Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
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, 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.
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.
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.
Pyelography: This is a series of X-ray films of your urinary tract taken after your have had a special dye injected into a vein (intravenous pyelography [IVP]) or into your urethra (retrograde pyelography). The dye highlights the organs of your urinary tract and makes the recognition of certain abnormalities easier. However, CT scanning with three-dimensional reconstruction is replacing pyelography in many centers in the United States.
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.
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.
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.
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.