How Is Bladder Cancer Diagnosed?

Sometimes during routine health checkups your doctor will notice blood in your urine (called hematuria). The blood may not be visible to the naked eye and may show up only when the doctor runs routine tests on it. Hematuria more often means a simple bladder infection rather than cancer. If you notice it, don't worry, but see your doctor soon for a complete diagnosis. Only one case in 50 is bladder cancer.

The symptoms of bladder cancer are the same as a bladder infection. They include urinary frequency, burning or irritation. Sometimes the cancer will obstruct the flow of urine and cause pain in the lower abdomen or flank. Eventually it can spread to other parts of the body and cause innumerable symptoms depending upon where it comes to rest.

A urinalysis always is the first step in diagnosis. If your urine is normal, there is little chance you have a bladder cancer. But if it isn't, if there's blood in it and there is no infection, the doctor has to look harder for the source of the bleeding. The cause of abnormal bleeding must always be discovered because it is often a local and treatable cancer.

The bladder sheds cells from its lining into the urine. Cancerous cells in urine sometimes can be seen under a microscope. More cells can be obtained by irrigating (washing) the bladder. This test is not good enough to be used routinely, but it may be useful if you are at high risk for bladder cancer, or to follow you for recurrences after a successful first treatment.

The next test you undergo will probably be a direct examination of the inside of your bladder with a tiny telescope called a cystoscope. This examination (cystoscopy) is usually done by an urologist, a specialist in diseases of the urinary system, and can often be done in an office setting under local anesthesia. In addition to seeing the inside of the bladder, specimens (biopsies) can be taken for examination under a microscope to determine the presence and type of cancer. Pathologists (physicians who conduct laboratory studies of tissues and cells) identify the type of tumor present, assign a grade to a patient's cancerous bladder tumor and help determine the patient's prognosis (projected outcome).

It is likely that you will also undergo several x-ray examinations. An intravenous pyelogram begins by injecting a dye into your veins. As the dye is picked up by your kidneys and excreted into your urine, x-rays mark its progress. A better view of your lower urinary system, the bladder and attached structures can be obtained by instilling a similar dye through a cystoscope during a cystoscopy.

This is often followed by a series of imaging scans to check the anatomy of the abdomen and pelvis. High-tech scans (CT MRI, and/or PET) are used to determine if the cancer has spread beyond its place of origin.

Sources:

Campbell's Urology, 6th ed., edited by P. Walsh, WB Saunders, 1997 (3 vols.).

Harrison's Principles of Internal Medicine, 14th edition, edited by Kurt Isselbacher et al. New York: McGraw-Hill, 1998.

Urol Clin North Am. 2000 Feb;27(1) and 1999 Aug;26(3) Eur Urol. 2000;37 Suppl 1).

Ozen H. Bladder cancer. Curr Opin Oncol. 1999 May;11(3):207-12. Review. PMID: 10328596 UI: 99259148.

Baniel J. Bladder cancer in women. Int Urogynecol J Pelvic Floor Dysfunct. 1999;10(6):399-404. Review. PMID: 10614978 UI: 20080641.

Otto T, Krege S, Noll F, Rubben H. Therapy of superficial bladder carcinomas. Urol Int. 1999;63(1):32-9. Review. PMID: 10592488 UI: 20075176.

Bohle A, Durek C. Recent perspectives in topical therapy in superficial bladder cancer. Curr Opin Urol. 1999 Sep;9(5):407-11. Review. PMID: 10579078 UI: 20046040.

Clark PE, Klein EA. Surgery for invasive bladder tumors: technique and outcome. Curr Opin Urol. 1999 Sep;9(5):413-8. Review. PMID: 10579079 UI: 20046041.

Sengelov L, von der Maase H. Radiotherapy in bladder cancer. Radiother Oncol. 1999 Jul;52(1):1-14. Review. PMID: 10577680 UI: 20043629.

Dollinger M, Rosenbaum EH, Temporo M, et al. Everyone's Guide to Cancer Therapy: Fourth Edition. Andrews McNeel Publishing: Kansas City. 2002.

This article was reviewed and updated June 2007.