Diagnosis

Diagnosing bladder cancer

Tests and procedures used to diagnose bladder cancer may include:

  • Cystoscopy. To perform cystoscopy, your doctor inserts a small, narrow tube (cystoscope) through the urethra. The cystoscope has a lens that allows your doctor to see the inside of your urethra and bladder, to examine these structures for signs of disease.
  • Biopsy. During cystoscopy, your doctor may pass a special tool through the scope and into your bladder to collect a cell sample (biopsy) for testing. This procedure is sometimes called transurethral resection of bladder tumor (TURBT). TURBT can also be used to treat bladder cancer.
  • Urine cytology. A sample of your urine is analyzed under a microscope to check for cancer cells in a procedure called urine cytology.
  • Imaging tests. Imaging tests, such as computerized tomography (CT) urogram or retrograde pyelogram, allow your doctor to examine the structures of your urinary tract.

    During a CT urogram, a contrast dye injected into a vein in your hand eventually flows into your kidneys, ureters and bladder. X-ray images taken during the test provide a detailed view of your urinary tract and help your doctor identify any areas that might be cancer.

    Retrograde pyelogram is an X-ray exam used to get a detailed look at the upper urinary tract. During this test, your doctor threads a thin tube (catheter) through your urethra and into your bladder to inject contrast dye into your ureters. The dye then flows into your kidneys while X-ray images are captured.

Staging bladder cancer

After confirming that you have bladder cancer, your doctor may order additional tests to determine how extensive your cancer is. Your doctor needs to know the stage and grade of your cancer to recommend the best treatment options for you.

Tests may include:

  • CT scan
  • Magnetic resonance imaging (MRI)
  • Bone scan
  • Chest X-ray

Bladder cancer stages

The stages of bladder cancer are:

  • Stage I. Cancer at this stage occurs in the bladder's inner lining but hasn't invaded the muscular bladder wall.
  • Stage II. At this stage, cancer has invaded the muscular bladder wall but is still confined to the bladder.
  • Stage III. The cancer cells have spread through the bladder wall to surrounding tissue.
  • Stage IV. By this stage, cancer cells may have spread to the lymph nodes and other organs, such as your bones, liver or lungs.

Bladder cancer grade

Bladder cancer tumors are further classified based on how the cancer cells appear when viewed through a microscope. This is known as tumor grade, and your doctor may describe bladder cancer as either low grade or high grade:

  • Low-grade bladder tumor. This type of tumor has cells that are closer in appearance and organization to normal cells (well-differentiated). A low-grade tumor usually grows more slowly and is less likely to invade the muscular wall of the bladder than is a high-grade tumor.
  • High-grade bladder tumor. This type of tumor has cells that are abnormal-looking and that lack any resemblance to normal-appearing tissues (poorly differentiated). A high-grade tumor tends to grow more aggressively than a low-grade tumor and may be more likely to spread to the muscular wall of the bladder and other tissues and organs.