Bladder Cancer Diagnosis


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.

bladder cancer staging investigations
Now, let’s discuss the diagnostic and staging investigations one by one.


urinalysis for bladder cancer 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).

Urinalysis can detect the presence of blood in urine that may be an early sign of bladder cancer in an individual and may help in early diagnosis of the disease.
Apart from this, urine culture is also performed to exclude any possibility of urinary tract infection that can also produce symptoms similar to that of bladder cancer.

Urine Cytology

urine cytology for cancer cells 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.

The urine sample for cystoscopy may be collected by voiding, but in that case the sensitivity of the test is very low. The other method that may improve the sensitivity of urine cytology is cystscopic irrigating the bladder with a sterile liquid and then checking that fluid for malignant cells. But despite that also, many cases of bladder cancer may not show positive cytology.

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.


cystoscopic examination of bladder Cystoscopy is a diagnostic technique which uses a cystoscope – a long, flexible, slender tube usually equipped with a camera, a light source, and some special instruments for biopsy or surgery. This enables to look inside the bladder by passing the cystoscope into the bladder via urethra to determine the presence and extent of the disease. Also, it helps in transuretheral resection of bladder tumor which is both, diagnostic as well as therapeutic.

cancer containing superficial layers are removed

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.

Intravenous Pyelogram

Intravenous pyelogram

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.

CT Scan or MRI

Pyelogram may be complemented with other imaging modalities, like CT scan or MRI, which help in better delineating the urinary tract.
Also, CT scan or MRI of the abdomen and pelvis helps to understand the local extention of the tumor to other structures and the involvement of regional lymph nodes. It also helps to diagnose the metastatic involvement of other structures.
Distant imaging of other parts of the body like bones, lungs, etc may be needed in some cases, especially when the bladder tumor is muscle-invasive, or has invaded into the muscle layer of the bladder. Also if there are symptoms suggestive of distant organ involvement. In such cases, further testing may be required like, CT chest, bone scan, whole bodt PET CT scan , etc.


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