Bladder cancer is often found because of signs or symptoms a person is having, or it might be found because of lab tests a person is getting for another reason. If bladder cancer is suspected, exams and tests will be needed to confirm the diagnosis. If cancer is found, further tests will be done to help determine the extent (stage) of the cancer. Tests and procedures used to diagnose bladder cancer may include:
• Biopsy
A biopsy is the removal of a small sample of body tissue to see if it is cancer. The tissue that is removed is sent to the lab, where it is looked at by a pathologist, a doctor who specializes in diagnosing diseases with lab tests. If bladder cancer is suspected, a biopsy is needed to confirm the diagnosis.
- Biopsies to look for cancer spread
If imaging tests (see the next section) suggest the cancer might have spread outside of the bladder, a biopsy is the only way to be sure. In some cases, biopsy samples of suspicious areas are obtained during surgery to remove the bladder cancer.
Another way to get a biopsy sample is to use a thin, hollow needle to take a small piece of tissue from the abnormal area. This is known as a needle biopsy, and by using it the doctor can take samples without an operation. Needle biopsies are sometimes done using a computed tomography scan or ultrasound to help guide the biopsy needle into the abnormal area.
- Bladder biopsies
Bladder biopsy samples are most often obtained during cystoscopy. A biopsy can show whether cancer is present and what type of bladder cancer it is. If bladder cancer is found, two important features are its invasiveness and grade.
Invasiveness: The biopsy can show how deeply the cancer has invaded (grown into) the bladder wall, which is very important in deciding treatment. If the cancer stays in the inner layer of cells without growing into the deeper layers, it is called non-invasive. If the cancer grows into the deeper layers of the bladder, it is called invasive. Invasive cancers are more likely to spread and are harder to treat.
You may also see a bladder cancer described as superficial or non-muscle invasive. These terms include both non-invasive tumors as well as any invasive tumors that have not grown into the main muscle layer of the bladder.
Grade: Bladder cancers are also assigned a grade, based on how they look under the microscope.
People with bladder cancer may develop more cancers in other areas of the bladder or in the urinary system. For this reason, during the biopsy the doctor may take tissue samples from several different areas of the bladder lining.
• Cystoscopy
Cystoscopy uses an instrument known as a cytoscope (a thin tube with a camera and light at the end) to examine the inside of your bladder. The procedure usually takes about five minutes.
• Biopsy
A biopsy is the removal of a small sample of body tissue to see if it is cancer. The tissue that is removed is sent to the lab, where it is looked at by a pathologist, a doctor who specializes in diagnosing diseases with lab tests. If bladder cancer is suspected, a biopsy is needed to confirm the diagnosis.
- Biopsies to look for cancer spread
If imaging tests (see the next section) suggest the cancer might have spread outside of the bladder, a biopsy is the only way to be sure. In some cases, biopsy samples of suspicious areas are obtained during surgery to remove the bladder cancer.
Another way to get a biopsy sample is to use a thin, hollow needle to take a small piece of tissue from the abnormal area. This is known as a needle biopsy, and by using it the doctor can take samples without an operation. Needle biopsies are sometimes done using a computed tomography scan or ultrasound to help guide the biopsy needle into the abnormal area.
- Bladder biopsies
Bladder biopsy samples are most often obtained during cystoscopy. A biopsy can show whether cancer is present and what type of bladder cancer it is. If bladder cancer is found, two important features are its invasiveness and grade.
Invasiveness: The biopsy can show how deeply the cancer has invaded (grown into) the bladder wall, which is very important in deciding treatment. If the cancer stays in the inner layer of cells without growing into the deeper layers, it is called non-invasive. If the cancer grows into the deeper layers of the bladder, it is called invasive. Invasive cancers are more likely to spread and are harder to treat.
You may also see a bladder cancer described as superficial or non-muscle invasive. These terms include both non-invasive tumors as well as any invasive tumors that have not grown into the main muscle layer of the bladder.
Grade: Bladder cancers are also assigned a grade, based on how they look under the microscope.
- Low-grade cancers look more like normal bladder tissue. They are also called well-differentiated cancers. Patients with these cancers usually have a good prognosis (outlook).
- High-grade cancers look less like normal tissue. These cancers may also be called poorly differentiated or undifferentiated. High-grade cancers are more likely to grow into the bladder wall and to spread outside the bladder. These cancers can be harder to treat.
