Bladder Cancer

Ways to diagnose bladder cancer

At the first sign of bladder cancer, doctors recommend additional testing to better define the disease and evaluate how advanced it is. Your doctor will have performed a thorough physical exam as part of your diagnostic testing, which likely included questions about your personal medical history, your family history of disease and any risk factors you might have.

The most common tests done to diagnose bladder cancer include cytoscopy, cytology and the imaging of kidneys and ureters. Following is a brief description of each of these tests as well as others your doctor may prescribe.

Urine tests

  • Cytology – a sample of urine is examined under a microscope to see if it contains any cancer cells.
  • Culture – a sample of urine is placed into a dish in the laboratory to see if bacteria grow. This test is done to determine whether an infection – rather than cancer – may be causing your symptoms.
  • Tumor marker testing – a urine sample is tested for specific substances commonly released by bladder cancer cells.
  • Molecular marker testing – a urine sample is tested for genetic abnormalities that have been shown to be associated with bladder cancer.

Imaging studies

  • Computed tomography (CT) – a test in which a scanner creates X-ray images of organs, tissues and bones inside the body and displays them on a computer screen. You will need to lie still on a table while the scan is being done. A special dye, called a contrast medium, may be injected into a vein in the arm, or you may be asked to drink a contrast liquid before the scan; this contrast enhances the images to provide better details. CT may also be called CAT.
  • Computerized tomography (CT) urogram – A CT urogram is a type of CT scan used to create images of the bladder, kidneys and ureters. As the contrast medium flows through these areas, X-ray pictures are taken to help assess how well the urinary tract is functioning and to look for abnormalities.
  • Magnetic resonance imaging (MRI) – an imaging test that involves the use of magnetic fields instead of X-rays to visualize internal structures of the body. For an MRI scan, you will lie on a table that moves through a large circular scanner. As with CT, a contrast medium may be injected into a vein in the arm before the scan to enhance the images. An MRI is done to see if cancer cells have spread outside of the bladder.
  • Ultrasound – a test in which sound waves are used to produce images of the organs inside the abdomen, including the bladder and nearby tissues.
  • Retrograde pyelogram – a catheter (thin tube) is inserted into the bladder, and dye is injected to make the bladder walls and any existing tumors easier to see on an X-ray. This test is usually done during a cystoscopy.
  • Bone scan – a test done to see if cancer has spread to your bones. A chemical called a radioactive tracer is injected into a vein in your arm and travels through your bloodstream to your bones where it collects and gives off a small amount of radiation. The radiation is then detected by a special camera that scans your body and takes pictures to show how much of the tracer has collected in your bones. This test shows “irritation” in the bone, which may – but does not always – indicate the spread of cancer to the bone.

Biopsy procedures

  • Biopsy – a procedure to remove a piece of tissue from a tumor or nearby tissue for examination. A pathologist analyzes the biopsy tissue sample and provides your doctor with a report of the findings, which include such details as the type and subtype of cancer, the grade, and other abnormalities. Bladder biopsy samples are almost always obtained during cystoscopy depending on how deep the cancer has spread.
  • Cytoscopy – a procedure that allows doctors to examine a patient’s bladder by inserting a cystoscope (a thin tube with a light and camera at the end) through the urethra. Sterile salt water is injected through the cystoscope to fill and expand the bladder, so that doctors can look for abnormal growths on the lining of the bladder. To obtain a biopsy sample, a thin instrument can be inserted through the cystoscope to cut out a small piece of the abnormal tissue to be evaluated. A cystoscopy is usually performed with the use of local anesthesia, but general or spinal anesthesia may be needed for some patients.
  • CT-guided needle biopsy – a procedure to remove a biopsy tissue sample that involves inserting a needle through the belly into the bladder tumor. CT is used to help the doctor see exactly where the tumor is located so the needle can be inserted precisely.

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