How Is Bladder Cancer Diagnosed?

In case you have symptoms of bladder cancer such as the presence of blood in the urine, you should see your doctor immediately. Your doctor will use many tests to possibly diagnose a bladder cancer and will also find out how far it has spread. Sometimes, bladder cancer may have spread to other parts of the body, which is referred to as "metastasis." The tests performed by your doctors may determine the most effective type of treatment for your condition. For example, a biopsy for the bladder or biopsy for other body parts in case of metastasis can be the most accurate diagnosis for bladder cancer. Imaging tests are also applicable if cancer has already spread to other body parts.

Below is a list that describes the best options for diagnosing cancer. Since not all tests described in this article will suit every person, your healthcare specialist will consider the following factors before deciding the best test for you:

• your age
• medical condition
• previous cancer test results
• the intensity of your signs and symptoms

You should note that the earlier your bladder cancer is diagnosed, the better you have chances for a successful treatment. However, you should know that there is not even one accurate test that can screen the general population of the cancer cells, which means that people are diagnosed with bladder cancer only when their symptoms begin to appear. For this reason, some people can be diagnosed with bladder cancer at its late or advanced stages. However, there are a number of people who are diagnosed with bladder cancer at a non-muscle invasive stage.

Laboratory Tests

Below are laboratory tests that can be used to diagnose and also learn more about your bladder cancer:

1. Cystoscopy

This procedure is used as the key diagnosis for bladder cancer.  It is a test, which gives your doctor a chance to see inside of your bladder by the use of a lightened, thin, flexible tube known as a cystoscope. This test is performed in your doctor’s office and does not require any anesthesia since the process does not induce pain. This short and simple procedure can examine any growths in your bladder and determine whether there is a need for transurethral resection for bladder tumor (TURBT) or biopsy.

2. Urinary Tests

In a urinary test, your doctor will collect a sample of your urine to screen whether it has tumor cells. In cases wherein a patient is undergoing a cystoscopy, an additional procedure is performed where your bladder is rinsed to collect a fluid through a cystoscope or through the insertion of a small tube in the urethra.

The sample fluid collected can be tested in different ways. The most common of these procedures is viewing of the cells present in the fluid under a powerful microscope in the process known as urinary cytology. The urine that you may pass during your normal urination should also be tested through cytology. Together with urinary cytology, other molecular analyses for your urine are performed to help diagnose cancerous cells.

3. Transurethral Resection for Bladder Tumor (TURBT)

TURBT is a test that is done in case your doctor finds abnormal tissues in your bladder during a cystoscopy. In this case, your doctor will do a biopsy. A biopsy is a procedure that involves taking a small piece of your bladder and sending it for deep examination under a powerful microscope. The surgical procedure that involves the removal of a small tissue from your bladder plus biopsy is called a transurethral bladder tumor resection (TURBT).

During this procedure, your doctor will remove the tumor and then take a sample of a muscle tissue near the bladder. Biopsies of other parts of your bladder are performed. After a TURBT, a urologist examines the bladder to see if there is any change in mass. This type of examination is called examination under anesthesia (EUA). Finally, a pathologist analyzes all the samples taken during the TURBT. This analysis involves interpreting all the lab tests and evaluation of the bladder cells as well as tissues to diagnose any disease.

TURBT is used to diagnose bladder cancer. It also helps in the determination of the stage and type of your tumor. It determines how deep your tumor has grown into the layers of your bladder and also helps to identify any extra microscopic changes of your cancer (carcinoma in situ).

Transurethral bladder tumor resection can also be used as a treatment option for non-muscle invasive bladder cancer.

Imaging Tests

Following are imaging tests that are commonly used to find out how far your bladder cancer has spread. These imaging tests can also help in the staging of your bladder cancer.

1. Computed Tomography Scan (CT Scan)

A CT scan provides a 3D picture of the inside of your body with the aid of a computerized X-ray machine. The computer then brings together the images into an advanced and detailed cross-sectional view, which can show any tumors or tissue abnormalities. A CT scan can as well be used to determine the size of your bladder tumor. At times, a special dye referred to as "contrast medium" is applied before the scan to give a better and detailed image. Contrast medium is always given as an injection or a liquid to swallow. A patient should first discuss with the medical staff before the use of this dye in case he or she is allergic to iodine or any other contrast media.

2. Positron Emission Tomography Scan (PET Scan)

According to statistics, a PET scan can help determine a bladder cancer that has spread. It is also a better imaging test compared with a CT or an MRI scan. A PET scan is a procedure that uses a PET machine to create a picture of tissues in your bladder. In this procedure, a limited amount of radioactive sugar is administered into the patient’s body through an intravenous injection. The radioactive sugar is taken by the cells that take the most energy during their growth, i.e., cancerous cells. Since cancerous cells use energy actively due to their uncontrolled growth, they absorb the radioactive sugar. A scanner is then used to detect the radioactive substance producing relevant images of your bladder.

The images are then forwarded to a radiologist, who interprets them and determines the area of spread of your bladder cancer. The radiologist gives back his or her results to your doctor who will review them and discuss with you. The doctor will stage your bladder cancer and recommend a suitable treatment plan.

3. Magnetic Resonance Imaging

This type of imaging test uses magnetic fields and not X-rays to produce detailed images of your bladder. An MRI scan can be used to measure the size of your bladder tumor. Like the PET scan, an MRI uses a special dye to bring forward better and clearer pictures of your bladder.

Bladder Cancer Staging After Diagnosis

• Stage I: In this stage, your bladder cancer is found within the inner lining of your bladder and has not yet invaded the bladder wall muscles.

• Stage II: In this stage, cancer has spread to the bladder wall but is still confined inside the bladder.

• Stage III: Cancer has spread through your bladder wall and invaded the neighboring cells and tissues.

• Stage IV: Cancer has spread to other organs in the body such as the bones, liver, lungs, and lymph nodes.

The Bottom Line

If you are experiencing chronic pain and notice some signs and symptoms that are related to bladder cancer, you need to visit your doctor immediately. At your visit, you will undergo some common medical procedures, scans, and tests, which your doctor can use to identify the cause of your bladder problems. The above-named procedures and tests can be used to diagnose your bladder cancer and its stage or grade to help you get the best treatment plan.