A thorough and accurate diagnosis is the first step in developing a bladder cancer treatment plan. Bladder cancerexperts use a variety of tests and tools for diagnosing this disease and developing a customized treatment strategy for each patient. Throughout treatment, imaging and laboratory tests are used to track the size of the tumor(s), monitor the response to treatment. and modify the treatment plan when needed.
Doctors may suspect cancer if a patient has bladder cancer symptomssuch as blood in the urineor pain when urinating—or if lab testsdone for another reason show abnormal results.
Tests for bladder cancer
To find bladder cancer, doctors may run tests to see whether there are certain substances—such as blood—in the urine. Tests may include:
- Urinalysis (looks for blood in urine)
- Urine cytology(looks for abnormal cells in urine)
- Urine culture (looks for an infection, rather than cancer)
For patients who have symptoms or have had bladder cancer in the past, newer tests that look for tumor markersin urine may include:
- UroVysion™ (looks for chromosome alterations)
- BTA tests (looks for bladder tumor-associated antigen—BTA—which is also known as CFHrp)
- ImmunoCyt™ (looks for mucin and carcinoembryonic antigen substances that are frequently found on cancer cells)
- NMP22 BladderChek® (looks for NMP22—nuclear matrix protein 22—which is often elevated in bladder cancer patients)
Researchers don’t know yet whether these tests are reliable enough to be used for screening, but they may help find some bladder cancers.
Most doctors recommend a cystoscopyto find bladder cancer, and it’s often performed without anesthesia. During this procedure, the doctor inserts a long, thin tube with a camera into the urethra to see the inside of the bladder for growths and collect a tissue sample (biopsy). The tissue is studied in a lab to search for cancer and obtain more information. During a cystoscopy, doctors may also perform a fluorescence cystoscopy, or blue light cystoscopy, inserting a light-activated drug into the bladder to see whether any cancer cells glow when they shine a blue light through the tube.
Doctors may also order imaging tests to see whether the cancer has spread. The most common imaging tests include the following.
Magnetic resonance imaging (MRI) uses magnets and radio waves to take pictures of the inside of the body. Before the test, a contrast medium (dye) is administered orally or by injection to help make the scan clearer.
Computed tomography (CT) scan uses X-rays to take pictures of the inside of the body. The patient may get a contrast medium injected into a vein to make the scan clearer.
Ultrasound uses sound waves to take pictures of the inside of the body.
While working to get a full picture of the diagnosis, doctors may order a transurethral resection of bladder tumor (TURBT), a surgery to remove the tumor and muscle near it for testing. This procedure helps provide more details about the type of tumor, how deeply it’s grown into the bladder and other important factors that may help determine treatment.
Bladder cancer treatment: The care you need is one call away
Your multidisciplinary team will work with you to develop a personalized plan to treat your bladder cancer in a way that fits your individual needs and goals.
Understanding bladder cancer grade and invasiveness
Two important pieces of information to know about this specific cancer are its invasiveness and grade.
Invasive and high-grade cancers may be harder to treat than noninvasive and low-grade ones. They may also require a different kind of treatment.
It’s also important to know the stage of bladder cancer, or how much the cancer has spread. If the cancer has spread to other parts of the body, it’s called metastatic.
What is invasive bladder cancer?
Invasiveness describes how deep the cancer is in the bladder wall, which is crucial to determining treatment. If the cancer is in the inner cell layers, it’s noninvasive or superficial. If it’s grown into deeper bladder layers or spread to other organs or lymph nodes, it’s invasive.
Bladder cancer grades
Grade describes how bladder cancer cells look under a microscope. Low-grade cancers, also called well-differentiated cancers, resemble regular bladder cells. High-grade, poorly differentiated or undifferentiated cancers don’t look as much like normal bladder cells, and they’re more likely to become invasive or spread to other body parts.
Bladder cancer screening and early detection
There isn’t a test yet that is able to screen the general population for bladder cancer. Doctors may recommend specific tests to screen for bladder cancer based on known risk factors.
Can bladder cancer be detected with a urine test?
Because bladder cancer causes urinary symptoms such as blood in the urine, it may be found early. However, because blood in urine is caused by a lot of conditions other than cancer, urinalysis isn’t a useful screening test for the general population.
FAQs
Cystoscopy. Cystoscopy is the key diagnostic procedure for bladder cancer. It allows the doctor to see inside the body with a thin, lighted, flexible tube called a cystoscope.
What test is most definitive in diagnosing bladder cancer? ›
Cystoscopy. Cystoscopy is the key diagnostic procedure for bladder cancer. It allows the doctor to see inside the body with a thin, lighted, flexible tube called a cystoscope.
