If doctors suspect that a patient has bladder cancer because of the presence of blood in the urine or an urgency to urinate, burning with urination, or unexplained increased frequency of urination, they may use several methods to confirm the diagnosis and determine the stage (spread) of the disease. Doctors at Columbia University Department of Urology at NewYork-Presbyterian Hospital use the latest laboratory testing and diagnostic technologies including:
- Urine cytology to diagnose bladder cancer: Doctors use this test to examine the urine under a microscope to look for any abnormal cells. (This is similar to a PAP smear.) They may also take a urine culture to rule out an infection, which can cause similar symptoms to bladder cancer.
- Cystoscopy to diagnose bladder cancer: Urologists place a cystoscope, a flexible instrument consisting of a slender tube with a lens and light, into the bladder through the urethra and check for possible cancers. Historically, cystoscopy was performed with a rigid metal instrument, which was associated with significant discomfort. The most modern instruments such as those used by Columbia are small, flexible and instead of having lenses, have small camera chips on the end. This improves visualization and significantly minimizes discomfort.
- Biopsy to diagnose bladder cancer: Doctors remove suspicious tissue during a cystoscopy and analyze it under a microscope for signs of cancer. Small biopsies can be performed in the office but deep biopsies require anesthesia and patients often need to be admitted to the hospital following the biopsy.
- Intravenous Urography to diagnose bladder cancer: Doctors inject a dye into the bloodstream, which travels to the kidneys, ureters, and bladder and more clearly outlines these organs on an x-ray. This test evaluates the urinary funnel system from the kidneys to the bladder and helps determine where blood in the urine originates.
- CT Scan to diagnose bladder cancer: A computed tomography (CT) scan of the abdomen and pelvis can show if the urinary funnel system is normal, and if cancer is present, how far it has spread outside the bladder.
- MRI Scan to diagnose bladder cancer: An MRI of the abdomen and pelvis can show if the urinary funnel system is normal and if cancer is present, how it has spread outside the bladder. MRI is preferred over CT scanning for some patients with reduced kidney function.
- Ultrasound to diagnose bladder cancer: This procedure uses sound waves to determine if there are polyps within the bladder.
Staging Bladder Cancer
Staging of bladder cancer, determining if and how far it has spread, helps doctors choose the most effective therapy. Staging takes into account how deeply the tumor has penetrated into the bladder wall, and whether it has spread to lymph nodes and metastasized or spread to other organs.
- Stage TA of Bladder Cancer: The tumor cells form a polyp and are confined within the bladder and have not invaded beyond the lining surface cells of the bladder wall.
- Stage TCIS of Bladder Cancer: The tumor cells are usually very aggressive in their appearance but they are confined to the bladder lining like a reddish stain.
- Stage T1 of Bladder Cancer: Cancer has spread from the lining cells of the bladder into the layer of connective or supporting tissue under the lining layer of the bladder, but has not spread to the thick layer of muscle in the bladder wall, to the lymph nodes, or to any other organs.
- Stage T2A of Bladder Cancer: The tumor has invaded the superficial half of the muscle layer of the bladder wall, but has not reached the deep muscle layers or the fatty tissue that surrounds the bladder or beyond.
- Stage T2B of Bladder Cancer: The tumor has invaded the deep half of the muscle layer of the bladder wall, but has not reached the fatty tissue that surrounds the bladder or beyond.
- Stage T3 of Bladder Cancer: Cancer has invaded into the fat that surrounds the bladder but has not invaded into nearby organs, such as the prostate, uterus, or vagina.
- Stage T4 of Bladder Cancer: Cancer has invaded nearby organs.
- Stage N (+) of Bladder Cancer: Cancer has spread to the lymph nodes.
- Stage M (+) of Bladder Cancer: Cancer has spread to more distant organs, such as bones, liver, or lungs.
Screening for Bladder Cancer
Early-stage bladder cancer often shows no symptoms, or symptoms that are similar to those of benign conditions such as bladder stones, an enlarged prostate, or urinary tract infection. For this reason it is important to be examined regularly by a physician. If symptoms do appear they should be evaluated promptly so that bladder cancer can be detected in its earliest, most treatable stages.
Doctors may conduct some screening tests during an examination. During a urine cytology the doctor examines urine under a microscope to look for any cancerous or precancerous cells. During another test called a cystoscopy urologists place a cystocope, a flexible instrument consisting of a steerable slender tube with a camera or lens and a light, into the bladder through the urethra. They check the bladder and urethra for signs of cancer, remove any suspicious tissue, and check it under a microscope.