Bladder Cancer Diagnosis

Nurse going over chart with bladder cancer patient

Bladder cancer occurs when cells that line the bladder—the hollow organ in the pelvis that holds urine—begin to change and grow uncontrollably. The result is a malignant (cancerous) tumor that can spread to other areas of the body if it is left untreated.

The first step of treating any cancer is making a diagnosis. A combination of methods can be used to evaluate a patient’s symptoms to either rule out or diagnose bladder cancer. There are several factors that a physician will consider when ordering bladder cancer tests, such as:

  • The patient’s specific symptoms
  • The type of cancer that is suspected
  • The patient’s age and overall health

How is bladder cancer diagnosed?

Diagnosing bladder cancer typically begins with a physical exam and discussion of symptoms. From there, a physician will likely order a series of diagnostic tests to gather more information about the patient’s health. Common methods used to help diagnose bladder cancer include:

Urinalysis

A urinalysis, which is a simple urine test, determines the levels of sugar, protein and red and white blood cells in the urine, all of which may indicate the presence of bladder cancer or a bladder infection (a much more common condition). Newer types of urine tests also screen for specific antigens and other substances (tumor markers) that can point to bladder cancer.

Urine cytology

Urine cytology involves examining a urine sample under a microscope to determine whether cancerous or precancerous cells are present. Although helpful in the diagnostic process, a cytology with negative results does not completely rule out the possibility of bladder cancer.

Imaging

If urine tests suggest the possibility of bladder cancer, one or more imaging tests may then be ordered. There are several types of imaging that can be used to produce detailed images of the bladder and help a physician reach a diagnosis, including:

  • Computed tomography (CT) scans. CT scans use X-ray imaging to produce detailed cross-sectional images. When performed to evaluate the urinary tract, this type of imaging is known as a CT urogram.
  • Magnetic resonance imaging (MRI) scans. MRI scans utilize radio waves and magnets to create images of the bladder. This type of test is sometimes used to distinguish local invasion but also can be used when patients are not candidates for CT scans for various reasons.
  • Ultrasound imaging. An ultrasound uses specially guided sound waves to produce images of internal organs. It may be ordered to help determine the size of bladder tumors or see if cancer has spread to surrounding organs, such as the kidneys.
portrait of blockquote author

"Blue Light Cystoscopy with Cysview has been shown in many studies to enhance the detection and treatment of non-muscle invasive bladder cancer. It may also provide a positive impact on reducing disease recurrence."

- Roger Li, MD

Cystoscopy

A cystoscopy is a procedure wherein a lighted tube with a lens is inserted into the bladder through the urethra to visually examine the bladder and, if appropriate, remove tissue samples for further testing.

During a standard cystoscopy procedure, a urologist examines the interior wall of a patient’s bladder using regular white light. During a Blue Light Cystoscopy, the urologist uses both white and blue light. However, the blue light is only effective if Cysview has been instilled in the patient’s bladder at least one hour before the procedure.

Cysview makes tumor cells glow bright pink in blue light, but it is not a dye. It drives increased production of a natural compound inside cells. Unhealthy cells do not process out the compound as quickly as healthy cells; the resulting accumulation creates a pink glow in blue light. For some bladder cancer patients, it can significantly improve disease management. The improved tumor visibility leads to more complete transurethral resection of bladder tumors (TURBTs) and better surveillance.

Moffitt is the first in Florida and among the first in the Southeast to use the latest high-definition Blue Light technology platform – Saphira.  It is an FDA-approved technology for use during TURBT surgery and follow-up cystoscopies. 

Biopsy

A biopsy—which involves removing a small portion of suspicious-looking tissue and testing it for cancer cells—is the only way to definitively confirm a bladder cancer diagnosis. Tissue can be removed from the bladder through a cystoscopy or image-guided procedures that incorporate CT and ultrasound technologies.

Can bladder cancer be detected with a urine sample?  

Individuals who are concerned about their bladder cancer risk may wonder if a urine test—such as those that are commonly performed during annual physicals and routine medical visits—can detect bladder cancer. 

It’s true that urine testing is a useful tool in the diagnostic process for bladder cancer and several other conditions like kidney disease, diabetes and urinary tract infections. But while a urine test can detect some possible signs of bladder cancer, such as microscopic amounts of blood or abnormal cells, it cannot conclusively rule out or diagnose this disease. Furthermore, urine tests aren’t currently viewed as a reliable form of bladder cancer screening for patients without symptoms.

Moffitt’s approach to bladder cancer detection

At Moffitt Cancer Center’s Genitourinary Oncology Clinic, many of the patients we see have already received a preliminary diagnosis from a physician outside of the Moffitt team and are seeking a second opinion or exploring alternative treatment options. When this is the case, we examine existing slides, X-rays, contrast studies and any other tests that have documented the potential for bladder cancer. We also conduct these tests for patients who have come directly to us for answers regarding their medical concerns. In either case, our experts will also conduct tests that evaluate urine, as well as examine the vagina or rectum through an internal exam, in order to accurately determine whether tumors are present in the bladder.

Moffitt is one of the nation’s leading cancer facilities, always striving to not only provide the most accurate bladder cancer diagnostics, but also offer the most advanced treatment options so that our patients can continue living life to the fullest. We assess each patient on a case-by-case basis, with our multispecialty team paying careful attention to the particular dynamics of each person’s condition and developing a targeted, individualized treatment plan. As part of our Genitourinary Oncology Program, each patient receives the comprehensive, compassionate care he or she deserves.

Medically reviewed by Dr. Roger Li 

There’s no referral needed to make an appointment at Moffitt and receive specialized diagnostic care. We invite you to fill out our new patient registration form, or contact us by calling 1-888-663-3488. Our team understands that a timely diagnosis is key to successful bladder cancer treatment and will connect you with a Moffitt representative within 24 hours of your call.

References

Bladder Cancer: Diagnosis
Tests for Bladder Cancer