Diagnosing bladder cancer

Saturday 1 March, 2014

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On this page:  Physical examination | Blood test and urine test (urinalysis) | Cystoscopy and biopsy | CT IVP or three-phase renal CT scan | MRI scan | Ultrasound | Radioisotope bone scan | X-rays | Staging bladder cancer | Grading bladder cancer | Which health professionals will I see? | Prognosis | Key points


To confirm the diagnosis of bladder cancer you will need several of the tests listed on this page.
  • General tests to investigate abnormal symptoms
    May include a physical examination, and certain blood and urine tests.
  • Tests to find the position of the cancer in the bladder
    A cystoscopy and biopsy, ultrasound and some types of CT scans.
  • Tests to find any cancer that may have spread
    Includes CT scans, MRI scans, radioisotope bone scans and x-rays.

Physical examination

As the bladder is close to the rectum and vagina, your doctor may do an internal examination by inserting a gloved finger into the rectum or the vagina to feel for anything unusual. This test may be embarrassing and uncomfortable, but it is painless and only takes a few minutes.

Some people will have an internal examination under anaesthesia, during the cystoscopy.

Blood test and urine test (urinalysis)

A blood sample will be taken regularly to check your general health. You will be asked to give a urine sample, which is sent to a laboratory and checked for blood, bacteria and any cancer cells. The urinalysis is usually done on three different days.

Cystoscopy and biopsy

Cystoscopy is the main procedure used to diagnose bladder cancer. A slender tube with a light, called a cystoscope, is used to examine the lining of the bladder.

You can have a cystoscopy under local or general anaesthetic.

Under local anaesthetic

The cystoscope is inserted through your urethra and into the bladder to examine the whole of the inside lining. This is usually done as day surgery. If the test finds abnormal tissue, a biopsy can be taken, but you will be asked to come back for a cystoscopy under general anaesthetic.

Under general anaesthetic

To take a tissue sample (biopsy) or to remove a tumour, you’ll have the cystoscopy in hospital under a general anaesthetic. Small pieces of tissue can be removed from suspicious areas or growths. These will be examined by a pathologist to check for cancer cells.

The cystoscopy takes 10–20 minutes. For a few days afterwards you may have some soreness, pain or blood in your urine. If the tumour is large, you may have a tube (catheter) left in your bladder to drain urine into a bag for 1–2 days. This is called a urinary catheter.

If cancer is found during the cystoscopy, it may be removed during the procedure.

CT IVP or three-phase renal CT scan

A CT (computerised tomography) scan is a type of x-ray that takes several pictures of the inside of your body. The pictures are put together to produce a three-dimensional picture of your urinary system. The scan may be called a three-phase renal CT or a CT IVP (intravenous pyelogram).

CT scans are usually done at a hospital or a radiology clinic. You will be asked not to eat (fast) for a few hours before the scan.

Before the procedure, a dye will be injected into your vein. The dye travels through your bloodstream to the kidneys, ureters and bladder, and shows up any abnormal areas. You will then lie on an examination table and pass through the CT scanner, which is large and round like a doughnut. You will usually be scanned three times: once before the dye is injected, once immediately afterwards, and then again a bit later.

The dye may make you feel flushed, and you may have abdominal discomfort. Symptoms should ease quickly but tell your doctor if you feel unwell. The whole procedure takes 30–45 minutes.

MRI scan

An MRI (magnetic resonance imaging) scan uses magnetic waves to create detailed cross-section pictures of organs in your abdomen. You may be injected with a dye that highlights the organs in your body. You will then lie on an examination table inside a large metal tube that is open at both ends.

The noisy, narrow machine makes some people feel anxious or claustrophobic. If you are concerned or feel distressed, speak to the person performing the scan. You may be given medication to help you relax or you might be able to bring someone into the room with you for support. The MRI scan takes 30–90 minutes.

People who are allergic to iodine, fish or dyes may also be allergic to the dye used in the MRI or CT scan. If you are allergic, tell your medical team before the scan. You should also let the doctors know if you have a pacemaker, as you may not be able to have an MRI scan due to the effect of the magnet.

Ultrasound

An ultrasound scan uses soundwaves to create a picture of your organs. It is used to show if cancer is present and how large it is. An ultrasound can’t always find small tumours, so your doctor may do further tests.

During this scan, you will uncover your abdomen and lie on an examination table. A gel will be spread on your skin and a device called a transducer will be moved across your abdomen. The transducer creates soundwaves that echo when they meet something solid, such as an organ or tumour. A computer makes the soundwaves into a picture.

Ultrasound scans are painless and take 15–20 minutes.

Radioisotope bone scan

A radioisotope scan may be done to see if any cancer cells have spread to the bones.

A tiny amount of radioactive dye is injected into a vein, usually in your arm. The dye collects in areas of abnormal bone growth. You will need to wait for several hours before having the scan. This gives the bones time to absorb the dye. The scanner will measure the radioactivity levels and records them on x-ray film.

To pass the time while you wait for the scan, you may want to bring a book, magazine or another activity.

Although only a small amount of radioactive material is used, it may take a few hours to leave your body. You will need to drink plenty of fluids, and the medical staff will discuss safety precautions, such as avoiding contact with pregnant women and young children for the rest of the day. Speak to your doctor if you are concerned.

