Bladder cancer

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Diagnosis of bladder cancer

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 commonly used to rule out or diagnose bladder cancer. Many of the same tests used to diagnose cancer are used to find out the stage, which is how far the cancer has progressed. Your doctor may also order other tests to check your general health and to help plan your treatment.

Health history and physical exam

Your health history is a record of your symptoms, risk factors and all the medical events and problems you have had in the past. In taking a health history, your doctor will ask questions about a personal history of:

  • smoking tobacco
  • occupational exposure to chemicals
  • chronic bladder irritation
  • radiation to the pelvis
  • chemotherapy

Your doctor may also ask about a family history of 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 bimanual pelvic exam
  • feel the abdomen for a lump and check if the liver is enlarged (swollen)
  • check for enlarged lymph nodes in the groin, abdomen and neck

During a bimanual pelvic exam, the doctor inserts gloved, lubricated fingers into the vagina (for women) or the rectum (for men) and places the other hand on the lower abdomen. By pressing on the abdomen and moving the fingers in the vagina or rectum, the doctor can feel a lump or thickened area on the bladder.

Find out more about physical exam.

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A cystoscopy uses an endoscope (a thin, tube-like instrument with a light and lens) to examine or treat the bladder and urethra. Doctors use a cystoscopy to look inside the urinary tract and closely examine the bladder. It allows doctors to see the size, location and growth pattern of any abnormalities in the bladder.

The doctor may remove small tumours or abnormal areas during a cystoscopy. (Tumours are removed through the urethra, so this is called a transurethral resection.) Biopsy and urine samples may also be taken during a cystoscopy.

A fluorescence cystoscopy uses a dye (called a porphyrin) and a special light to help make cancer cells easier to see. Porphyrins are a group of chemicals that glow when they are exposed to blue light. The doctor injects the porphyrin into the bladder and the cancer cells take it up. The doctor then uses a cystoscope to shine a blue light in the bladder. The cancer cells that took up the porphyrin glow in the blue light.

Find out more about cystoscopy.

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During a biopsy, the doctor removes tissues or cells from the body so they can be tested in a lab. The pathology report from the lab will confirm whether or not cancer cells are present in the sample.

The doctor may take a biopsy sample or remove small tumours during a cystoscopy. The doctor may also collect samples of normal-looking bladder tissue to check for very early cancer (called carcinoma in situ). The biopsy sample or tumour is examined under a microscope to look for bladder cancer and see how far the cancer cells have grown into the bladder wall (called the depth of invasion).

Find out more about biopsy.

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Intravenous pyelogram (IVP)

An IVP is also called an intravenous or excretory urogram. It is a series of x-rays of the urinary system, including the kidneys, ureters, bladder and urethra. A contrast medium (radiopaque iodine) is injected into a vein. The radiopaque iodine concentrates in the urine. X-rays are taken as the urine moves through the urinary system. The images can help doctors diagnose abnormalities in the bladder and the rest of the urinary system. An IVP isn’t used as commonly as a CT scan in diagnosing bladder cancer.

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 causing a blockage, or obstruction, in the normal flow of urine. It can also help diagnose cancer in the inner lining of the ureter or kidney. It is used if someone cannot have the injected contrast medium used in an IVP because they are allergic to it or they have poor kidney function.

Find out more about intravenous pyelogram (IVP).

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Urine tests

Urine tests help doctors determine a person’s overall health and check for any problems. Different urine tests may be done if the doctor suspects bladder cancer.

Urinalysis is a routine urine test that describes the colour, appearance and contents of a urine sample. It also measures substances found in urine, such as electrolytes, hormones and waste products of metabolism. A urinalysis is done to find abnormalities in the urine. For example, blood in the urine means that there is bleeding somewhere in the urinary tract (kidneys, ureters, bladder or urethra). This may indicate an infection or cancer.

Find out more about urinalysis.

Urine culture is the process of growing micro-organisms (such as bacteria), cells or tissues in a specially prepared growth medium. 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 where bacteria can grow. After 1–3 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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Cytology is the study of cells.

