Bladder Cancer Diagnosis & Detection

The team of cancer doctors at Cancer Treatment Centers of America (CTCA) uses sophisticated imaging technology and tests to ensure that you receive an accurate bladder cancer diagnosis.

During your first visit to a CTCA hospital, you’ll undergo a comprehensive exam to evaluate the disease and determine if it has spread to any other part of your body. This helps your team formulate an individualized treatment plan that is appropriate for your needs.

Throughout your bladder cancer treatment, we will use diagnostic imaging and laboratory tests to monitor your progress. If the disease is resisting treatment, we will modify your treatment or recommend using a different therapy. Our turnaround time goal from the time of imaging scans to results is four hours, so that treatment planning can occur as quickly as possible.

How Is Bladder Cancer Diagnosed?

Usually, bladder cancer is found as a result of symptoms a person is experiencing. Although routine tests for bladder cancer are not typically recommended, several can be performed if any symptoms of this disease are present and do not go away.

• Medical History and Physical Exam: The first step in diagnosing bladder cancer is usually a general physical. Your doctor will ask you about your symptoms, whether you have any of the known risk factors and about any other medical conditions. During a physical exam, your doctor may find signs of bladder cancer, or a precancerous condition. Your doctor may examine the rectum and, in women, the vagina, to measure the size of the bladder tumor and how much it has spread, if at all.

If your doctor is concerned that you may have cancer, he or she will refer you to a specialist, called a urologist, for additional tests to examine the urinary system. In order to make an accurate bladder cancer diagnosis, your urologist may perform one or more of the following tests:

• Cytoscopy: The specialist will carefully examine the entire bladder area. For this procedure, your doctor will likely use a cytoscope, which is a thin, lighted tube that can be inserted through the urethra and into the bladder. A small lens or video camera is attached to the tip, so that your doctor can see inside. Sterile salt water is injected through the cytoscope, which expands the bladder, making it easier to examine.

The initial cytoscopy is usually done in a doctor’s office and patients are offered local anesthesia to numb the urethra and bladder. When a more general anesthesia is needed, the cytoscopy will be done in an operating room.

If your doctor sees an area with abnormal cells, a biopsy will be done to remove tissues for closer examination. To obtain a sample of tissue from inside the bladder, a thin instrument is inserted through the cytoscope. Collecting saltwater washings from inside the bladder can also help your doctor examine cancer cells inside the bladder.

• Fluorescence Cytoscopy: This procedure may be done alongside the standard cytoscopy. During this test for bladder cancer, medicines known as porphyrins are inserted into the bladder. These drugs are readily absorbed by cancer cells, and cause the cells to glow, or fluoresce, under a blue light. This process enables your doctor to see any areas of the bladder where there are cancer cells that may have been missed during the routine cytoscopy.
• Urine Cytology: With this test, a urine sample is looked at under a microscope to see if any cancer or pre-cancer cells are present. This test can also be done with bladder washings from the cytoscopy. It’s important to know that cytology tests are not always accurate, and other tests are needed to confirm whether or not cancer is present.
• Urine Culture: This test can help determine whether any urinary symptoms are due to an infection, rather than cancer.
• Urine Tumor Marker Tests: Most doctors consider cytoscopy a good way to determine whether or not there are cancer cells in the bladder. However, there are also several tests for bladder cancer that measure the presence of various substances in the urine that may indicate the presence of cancer. Tests for NMP22 and BTA, the Immunocyt test and the UroVysion test are examples of ways to check for markers, or indicators, of cancer in the urine.
• Biopsy: Only a biopsy can help your doctor make a definitive bladder cancer diagnosis. A sample of tissue or cells is required for a biopsy, which must be conducted before treatment can begin. With bladder cancer, biopsies are usually done during a cytoscopy. A thin instrument is inserted through the cytoscopy tube, and a small sample of tissue that appears possibly cancerous is collected from inside the bladder.

Imaging Tests for Bladder Cancer

After diagnosing your bladder cancer, your CTCA doctor may choose one or a combination of the following imaging tests to monitor the cancerous tissue and determine whether it has spread beyond the bladder:

• Intravenous Pyelogram (IVP): In this test, also called an intravenous urogram, or IVU, a special dye is injected into a vein and then flows into the ureters and bladder. When an x-ray is then taken, the dye outlines the bladder area, which helps in identifying urinary tract tumors.
• Retrograde Pyelogram: This imaging test for bladder cancer is similar to an IVP in that it also uses a dye to improve the view of the bladder area. With this approach, the dye is injected through a catheter that is placed through the urethra and into the bladder or ureter. This test is useful for people who are allergic to the dye used for the x-ray test.
• Chest X-ray: An x-ray of the chest may be taken to check if the cancer has spread to the lungs. Cancer will not be present in the lungs unless it is in an advanced stage. An x-ray is usually an outpatient procedure, meaning that you do not have to be admitted to a hospital for the test. If the result is abnormal, additional bladder cancer detection tests will be performed.
• Computed Tomography (CT) Scan: A CT scan can provide information about the size, shape and position of any tumors, and may also help identify enlarged lymph nodes that may contain cancer cells. A CT of the bladder, ureters and kidneys is called a CT urogram. Sometimes, this imaging test may be done instead of an IVP to look specifically at the upper part of the urinary system. A CT urogram can also help locate any enlarged lymph nodes and gives useful information about the abdominal and pelvic regions.
• Magnetic Resonance Imaging (MRI): With bladder cancer, MRIs are used mainly to look for any signs that cancer has spread beyond the bladder into nearby tissues or lymph nodes. An MRI urogram may sometimes be done instead of an IVP to examine the top portion of the urinary system.
• Ultrasound: This imaging test can help determine the size of bladder cancer and whether it has spread to nearby organs or tissues.
• Bone Scan: When cancer advances and spreads to other regions of the body, it often moves to the bones. If an individual is complaining of bone pain, or if blood tests indicate that cancer may have spread to the bones, then a bone scan can be done to check for malignant cells. With this procedure, a minor amount of very mildly radioactive material is injected into a vein. Over several hours, this material will end up in areas of damaged bone. A camera will scan the body and identify where the radioactive material is, indicating the possible presence of cancer. These “hot spot” areas of damaged bone may be due to other bone diseases, so other tests will be needed to confirm whether or not cancer is present.

Next Topic: Bladder Cancer Staging