Diagnoses - Bladder Cancer Canada

HOW IS BLADDER CANCER DIAGNOSED?

The earlier bladder cancer is diagnosed, the better the outcome of treatment. Since there is no “screening” test for bladder cancer at this time, most people are diagnosed after they show some symptoms, such as blood in the urine. Because symptoms such as blood in the urine can be a sign of other conditions, such as a urinary tract infection (UTI), there can be a delay in diagnosing bladder cancer.

Here are some of the tests and procedures used to detect bladder cancer. Please note that, since individual cases and facilities are different, not all of these tests may be required or available.

After diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer (called staging and grading).

URINE CYTOLOGY

A sample of urine is examined under a microscope to see if there are any tumour cells in the urine.

CYSTOSCOPY

A hollow tube with a lens is inserted through the urethra (the tube which drains urine from the bladder) and slowly moved into the bladder, so that doctors can examine the lining of the bladder for tumours. This is the main way bladder cancer is detected. The procedure can be done in a doctor’s office or hospital setting. Most often a local anesthetic is used to numb the urethra, but sometimes the procedure is done as an outpatient with sedation.

SCANS

To help detect if the cancer has spread and to help with staging, the medical facility may use a scan. Depending on the facility and disease status, “Computed tomography” (CT or CAT) scan, “Magnetic resonance imaging” (MRI), or a “Positron emission tomography” (PET or PET-CT) scan may be used.

ULTRASOUND

Uses sound waves to create a picture of the internal organs. It can help find out if the kidneys or ureters are blocked.

TRANSURETHRAL RESECTION OF BLADDER TUMOR (TURBT)

A surgical procedure through the urethra done in a hospital setting under general or regional (your anesthesiologist injects medication near a cluster of nerves to numb only the area of your body that requires surgery) anesthesia, to biopsy any abnormal tissue that is found during a cystoscopy. During the TURBT, the doctor will remove tumours and samples of the bladder muscle near the tumours. The material removed is sent to a lab for analysis under a microscope. The result of the analysis is used to help determine the stage and grade of the bladder cancer. (See the following section on “Staging and grading your bladder cancer.”)

Another procedure often done during the TURBT is called EUA (exam under anesthesia). In this procedure, the urologist evaluates the bladder to see if any masses can be felt.

In some facilities, Cysview (hexaminolevulinate HCl) with blue light cystoscopy may be used during the TURBT procedure. A solution containing the hexaminolevulinate HCl (called an “agent”) is inserted into the bladder about an hour before the TURBT. The agent essentially “marks” the tumour, which can be more clearly seen using a blue light. The procedure is designed to enhance detection and visualization of nonmuscle-invasive bladder cancer, in particular carcinoma in situ (CIS) to help ensure the resections (surgical removal) of all suspicious lesions. It reveals lesions that may not be seen with standard white light cystoscopy. Note that Cysview is not available in all medical facilities.