People with bladder cancer may develop more cancers in other areas of the bladder or in the urinary system. For this reason, during the biopsy the doctor may take tissue samples from several different areas of the bladder lining.
• Cystoscopy
Cystoscopy uses an instrument known as a cytoscope (a thin tube with a camera and light at the end) to examine the inside of your bladder. The procedure usually takes about five minutes.
During a cystoscopy a local anaesthetic gel is applied to your urethra (the tube through which you urinate) so you don't feel any pain. The gel also helps the cystoscope to pass into the urethra more easily.
• Imaging tests
Imaging tests allow your doctor to examine the structures of your urinary tract. Tests to highlight the urinary tract sometimes use a dye, which is injected into a vein before the procedure. An intravenous pyelogram is a type of X-ray imaging test that uses a dye to highlight your kidneys, ureters and bladder. A computerized tomography (CT) scan is a type of X-ray test that allows your doctor to better see your urinary tract and the surrounding tissues.
• Lab tests
Urine culture
If you are having urinary symptoms, this test may be done to see if an infection (rather than cancer) is the cause. Infections and bladder cancers can cause similar symptoms. For a urine culture, a sample of urine is put into a dish in the lab to allow any bacteria that are present to grow. It can take time for the bacteria to grow, so it may take a few days to get the results of this test.
Urine cytology
A sample of your urine is analyzed under a microscope to check for cancer cells in a procedure called urine cytology. Cytology is also done on any bladder washings taken when the cystoscopy was done. Cytology can help find some cancers, but this test is not perfect. Not finding cancer on this test doesn’t always mean you are cancer free.
Urine tumor marker tests
Different urine tests look for specific substances released by bladder cancer cells. These tests may be used along with urine cytology to help determine if a person has bladder cancer. They include the tests for NMP22 and BTA, the Immunocyt test, and the UroVysion test.
Some doctors find these urine tests useful in looking for bladder cancers, but they may not help in all cases. Most doctors feel that cystoscopy is still the best way to find bladder cancer. Some of these tests are more helpful when looking for possible recurrence of bladder cancer in someone who has already had it, rather than finding it in the first place.
• Medical history and physical exam
A physical exam provides other information about possible signs of bladder cancer and other health problems. The doctor might examine the rectum and vagina (in women) to feel for a bladder tumor, determine its size, and to see if and how far it has spread.
If the results of the exam are abnormal, your doctor will probably do lab tests such as a urinalysis and might refer you to a urologist (a doctor specializing in diseases of the urinary system and male reproductive system) for further tests and treatment.
• Imaging tests
Imaging tests allow your doctor to examine the structures of your urinary tract. Tests to highlight the urinary tract sometimes use a dye, which is injected into a vein before the procedure. An intravenous pyelogram is a type of X-ray imaging test that uses a dye to highlight your kidneys, ureters and bladder. A computerized tomography (CT) scan is a type of X-ray test that allows your doctor to better see your urinary tract and the surrounding tissues.
• Lab tests
Urine culture
If you are having urinary symptoms, this test may be done to see if an infection (rather than cancer) is the cause. Infections and bladder cancers can cause similar symptoms. For a urine culture, a sample of urine is put into a dish in the lab to allow any bacteria that are present to grow. It can take time for the bacteria to grow, so it may take a few days to get the results of this test.
Urine cytology
A sample of your urine is analyzed under a microscope to check for cancer cells in a procedure called urine cytology. Cytology is also done on any bladder washings taken when the cystoscopy was done. Cytology can help find some cancers, but this test is not perfect. Not finding cancer on this test doesn’t always mean you are cancer free.
Urine tumor marker tests
Different urine tests look for specific substances released by bladder cancer cells. These tests may be used along with urine cytology to help determine if a person has bladder cancer. They include the tests for NMP22 and BTA, the Immunocyt test, and the UroVysion test.
Some doctors find these urine tests useful in looking for bladder cancers, but they may not help in all cases. Most doctors feel that cystoscopy is still the best way to find bladder cancer. Some of these tests are more helpful when looking for possible recurrence of bladder cancer in someone who has already had it, rather than finding it in the first place.
• Medical history and physical exam
A physical exam provides other information about possible signs of bladder cancer and other health problems. The doctor might examine the rectum and vagina (in women) to feel for a bladder tumor, determine its size, and to see if and how far it has spread.
If the results of the exam are abnormal, your doctor will probably do lab tests such as a urinalysis and might refer you to a urologist (a doctor specializing in diseases of the urinary system and male reproductive system) for further tests and treatment.