Understanding Bladder Cancer: The Diagnosis
If your doctor thinks you might have bladder cancer, there are several different tests you may need.
Samples and lab tests
Cystoscopy: A cystoscope is a thin tube with a lens and a light. Your doctor puts it into your bladder through your urethra. The area will be numbed so you feel no pain during the procedure. Some patients are given general anesthesia to go to sleep. Your doctor will use the cystoscope to see inside your bladder. If anything looks abnormal, your doctor will remove a small piece of tissue and examine it under a microscope.
Urine cytology: This procedure goes along with cystoscopy. Urine or cells taken from your bladder during cystoscopy are sent to the lab. They will be examined to see if cancer cells are there. This test is not foolproof. It doesn’t always find all cancers.
Urine culture: In this test, the lab examines a sample of your urine to see if you have an infection. Sometimes a simple infection can cause the same symptoms as bladder cancer. It can take a few days to get the results of this test.
Urine tumor marker tests: These tests look for specific substances that cancer cells release into your urine. These tests are not as reliable. Most doctors prefer cystoscopy to find bladder cancer.
Biopsy: A biopsy is the only sure way to tell if something is cancer. In a biopsy, your doctor will take a sample of the tissue that looks abnormal. Usually a biopsy for bladder cancer is done during cystoscopy.
Your doctor will probably want to do imaging tests. These help the doctor see your bladder and other organs. This lets you know whether the cancer has spread to tissues near the bladder, nearby lymph nodes, or other organs.
Intravenous pyelogram (IVP): An IVP is an X-ray of your urinary system. Before taking this test, you will have a special dye injected into your vein. This dye goes into your ureters and bladder. The dye outlines these organs on X-rays. This helps your doctor clearly see tumors.
Retrograde pyelography: In this test, a thin, flexible tube called a catheter is inserted into your bladder. Or it may be put into a ureter. A special dye is put through the catheter. This dye makes the lining of your bladder, ureters and kidneys easier to see on X-rays. This test is used to find tumors in the upper part of your urinary system.
Chest X-ray: If you doctor suspects bladder cancer has spread, you may need a chest X-ray. This test looks for a tumor or a spot on your lungs. Finding this would mean that the cancer has spread from your bladder.
CT scan (CAT scan or computed tomography): The CT scan is an X-ray test that produces detailed pictures of your body. Instead of taking one picture, like a regular X-ray does, a CT scanner takes many pictures. It does this by rotating around you while you lie on a table. Then a computer combines all these images. That produces a 3-dimensional picture of your bladder.
Before any pictures are taken, you may have to drink 1 to 2 pints of a liquid. It is called oral contrast. This fluid helps outline your intestine. This helps the doctor identify tumors. You may also receive an IV (intravenous line) in your arm or hand. A different type of contrast dye can be injected through the IV. Its purpose is also to outline structures in your body.
The injection may make you feel flushed or warm. It is a little uncomfortable, but not painful. Many patients say that having to lie still is difficult. CT scans can help find tumors in your bladder, kidneys, and other organs. It can also show any swollen lymph nodes that might have cancer.
A CT scan can also be used to guide a biopsy needle in a tumor. This procedure is called a CT-guided needle biopsy. In this procedure, the radiologist puts a biopsy needle through your skin and into the mass. Then a tissue sample is removed and examined under a microscope.
MRI scan (magnetic resonance imaging): MRIs are similar to CT scans. An MRI scan provides detailed pictures like CT scans. The difference is that MRI scans use radio waves and strong magnets instead of X-rays. The energy from the radio waves produces patterns. A computer takes these and turns them into detailed images of specific parts of your body.
MRI pictures helps find signs that cancer has spread out of your bladder. MRIs can also help find cancer that has spread to your brain or spinal cord.
MRI scans are often little more uncomfortable than CT scans. For one thing, an MRI takes up to an hour. You may be placed inside a narrow tube. This can feel confining. There are newer, open MRI machines in many hospitals and clinics around the country.
Ultrasound: An ultrasound uses sound waves to makes pictures. Your doctor may want an ultrasound to determine the size of a bladder cancer and whether it has spread. An ultrasound can also be used to look at your kidneys. Having an ultrasound is painless. You lie on a table while the doctor or technician passes a wand over your bladder.
Sometimes a doctor will use an ultrasound to help guide a biopsy needle.
Bone scan: If your doctor suspects the bladder cancer has spread to your bones, you may need to have a bone scan. In this test, a small amount of radioactive substance will be injected into your vein. This substance builds up in areas of your bones that have cancer. A scanner located these places and shows them on a picture. Your doctor will probably not order a bone scan unless:
- You have bone pain or
- Blood tests indicate the cancer might have spread to your bones.