Bladder Cancer Diagnosis
When someone is suspected of bladder cancer based on presence of signs or symptoms, certain diagnostic investigations are required to confirm and stage the disease.
These diagnostic tests discussed below help us confirm the presence of bladder tumor, and also other details, like type of tumor, number, depth of invasion, involvement of regional lymph nodes, and spread to distant sites.
All this information helps the oncologist to take an appropriate treatment decision. The infographic below lists some of the investigations.
Urinalysis helps us detect the presence of blood cells (RBCs) in urine. Patients with bladder cancer may have hematuria (blood in urine). It may be grossly visible (macroscopic hematuria) or may be detected only on microscopic examination of the urine sample (microscopic hematuria).
In this test, a urine sample is checked for the presence of abnormal (precancerous or cancerous) cells using a microscope. Presence of abnormal cells may indicate diagnosis of cancer in the urinary tract. Further investigation is required to find the location of the tumor.
Urine Tests for Tumor Markers
With the advancement of science, newer tests are now available to check the presence of certain markers in the urine which may suggest bladder cancer. For example, Telomerase (an enzyme usually found in cancer cells), bladder tumor-associated antigen (BTA), carcinoembryonic antigen (CEA), and NMP22 protein. But these tests are not very reliable and may provide with a supportive evidence of the tumor.
As you can see in this figure, only cancer containing superficial layers of the bladder is removed, without damaging the deeper layers.
Transurethral resection of bladder tumor (TURBT)
If the abnormal area(s) are observed during cystoscopy, biopsy samples are collected from the abnormal area through a transurethral resection of bladder tumor (TURBT) or transurethral resection (TUR) technique. The tumor along with underlying muscle tissue is removed to check the extent of invasion into the bladder wall. Multiple biopsies may be obtained depending upon the cystoscopy observations. This technique helps in establishing the stage of the disease.
In this technique, various x-ray images are taken of the urinary system after injecting a contrast (dye) into patient’s vein. The dye outlines the complete urinary system on the x-ray images and is excreted in the urine by kidneys. This helps the doctor to examine the urinary tract for any abnormal areas.
In some cases, we may require a Retrograde Pyelogram in which a dye is injected into the ureter with the help of cystoscope, followed by a series of images.