What tests will I have if my doctor suspects bladder cancer or another urinary problem?
What tests will I have if my doctor suspects bladder cancer or another urinary problem?
Your doctor will want to analyze your urine (urinalysis) to determine if an infection could be a cause of your symptoms. A microscopic examination of the urine, called cytology, will look for cancer cells.
A cystoscopy is the main procedure to identify and diagnose bladder cancer. In this procedure, a lighted telescope (cystoscope) is inserted into your bladder from the urethra to view the inside of the bladder and, when done under anesthesia, take tissue samples (biopsy), which are later examined under a microscope for signs of cancer. When this procedure is done in the doctor’s office, local anesthesia gel is placed into the urethra prior to the procedure to minimize the discomfort.
If the diagnosis of bladder cancer is made, then the next step is to remove the tumor for detailed staging and diagnosis.
Transurethral resection (TURBT) is a procedure done under general or spinal anesthesia in the operating room. A telescope is inserted into the bladder and the tumor is removed by scraping it from the bladder wall (a portion of the bladder wall is removed with it), using a special cystoscope (called a resectoscope). This procedure is diagnostic as well as therapeutic.
This often can be done as an outpatient procedure, with patients discharged from hospital the same day. After removal, the tumor is analyzed by a pathologist, who will determine the type of tumor, the tumor grade (aggressiveness) and the depth of invasion. The purpose of the procedure is to remove the tumor and obtain important staging information (such as the tumor grade and depth of invasion).
For some patients with invasive cancer, a CT scan of the abdomen and pelvis might be the next step to determine if there is any spread of the disease outside of the bladder.
Magnetic resonance imaging, which uses a magnet, radio waves, and a computer to take detailed images, can also be done, and is helpful in planning additional treatment.
A chest X-ray may also be performed to detect if any cancer has spread to the lungs. At times, a bone scan may be performed to look for metastasis (spread) of the cancer to the bone. Most of these tests are used selectively, i.e., only in certain patients with related symptoms.
Once bladder cancer is diagnosed, staging of the disease is done using the tests described above. The stage of the disease will determine the treatment course.