X-rays

A chest x-ray may be taken to check the health of your lungs and for any signs the cancer has spread. This is sometimes done with the CT scanner.

In some cases, cancer cells that have spread outside the bladder are not detected in further tests.

Staging bladder cancer

To help plan the best treatment for bladder cancer, tumours are given a stage to describe the extent of the cancer in the body.

The most common staging system is the TNM system. In this system, letters are assigned numbers to describe the cancer.

TNM system
T
Tumour
Indicates the size and depth of tumour invasion into the bladder and nearby tissues.
  • Ta – non-invasive papillary tumour
  • Tis – carcinoma in-situ
  • T1 – the tumour has grown into the lamina propria
  • T2 – the tumour has grown into the muscle layer
  • T3 – the tumour is in the tissue surrounding the bladder (perivesical tissue)
  • T4 – the tumour has invaded nearby structures, suchas the pelvic wall, seminal vesicles or the uterus
N
Nodes
Shows if the cancer has spread to nearby lymph nodes.
  • N0 – the cancer has not spread to the lymph nodes
  • N1 – the cancer is in one lymph node in the pelvis
  • N2 – the cancer is in multiple lymph nodes in the pelvis
  • N3 – the cancer has spread to lymph nodes located ear a major artery
M
Metastasis
Shows if the cancer has spread to other parts of the body.
  • M0 – cancer has not spread to distant parts of the body
  • M1 – cancer has spread to distant parts of the body, such as the liver

Another way of staging cancer is with numbers, however, this method is not used often for bladder cancer. There are usually four main stages: stage 1 is the earliest cancer and stage 4 is the most advanced. For more information, ask your doctor.

Grading bladder cancer

Your doctor may talk to you about the grade of the cancer. This describes how quickly a cancer might grow. Knowing the grade helps your specialist predict how likely the cancer is to come back and if you need further treatment after surgery.

  • Low grade
    The cancer cells look similar to normal bladder cells, are usually slow-growing and are less likely to spread. Most bladder tumours are low grade, especially if they are superficial.
  • High grade
    The cancer cells look very abnormal and grow quickly. They are more likely to spread into the bladder muscle.

Which health professionals will I see?

Your GP will arrange the first tests to check out your symptoms. You will then be referred to a urologist or a local hospital that specialises in urology, who will examine you and may do more tests. Health professionals will work as a team to treat you.

Most people with non-invasive bladder cancer do not need systemic chemotherapy or radiotherapy, so they do not see a medical oncologist or radiation oncologist.

Health professional Role
urologist a surgeon who specialises in treating diseases of the urinary system and the male reproductive system
radiation oncologist prescribes and coordinates the course of radiotherapy
medical oncologist prescribes and coordinates the course of chemotherapy
cancer care coordinator supports patients and families throughout treatment and liaises with other staff
nurses help administer drugs, including hemotherapy, and provide care, information and support throughout your treatment
stomal therapy nurses provide advice and support to patients with a stoma
continence nurses assess and educate patients about continence care
dietitian recommends an eating plan for you to follow while you are in treatment and recovery
social worker, hysiotherapist, occupational therapist link you to support services and help you with any physical or practical problems
counsellor, psychologist, clinical psychiatrist help you with emotional concerns

Prognosis

Prognosis means the expected outcome of a disease. You may discuss your prognosis with your doctor, but it is not possible for any doctor to predict the exact course of your disease. Test results, the type of cancer you have, its stage and grade, how well you respond to treatment, and other factors such as age and medical history, are important in assessing your prognosis.

Bladder cancer can usually be effectively treated, especially if it is found early, before it spreads outside the bladder.

Key points

  • Several tests may be performed to diagnose bladder cancer. These include general tests, tests to find the position of the cancer, and tests to determine if the cancer has spread.
  • In an internal examination, the doctor will insert a gloved finger into your rectum or vagina to feel for anything unusual.
  • You may be asked to give blood or urine samples, which can show how your body is functioning and if infection or cancer cells are present.
  • Cystoscopy is the main test used to diagnose bladder cancer. A thin microscope is inserted into the urethra. The doctor can view the bladder and may take tissue samples. If cancer is found, it may be removed at this time.
  • MRI and CT scans involve an injection of dye into the body, followed by a scan.
  • In an ultrasound, the technican will spread gel over your abdomen and use a device called a transducer to create pictures of your organs.
  • Further tests, such as a radioisotope bone scan or x-rays, can show if the cancer has spread to other parts of the body.
  • The bladder cancer is assigned a stage to describe how much cancer there is and where it has spread. The grade describes how fast the cancer cells are growing.
  • You will see a range of health professionals including your GP, urologist and nurses. The specialists you see will depend on the type of treatment required.

Reviewed by: Dr Mohan Arianayagam, FRACS (Urol), Urologic Oncologist, Nepean Hospital, Penrith, NSW; Donna Clifford, Urology Nurse Practitioner Candidate, Royal Adelaide Hospital, SA and David Connah, Cancer Council Connect Consumer Volunteer.

Updated: 01 Mar, 2014