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Bladder Cancer (cont.)

When Should Someone Seek Medical Care for Suspected Bladder Cancer?

Any new changes in urinary habits or appearance of the urine warrants a visit to your health-care professional, especially if you have risk factors for bladder cancer. In most cases, bladder cancer is not the cause, but you will be evaluated for other conditions that can cause these symptoms, some of which can be serious.

How Do Physicians Diagnose Bladder Cancer?

Like all cancers, bladder cancer is most likely to be successfully treated if detected early, when it is small and has not invaded surrounding tissues. The following measures can increase the chance of finding a bladder cancer early:

  • If you have no risk factors, pay special attention to urinary symptoms or changes in your urinary habits. If you notice symptoms that last more than a few days, see your health-care professional right away for evaluation.
  • If you have risk factors, talk to your health-care professional about screening tests, even if you have no symptoms. These tests are not performed to diagnose cancer but to look for abnormalities that suggest an early cancer. If these tests find abnormalities, they should be followed by other, more specific tests for bladder cancer.
  • Screening tests: Screening tests are usually performed periodically, for example, once a year or once every five years. The most widely used screening tests are medical interview, history, physical examination, urinalysis, urine cytology, and cystoscopy.
  • Medical interview: Your health-care professional will ask you many questions about your medical condition (past and present), medications, work history, and habits and lifestyle. From this, he or she will develop an idea of your risk for bladder cancer.
  • Physical examination: Your health-care professional may insert a gloved finger into your vagina, rectum, or both to feel for any lumps that might indicate a tumor or another cause of bleeding.
  • Urinalysis: This test is actually a collection of tests for abnormalities in the urine such as blood, protein, and sugar (glucose). Any abnormal findings should be investigated with more definitive tests. Blood in the urine, hematuria, although more commonly associated with noncancerous (benign) conditions, may be associated with bladder cancer and thus deserves further evaluation.
  • Urine cytology: The cells that make up the inner bladder lining regularly slough off and are suspended in the urine and excreted from the body during urination. In this test, a sample of the urine is examined under a microscope to look for abnormal cells that might suggest cancer.
  • Cystoscopy: This is a type of endoscopy. A very narrow tube with a light and a camera on the end (cystoscope) is used to examine the inside of the bladder to look for abnormalities such as tumors. The cystoscope is inserted into the bladder through the urethra. The camera transmits pictures to a video monitor, allowing direct viewing of the inside of the bladder wall.
  • Fluorescence cystoscopy (blue light cystoscopy) is a special type of cystoscopy involving the placement of a light-activated drug into the bladder, which is picked up by the cancer cells. The cancer cells are identified by shining a blue light through the cystoscope and looking for fluorescent cells (the cells that have picked up the drug).

These tests are also used to diagnose bladder cancers in people who are having symptoms. The following tests might be done if bladder cancer is suspected:

  • CT scan: This is similar to an X-ray film but shows much greater detail. It gives a three-dimensional view of your bladder, the rest of your urinary tract (especially the kidneys), and your pelvis to look for masses and other abnormalities.
  • Retrograde pyelogram: This study involves injecting dye into the ureter, the tube that connects the kidney to the bladder, to fill the ureter and inside of the kidney. The dye is injected by placing a small hollow tube through the cystoscope and inserting the hollow tube into the opening of the ureter in the bladder. X-ray pictures are taken during filling of the ureter and kidney to look for areas that don't fill out with the dye, known as filling defects, which could be tumors involving the ureter and/or lining of the kidney. This test may be performed to evaluate the kidneys and ureters in individuals who are allergic to intravenous dye and thus cannot have a CT scan with contrast (dye) performed.
  • MRI (magnetic resonance imaging) is also an alternative test to look at the kidneys, ureters, and bladder in individuals with contrast (dye) allergies.
  • Biopsy: Tiny samples of your bladder wall are removed, usually during cystoscopy. The samples are examined by a physician who specializes in diagnosing diseases by looking at tissues and cells (pathologist). Small tumors are sometimes completely removed during the biopsy process. (transurethral resection of bladder tumor [TURBT]).
  • Urine tests: Other urine tests may be performed to rule out conditions or to obtain specifics about urine abnormalities. For example, a urine culture may be done to rule out an infection. The presence of certain antibodies and other markers may indicate cancer. Some of these tests may be helpful in detecting recurrent cancer very early.
  • Urine tumor markers: There are several newer molecular tests that look at substances in the urine that might help determine if a bladder cancer is present. These include UroVysion (FISH), BTA tests, ImmunoCyt, NMP 22 BladderChek, and BladderCx.

If a tumor is found in the bladder, other tests may be performed, either at the time of diagnosis or later, to determine whether the cancer has spread to other parts of the body.

  • Ultrasound: This is similar to the technique used to look at a fetus in a pregnant woman's uterus. In this painless test, a handheld device run over the surface of the skin uses sound waves to examine the contours of the bladder and other structures in the pelvis. This can show the size of a tumor and may show if it has spread to other organs.
  • Chest X-ray film: A simple X-ray film of the chest can sometimes show whether bladder cancer has spread to the lungs.
  • CT scan: This technique is used to detect metastatic disease in the lungs, liver, abdomen, or pelvis, as well as to evaluate whether obstruction of the kidneys has occurred. PET/CT, a special type of CT scan, may be helpful in the evaluation of individuals with invasive, higher-stage bladder cancer to determine if the bladder cancer has spread.
  • MRI (magnetic resonance imaging) may also be useful in the staging of bladder cancer and can be performed without contrast in individuals with a contraindication to contrast.
  • Bone scan: This test involves having a tiny amount of a radioactive substance injected into your veins. A full body scan will show any areas where the cancer may have affected the bones.
Medically Reviewed by a Doctor on 11/23/2016
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