Diagnosis is the process of finding the underlying cause of a health problem. If cancer is suspected, the healthcare team will confirm if it is present or not, and what type of cancer it is. The process of diagnosis may seem long and frustrating, but it is important for the doctor to rule out other possible reasons for a health problem before making a cancer diagnosis.
Diagnostic tests for bladder cancer are usually done when:
- the symptoms of bladder cancer are present
- the doctor suspects bladder cancer after talking with a person about their health and completing a physical examination
- a routine test suggests a problem with the bladder
Many of the same tests used to initially diagnose cancer are also used to determine the stage (how far the cancer has progressed). Your doctor may also order other tests to check your general health and to help plan your treatment. Tests may include the following.
Medical history and physical examination
The medical history is a record of present symptoms, risk factors and all the medical events and problems a person has had in the past. The medical history of a person's family may also help the doctor to diagnose bladder cancer.
In taking a medical history, the doctor will ask questions about:
- a personal history of
- tobacco smoking
- occupational exposure to chemicals
- chronic bladder irritation
- radiation to the pelvis
- chemotherapy
- a family history of bladder cancer
- signs and symptoms
A physical examination allows the doctor to look for any signs of bladder cancer. During a physical examination, the doctor may:
- do a digital rectal examination (DRE) to feel for a lump or thickened area of the bladder
- do a bimanual pelvic examination
- The doctor will insert one or two fingers of one hand into the vagina and place the other hand on the lower abdomen.
- By pressing on the abdomen and moving the fingers in the vagina, the doctor can feel a lump or thickened area of the bladder.
- feel the abdomen for a lump or enlarged liver
- feel the groin, abdomen and neck for enlarged lymph nodes
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Cystoscopy
Cystoscopy is a type of endoscopy that is done to examine the bladder more closely if certain symptoms suggest bladder cancer. It allows a doctor to look inside the urinary tract using a flexible tube with a light and lens on the end (a cystoscope). Cystoscopy allows the doctor to see the size, location and growth pattern of any abnormalities in the bladder. A urine sample may be taken for testing during the procedure.
In women, a bimanual pelvic examination may be done at this time because the abdominal muscles are relaxed from the anesthetic that is given before the cystoscopy begins. This may help identify tumour size, depth of cancer growth into the bladder wall and whether or not the tumour is attached to other organs or structures.
Fluorescence cystoscopy
Fluorescence cystoscopy may be used at the time of cystoscopy.
- Porphyrins are inserted into the bladder. Porphyrins are a group of chemicals that glow when exposed to blue light.
- The porphyrins are taken up by cancer cells.
- A blue light is shone through the cystoscope.
- Cancer cells glow when exposed to the blue light. These areas with cancer cells may not have shown up with the white light that is generally used for cystoscopy.
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Biopsy
During a biopsy, tissues or cells are removed from the body so they can be tested in a laboratory. The pathology report from the laboratory will confirm whether or not cancer cells are present in the sample.
A biopsy for bladder cancer is taken with the cystoscope during cystoscopy. A small tumour can also be completely removed during cystoscopy. The tumour is removed through the urethra, so it is called a transurethral resection. Both procedures are performed in a hospital operating room using general or spinal anesthesia.
- Samples of tissue, cells or urine are removed from the bladder.
- Samples of normal-looking bladder tissue may also be taken to check for very early cancer (carcinoma in situ).
- The biopsy sample or the removed tumour is examined to see how far the cancer cells have grown into the bladder wall (the depth of invasion).
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Intravenous pyelogram (IVP)
An intravenous pyelogram (IVP) is a series of x-rays of the urinary system (kidneys, ureters and bladder). The x-rays are taken after injection of a radiopaque dye (contrast dye) into a vein in the body. An IVP is used to help diagnose abnormalities of the urinary system. An IVP is also called an intravenous or excretory urogram.
A retrograde pyelogram may be done. It 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 during cystoscopy.
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Urinalysis
A urinalysis is a routine urine test that describes the colour, appearance and contents of a urine sample. It is done to find abnormalities such as blood in the urine. Blood in the urine means that there is bleeding somewhere in the urinary tract (kidneys, ureters, bladder or urethra).
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Urine culture
A urine culture is done to find out if there are bacteria in the urine. (Urine in the bladder does not normally contain bacteria.) A urine sample is collected and kept in conditions in which bacteria can grow. After 1 to 3 days, the sample is examined under a microscope to look for bacteria. A urine culture is done to rule out infection as the cause of urinary symptoms.
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Urine cytology
Urine cytology looks at the cells that are shed by the lining of the bladder into the urine. The presence of abnormal cells means that there could be cancer somewhere in the urinary tract. Cells for cytology may be collected in a normal urine sample or in bladder washings obtained by flushing the bladder with saline (salt water).
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Complete blood count
A complete blood count (CBC) measures the number and quality of white blood cells, red blood cells and platelets. A CBC is done to:
- check for anemia from long-term (chronic) bleeding from the bladder
- help rule out infection
- provide a baseline for comparison of future blood counts taken during and after treatment
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Blood chemistry tests
Blood chemistry tests measure certain chemicals in the blood. They show how well certain organs are functioning and can also be used to detect abnormalities. Some blood chemistry values may be higher than normal in metastatic bladder cancer.
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Chest x-ray
An x-ray uses small doses of radiation to make images of the body’s structures on film. A chest x-ray may be done to detect the spread of bladder cancer to the lungs.
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Computed tomography (CT) scan
A CT scan uses special x-ray equipment to make 3-dimensional and cross-sectional images of organs, tissues, bones and blood vessels inside the body. A computer turns the images into detailed pictures. It is used to:
- look at the bladder, ureters and kidneys
- find the location and size of a tumour
- check for spread of the cancer to the lymph nodes, liver and structures surrounding the bladder
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Magnetic resonance imaging (MRI)
MRI uses powerful magnetic forces and radio-frequency waves to make cross-sectional images of organs, tissues, bones and blood vessels. A computer turns the images into 3-dimensional pictures. An MRI of the abdomen and pelvis may be done instead of a CT scan to:
- look at the bladder, ureters and kidneys
- find the location and size of a tumour
- check for spread of the cancer to the lymph nodes, liver and structures surrounding the bladder
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Ultrasound
Ultrasound uses high-frequency sound waves to make images of structures in the body. It is used to find out the size of a bladder tumour and whether it has spread beyond the bladder.
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Bone scan
A bone scan uses bone-seeking radioactive materials (radiopharmaceuticals) and a computer to create a picture of the bones. It may be done to detect spread of the cancer to the bones.
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See a list of questions to ask your doctor about diagnostic tests.