How is bladder cancer diagnosed?

In addition to a complete medical history and physical examination, your doctor may order some of the following procedures for bladder cancer diagnosis or staging:

  • Rectal or vaginal examination. The doctor can check for the presence of tumors large enough to be felt.
  • Cystoscopy (also called cystourethroscopy). An examination in which a scope, a flexible tube and viewing device, is inserted through the urethra to examine the bladder and urinary tract for structural abnormalities or obstructions, such as tumors or stones. Samples of the bladder tissue (called a biopsy) may be removed through the cystoscopy for examination under a microscope in the laboratory.
  • Intravenous pyelogram (IVP). A series of X-rays of the kidney, ureters, and bladder with the injection of a contrast dye into the vein. This test is used to detect tumors, abnormalities, kidney stones, or any obstructions, and to assess renal blood flow. It may also be used to rule out other diseases or check for spread (metastasis) of the bladder cancer to other areas of the urinary tract.
  • Laboratory tests. Tests may be performed on the urine to check for blood, chemicals, bacteria, and cells. The urine may be examined microscopically or grown in culture to check for infection. Cancerous cells may be detected using the microscope.
  • Bladder tumor marker studies. Tests to determine cellular characteristics and markers or substances released by bladder cancer cells into the urine.
  • Ultrasound [staywell] (also called sonography). A diagnostic imaging technique that uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function and to assess blood flow through various vessels.
  • Computed tomography scan (also called a CT or CAT scan). A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.
  • Magnetic resonance imaging [staywell] (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
  • Positron emission tomography (PET). A PET scan may show areas of cancer that may not be seen on a CT scan or an MRI scan.
  • Bladder biopsy. A procedure in which tissue samples are removed (with a needle or during surgery) from the bladder for examination under a microscope to determine if cancer or other abnormal cells are present.

Once bladder cancer is diagnosed, your doctor will determine the grade and stage of the cancer:

  • Grade. This differentiates the cells from normal tissue and estimates the rate of cancer growth
  • Stage. This indicates the extent the cancer has spread and if other body parts or organs are affected. Additional tests may be needed to determine if bladder cancer is limited to the bladder or if it has spread

The American Joint Committee on Cancer provides guidelines for staging of bladder cancer. The stages range from Stage 0 to Stage IV and have detailed criteria for tumor size, invasiveness, presence in lymph nodes, and whether or not the cancer has metastasized (spread) to other organs. A general description of each stage of bladder cancer follows:

  • Stage 0. Cancer cells are found only on the inner lining of the bladder. This is also called superficial cancer or carcinoma in situ.
  • Stage I. Cancer cells are found deep in the lining of the bladder, but have not invaded the bladder muscle.
  • Stage II. Cancer cells are present in the muscle of the bladder.
  • Stage III. Cancer cells have spread through the bladder muscle into the tissues around the bladder, such as the prostate in men or the uterus in women.
  • Stage IV. Cancer has progressed further into the abdominal cavity, and may have spread to lymph nodes and other organs in the body.
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