detailed cross-sectional images of the body. Instead of taking one picture a CT scanner takes many pictures as it rotates around the person to identify possible cancers.
Intravenous pyelogram - An intravenous pyelogram (IVP) is an x-ray of the urinary system. Images are taken after injecting a special dye into a vein and are used to more clearly outline these organs and find urinary tract tumors.
Magnetic resonance imaging scans (MRI) - This procedure is similar to a CT scan. It uses powerful magnets and radio waves instead of x-rays to take detailed cross-sectional images and search for cancer cells
Positron emission tomography (PET) scan – This is a test that uses radioactive glucose (sugar) to look for cancer cells.
Retrograde pyelography - During this procedure, a tube (catheter) is placed into the bladder or into a ureter. A dye is injected through the catheter to make the lining of the bladder, ureters, and kidneys easier to see on x-rays.
Ultrasound - Ultrasound uses sound waves to create pictures of internal organs. It can be useful in determining the size of a bladder cancer and whether it has spread beyond the bladder.
Urine tests – Doctors and pathologists can check the urine for blood, cancer cells, and other signs of disease. There are a number of different urine tests that look for specific substances released by bladder cancer cells. These include the test for NMP22 . Other tests that may be used are the ImmunoCyt test, the BTA stat test, and the UroVysion test. Tests for bladder cancer using urine specimens may include:
Urine cytology - Urine is examined under a microscope to see if it contains any cancerous or pre-cancerous cells.
Urine culture - A sample of urine is put into a dish in the lab to allow any bacteria that are present to grow
If the results of diagnostic testing are positive, then doctors must also determine the extent of spread (stage) of the disease. To learn how doctors stage bladder, continue reading. We cover the stages of bladder cancer and the first steps of bladder cancer prognosis in the section that follows.