Diagnosis of bladder cancer

Diagnosis is the process of finding out the cause of a health problem. Diagnosing bladder cancer usually begins with a visit to your family doctor. Your doctor will ask you about any symptoms you have and may do a physical exam. Based on this information, your doctor may refer you to a specialist or order tests to check for bladder cancer or other health problems.

The process of diagnosis may seem long and frustrating. It’s normal to worry, but try to remember that other health conditions can cause similar symptoms as bladder cancer. It’s important for the healthcare team to rule out other reasons for a health problem before making a diagnosis of bladder cancer.

The following tests are usually used to rule out or diagnose bladder cancer. Many of the same tests used to diagnose cancer are used to find out how far the cancer has spread (the stage). Your doctor may also order other tests to check your general health and to help plan your treatment.

Your health history is a record of your symptoms and risks and all the medical events and problems you have had in the past. Your doctor will ask questions about your history of:

• symptoms that suggest bladder cancer, such as blood in the urine (pee)
• general symptoms that may suggest cancer, such as fatigue, loss of appetite and sweating at night
• smoking tobacco
• working with chemicals, such as in paints, rubber, metals, textiles and dyes
• radiation therapy to the pelvis
• long-term (chronic) bladder irritation

Your doctor may also ask about a family history of:

• bladder cancer
• other cancers in the urinary tract
• risks for bladder cancer

A physical exam allows your doctor to look for any signs of bladder cancer. During a physical exam, your doctor may do a pelvic exam or a digital rectal exam (DRE).

Find out more about a physical exam.

A urinalysis examines your urine. It finds and measures substances in a sample of urine, such as blood, bacteria and cells. It is often one of the first tests done to check for abnormalities in the urine and problems in the urinary tract.

Blood in the urine (hematuria) may mean there is bleeding in the urinary tract, which could be caused by cancer. Nitrites in the urine may mean you have a urinary tract infection (UTI).

A urine culture tests a sample of urine for bacteria and other germs that can cause an infection. In a lab, the urine is placed in a special substance where germs can grow. After a few days, the sample is examined under a microscope to check if bacteria and other germs have grown. A urine culture is done to check if an infection could be the cause of bladder symptoms.

Urine cytology studies the cells in a urine sample or bladder washings (collected during a cystoscopy when the bladder is rinsed with salt water). Urine cytology can be used to look for abnormal cells, including bladder cancer cells.

Find out more about a urinalysis.

A cystoscopy uses a thin tube with a light and lens on the end (called a cystoscope) to look inside the bladder and urethra. It is used to look for any tumours or abnormal areas. Biopsy samples and salt water rinses from the bladder (bladder washings) may be taken during a cystoscopy. A cystoscopy is usually done when there is blood or abnormal cells in the urine.

A fluorescence cystoscopy may be done along with a regular cystoscopy. It uses a dye ( contrast medium) and a special blue light to help make cancer cells easier to see. The doctor injects the dye into the bladder and then uses a cystoscope to shine a blue light in the bladder. The cancer cells that take up the dye will glow in the blue light.

A ureteroscopy may be used if the doctors want to look at the upper parts of the urinary tract. It is done like a cystoscopy, except the doctor will look at the ureters and renal pelvis.

Find out more about a cystoscopy and ureteroscopy.

During a biopsy, the doctor removes tissues or cells from the body so they can be tested in a lab. A report from a pathologist will show whether or not cancer cells are found in the sample. Small tumours and biopsy samples from the bladder are usually removed during a cystoscopy.

A transurethral resection of bladder tumour (TURBT) is the most common type of biopsy used to diagnose bladder cancer. It is surgery that removes the tumour and some muscle from the bladder wall near it. A TURBT can show how far the cancer has grown into the bladder wall (depth of invasion). It is also used to treat early stages of bladder cancer.

Find out more about a biopsy and surgery for bladder cancer, which includes a TURBT.

A complete blood count (CBC) measures the number and quality of white blood cells, red blood cells and platelets. A CBC may be done to check for anemia from long-term bleeding from the urinary tract. It may also be used to check for infection.

A CBC is usually done before any cancer treatment starts. This provides a baseline to compare with future CBCs.

Find out more about a complete blood count (CBC).

Blood chemistry tests measure certain chemicals in the blood. They show how well certain organs are working and can help find abnormalities. Blood chemistry tests used to stage bladder cancer include the following.

Kidney function tests measure how well the kidneys are working. Higher levels of certain chemicals may mean that there are kidney problems or a blocked urinary tract.

Alkaline phosphatase (ALP) is an enzyme found throughout the body. The highest amounts are found in the cells of the bone and liver. Increased levels of ALP may mean the cancer has spread to bone or the liver.

Liver function tests( including ALP) measure how well the liver is working. Higher levels of certain chemicals may mean that the cancer has spread to the liver.

Find out more about blood chemistry tests.

An intravenous pyelogram (IVP) is also called an intravenous urography. It makes images of the urinary system, including the kidneys, ureters, bladder and urethra. A dye is injected into a vein and concentrates in the urine. X-rays are taken as the urine (with the dye) moves through the urinary tract. The images can help diagnose tumours and other abnormalities in the bladder and the rest of the urinary tract.

A retrograde pyelogram is like an IVP, but the dye is injected directly into the urinary system (instead of a vein) through a tube placed into the ureter using a cystoscopy. This procedure is sometimes used to find out what is blocking the flow of urine. It can also help diagnose cancer in the inner lining of the ureters or kidneys. It may be used if someone can’t have an IVP.

Find out more about an intravenous pyelogram (IVP).

A computed tomography (CT) scan uses special x-ray equipment to make 3D and cross-sectional images of organs, tissues, bones and blood vessels inside the body. A computer turns the images into detailed pictures.

A CT scan of the abdomen and pelvis is used to check the urinary system for any tumours or blockages. It is also used to check if bladder cancer has spread to lymph nodes, the liver or other organs and tissue around the bladder. A CT scan of the chest may be used to check if bladder cancer has spread to the lungs.

CT urography is an IVP that uses a CT scan instead of regular x-rays to make images of the urinary tract. It is used to look for tumours in the urinary tract.

Find out more about a CT scan.

Magnetic resonance imaging (MRI) uses powerful magnetic forces and radiofrequency waves to make cross-sectional images of organs, tissues, bones and blood vessels. A computer turns the images into 3D pictures. An MRI may be used to check if bladder cancer has spread to organs or areas outside the bladder.

Find out more about an MRI.

An ultrasound uses high-frequency sound waves to make images of parts of the body. It may be used to check if bladder cancer has spread to other organs or areas in the pelvis and abdomen. An ultrasound can also be used to check the health of the kidneys.

Find out more about an ultrasound.

An x-ray uses small doses of radiation to make an image of parts of the body on film. A chest x-ray is used to check if bladder cancer has spread to the lungs.

Find out more about an x-ray.

A bone scan uses bone-seeking radioactive materials called radiopharmaceuticals and a computer to create a picture of the bones. It is used to check if bladder cancer has spread to bone. It is usually only done if you have symptoms such as bone pain or if the level of alkaline phosphatase (ALP) in the blood is high.

Find out more about a bone scan.

To make the decisions that are right for you, ask your healthcare team questions about a diagnosis.