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Diagnosing bladder cancer

A thorough and accurate diagnosis is the first step in developing a bladder cancer treatment plan. Our bladder cancer experts use a variety of tests and tools for diagnosing bladder cancer, evaluating the disease and developing a customized treatment strategy for each patient. Throughout treatment, imaging and laboratory tests are used to track the size of the tumor(s), monitor the response to treatment and modify the treatment plan when needed. Common tools used for diagnosing bladder cancer include:

Cytoscopy

If your doctor sees abnormal cells, a biopsy will be performed to remove tissues for closer examination. To obtain a sample of tissue from inside the bladder, a cystoscope, a thin, instrument, is inserted into the bladder through the urethra. Collecting saltwater washings from inside the bladder may also help your doctor examine cancer cells inside the bladder.

Sometimes, a fluorescence cytoscopy is performed with a 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, causing the cells to glow, or fluoresce, under a blue light. This process enables the doctor to see areas of the bladder where cancer cells may have been missed during the routine cytoscopy.

Lab tests

Tests conducted in the laboratory for diagnosing bladder cancer include:

Urine cytology: A urine sample is examined under a microscope to see if cancer or pre-cancer cells are present. This test may also be performed 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 cancer is present.

Urine culture: This test may help determine whether urinary symptoms are due to an infection, rather than cancer.

Urine tumor marker tests: Most doctors consider cytoscopy a good way to determine whether cancer cells have formed in the bladder. However, other tests for bladder cancer 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.

Advanced genomic testing: Genomic testing examines the DNA of a tumor to find alterations that may be driving the growth of cancer. By identifying the mutations (changes) that occur in a cancer cell's genome, doctors may better understand what caused the tumor and tailor treatment based on these findings.

Nutrition panel: Patients are evaluated for nutrient deficiencies, such as vitamin D and iron. The test helps identify the nutrients that need to be replaced or boosted to support the patient’s quality of life.

Biopsy

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.

Pyelogram

A retrograde pyelogram is an imaging test for bladder cancer that uses dye to improve the view of the bladder area. With this approach, the dye is injected through a catheter 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.

X-ray

An X-ray of the chest may be taken to determine whether the cancer has spread to the lungs. Cancer will not be present in the lungs unless it is in an advanced stage.

CT scan

A CT (computed tomography) of the bladder, ureters and kidneys is called a CT urogram. Sometimes, this imaging test may be performed instead of an intravenous pyelogram to look specifically at the upper part of the urinary system. A CT urogram may also help locate enlarged lymph nodes and offer useful information about the abdominal and pelvic regions.

MRI 

With bladder cancer, an MRI (magnetic resonance imaging) is used mainly to look for signs that cancer has spread beyond the bladder into nearby tissues or lymph nodes. An MRI urogram may sometimes be performed instead of an intravenous pyelogram to examine the top portion of the urinary system.

Ultrasound

This imaging test may help determine the size of bladder cancer and whether it has spread to nearby organs or tissues.

Bone scan

Bladder cancer sometimes metastasizes (spreads) to the bones. If a patient is experiencing bone pain or blood tests reveal elevated calcium levels, the radiation oncologist may perform a bone scan to detect whether bladder cancer has spread to the bone.

Next topic: How is bladder cancer treated?