Urine cytology looks at cells from the lining of the bladder, ureters and kidneys that are shed 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. The doctor may flush the bladder with saline (salt water) during a cystoscopy to collect cells (called bladder washings).

Fluorescence in situ hybridization (FISH) is a type of chromosome analysis, or cytogenetic test. It can be used to look for specific changes in chromosomes in bladder cells. FISH uses special dyes that attach only to specific parts of certain chromosomes. Some abnormalities that are too small to be found with standard chromosome analysis can be found using FISH. Urovysion assay is a FISH test that may be used to find chromosome abnormalities that are linked with cancer in bladder cells.

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Tumour marker tests

Tumour markers are substances (usually proteins) in the urine that may mean bladder cancer is present. Tumour marker tests are generally used to check your response to cancer treatment. They can also be used to diagnose bladder cancer.

The following tumour markers may be measured for bladder cancer.

Bladder tumour–associated antigen (BTA) is a protein that can be in the urine when bladder cancer is present.

Nuclear matrix proteins (NMP) are proteins released into the urine by bladder cancer cells. Urine tests to look for a nuclear matrix protein called NMP22 may be used to diagnose bladder cancer.

Mucin and carcinoembryonic antigen (CEA) is a substance that is sometimes present on bladder cancer cells. Tests such as ImmunoCyt/uCyt+ may be used to look for this substance on bladder cancer cells in the urine.

Find out more about tumour marker tests.

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Complete blood count (CBC)

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, or chronic, bleeding from the bladder
  • help rule out infection
  • provide a baseline for comparison with blood counts taken during and after treatment

Find out more about complete blood count (CBC).

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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. Kidney function is especially important in people being treated for bladder cancer. Blood chemistry tests are also used to find out if bladder cancer has spread to other organs.

Some blood chemistry values may be higher than normal if bladder cancer has spread, or metastasized, to certain organs. For example, liver function tests may be abnormal if bladder cancer has spread to the liver. Higher than normal levels of an enzyme called alkaline phosphatase in the blood may mean that bladder cancer has spread to the bone.

Find out more about blood chemistry tests.

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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 check if bladder cancer has spread to the lungs.

Find out more about x-ray.

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CT scan

A computed tomography (CT) scan uses special x-ray equipment to make 3-D 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 may be done to:

  • look at the bladder, ureters and kidneys
  • find a tumour and determine its size
  • check if cancer has spread to lymph nodes, the liver or other structures around the bladder

A CT-IVP is an intravenous pyelogram that uses a CT scan instead of x-rays. It is used to look specifically at the inner lining of the kidneys and ureters. A CT-IVP is often done instead of an IVP.

Find out more about CT scan.

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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 3-D 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 a tumour and determine its size
  • check if cancer has spread to lymph nodes, the liver or other structures around the bladder

Find out more about MRI.

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Ultrasound uses high-frequency sound waves to make images of structures in the body. It is used to:

  • determine the size of a bladder tumour
  • check if cancer has spread to other organs or structures

An ultrasound doesn’t show as much detail as a CT scan, so it isn’t as reliable as a CT scan. Ultrasound alone can’t give doctors enough information to fully assess bladder cancer. Also, many bladder tumours may not be found with an ultrasound or even with a CT scan.

Find out more about ultrasound.

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Bone scan

A bone scan uses bone-seeking radioactive materials (called radiopharmaceuticals) and a computer to create a picture of the bones. It may be done to check if bladder cancer has spread to the bones. It is usually only done if you have more advanced bladder cancer and bone pain.

Find out more about bone scan.

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Questions to ask your healthcare team

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

alkaline phosphatase

An enzyme normally present in high amounts in the liver, bone and bile duct (the tube that carries bile, a yellow-green fluid that helps digest fat, from the liver to the duodenum, or first part of the small intestine).

An increased level of alkaline phosphatase may be a sign of bone disease, liver disease or a blocked bile duct.


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