Which is most accurate diagnostic method for bladder cancer? ›
If bladder cancer is suspected, a biopsy is needed to be sure of the diagnosis. The procedure used to biopsy an abnormal area is a transurethral resection of bladder tumor (TURBT), also known as just a transurethral resection (TUR).
What is the gold standard for diagnosing bladder cancer? ›
Urine cytology remains the gold standard for bladder cancer screening. It is the test against which all others are compared when evaluating potential bladder tumor markers.
What is the best screening test for bladder cancer? ›
Cystoscopy. A cystoscope (a thin, tube-like instrument with a light and a lens for viewing) is inserted through the urethra into the bladder. Fluid is used to fill the bladder. The doctor looks at an image of the inner wall of the bladder on a computer monitor to check for abnormal areas.
What are three diagnostic tests used to confirm bladder cancer? ›
Tests and procedures used to diagnose bladder cancer may include:
- Using a scope to examine the inside of your bladder (cystoscopy). ...
- Removing a sample of tissue for testing (biopsy). ...
- Examining a urine sample (urine cytology). ...
- Imaging tests.
NMP22 BladderChek®: This test looks for a protein called NMP22 (nuclear matrix protein 22) in the urine. People who have bladder cancer often have higher levels .
What are the odds of beating bladder cancer? ›
The 5-year relative survival rate of people with bladder cancer that has not spread beyond the inner layer of the bladder wall is 96%. Almost half of people are diagnosed with this stage. If the tumor is invasive but has not yet spread outside the bladder, the 5-year relative survival rate is 70%.
Can bladder cancer be missed on cystoscopy? ›
Until recently it was assumed that the standard procedure, white light cystoscopy (WLC) was accurate but it is now accepted that this will miss some bladder cancers. One particular type of bladder cancer called carcinoma in situ (CIS) although rare is easy to miss when using WLC.
How accurate is cystoscopy in bladder cancer? ›
The sensitivity of cystoscopy in our study was found to be 81%, which is consistent with the reported range in the literature of 68–100%. A systematic review also reported a specificity range of 57–97%, with our study reporting a specificity of 73% [13].
How effective are CT scans at detecting bladder cancer accurately? CT scans are very effective at detecting urinary tract cancers. A 2018 study found that CT urographies had a 91.5% accuracy rate.
How accurate is CT scan for bladder cancer? ›
While a CT scan can detect larger bladder tumors, it is not sensitive enough to detect small tumors or flat tumors in the bladder. CT is most useful to evaluate the kidneys and ureters and the area around the bladder and lymph nodes, as well as evaluate other organs in the body.
How is bladder cancer detected early? ›
Bladder cancer is typically diagnosed by going through the patient's health history and checking for physical signs of the disease. A urine sample may also be taken and checked for abnormal cells.
What does Stage 1 bladder cancer feel like? ›
The first sign of bladder cancer is blood in the urine, which is painless for most people. In the early stages, this may be your only symptom, though some people don't experience it. Other symptoms include changes in bladder habits, frequent urinary infections, and pelvic or back pain, which might be on one side.
How long can you have bladder cancer without knowing? ›
Can bladder cancer go undetected for years? If symptoms such as blood in the urine and changes in urinary habits are ignored by an individual and/or repeatedly misdiagnosed, it's possible that bladder cancer may not be detected for months or, in some cases, even years.
What does bladder cancer look like on cystoscopy? ›
CIS: Carcinoma in situ (CIS) is often seen as a red, velvety patch in the bladder. This type of cancer grows on the surface of the bladder. It has a high risk of changing into disease that can invade into the muscle of the bladder wall.
How accurate is a cystoscopy in detecting bladder cancer? ›
Among 181 cystoscopies with clinically negative results that underwent a follow-up cystoscopy, 17 patients (9.4%) were subsequently diagnosed with bladder cancer, with the lesions identified in the initial cystoscopy. The sensitivity and specificity of cystoscopy in these cases were 81% and 73%, respectively.
How accurate is a CT scan for bladder cancer? ›
How often does a CT scan miss bladder cancer? Most of the time, CT scans are very accurate, though false negatives and false positives can happen. A 2018 study found that some false positives can occur. Researchers cited 13 false negatives out of 710 scans.
How accurate is urine cytology for bladder cancer? ›
Urine cytology is associated with a significant false-negative rate, especially for low-grade carcinoma (10-50% accuracy rate). The false-positive rate is 1-12%, although cytology has a 95% accuracy rate for diagnosing high-grade carcinoma and CIS. Urine cytology is often the test used for diagnosis of CIS.
