How Is Bladder Cancer Diagnosed?

You might receive a diagnosis because of the results of a bladder cancer screening exam or because you have some of the symptoms of bladder cancer. To diagnose bladder cancer, your doctor will perform some of the following tests:

• Medical history and physical examination - The doctor checks you for risk factors and symptoms.
• Rectal or vaginal examination - The doctor inserts gloved fingers into the vagina and/or rectum to feel for lumps.
• Cystoscopy (also called cystourethroscopy) - The doctor inserts a cystoscope, a flexible tube with a light, through the urethra to examine the inside of the bladder. During cystoscopy, the doctor might place a salt solution into your bladder through a catheter and remove the solution to examine it under a microscope.

Laboratory Tests

The doctor might test your urine for blood, chemicals, bacteria, and cells:

• Biopsy - If your doctor sees anything suspicious during a cystoscopy, he or she will remove a small piece of bladder tissue (biopsy) so that a pathologist (doctor who specializes in diagnosing disease) can examine it under a microscope. A biopsy is the only definitive way to diagnose bladder cancer and figure out which type it is. A biopsy can also tell how far the cancer has penetrated, which is important for selecting the appropriate treatment.
• Urine cytology - The doctor examines your urine under a microscope to look for cancerous or precancerous cells. The doctor might also do cytology on bladder washings taken during cystoscopy.
• Urine culture - A sample of urine is tested in the lab to see if it has certain bacteria. This test can rule out an infection as the cause of your symptoms.
• Blood tests - The doctor may order a complete blood count (CBC) to find out whether your blood has the correct number of various types of blood cells. This test can find out if you have lost blood because the cancer has spread to the bone marrow, where blood cells form. Blood chemistry tests can be used to find chemical changes in the blood caused by spread of the bladder cancer to the bone or liver.
• Bladder tumor marker studies - Tests may be performed to determine the characteristics of cells and markers or substances released by bladder cancer cells into urine.

Imaging Tests

• Intravenous pyelogram (IVP) - A series of x-rays are taken of the kidneys, ureters, and bladder after a contrast dye is injected into the bloodstream through a vein. The dye makes the bladder and other organs easier to see on the x-rays. This test can be used to rule out other diseases or find out whether the bladder cancer has spread (metastasized) to other areas of the urinary tract. This procedure is also known as intravenous urography.
• Retrograde pyelogram - A contrast dye is injected through a catheter placed with a cystoscope into the ureter to make the lining of the bladder, ureters, and kidneys easier to see on x-rays.
• Chest x-ray - A chest x-ray can show a mass or spot on the lungs that might be a metastatic tumor (cancer cells that have traveled from the bladder to the lung).
• Computed tomography (CT) - Instead of taking one picture, like a conventional x-ray, a CT scanner takes many pictures as it rotates around you. A computer is used to combine these pictures into an image of a slice of your body (like a loaf of sliced bread). CT scans can be used to find cancer in tissues next to the bladder, in nearby lymph nodes, and in distant organs.
• Magnetic resonance imaging (MRI) scans - This procedure uses powerful magnets and radio waves to take detailed cross-sectional images. This produces images of cross-sectional slices of your body like a CT scanner; it can also produce images of slices that are parallel to the length of your body. MRI scans can be used to find cancer in tissues next to the bladder, in nearby lymph nodes, or in distant organs.
• Ultrasound - This test uses sound waves to create "echoes" of internal organs. The doctor can use the pattern of echoes reflected by tissues to determine the size of the bladder cancer and whether it has spread beyond the bladder.
• Bone scan - The doctor injects a small amount of a radioactive substance into a vein. This substance gathers in areas of bone where the cancer has spread. The doctor can then look at these areas with a special camera.

Monitoring

After you receive treatment for bladder cancer, you should be tested afterward on a regular basis. Bladder cancer often comes back, and it is important to catch any new cancer as early as possible. Routine surveillance (monitoring) tests include:

• Urine cytology - To find new cancer cells in the urine.
• Cystoscopy - Typically done every 3 months after treatment of early-stage bladder cancer.
   

This content has been reviewed and approved by Myo Thant, MD.