Bladder Cancer Overview

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Early Detection, Diagnosis, and Staging TOPICS

How is bladder cancer found?

Bladder cancer can sometimes be found early. Finding it early improves the chances that it can be treated with success.

Screening for bladder cancer

Screening tests are used to look for a disease in people who do not have any symptoms. Expert groups do not advise screening tests for bladder cancer for most people, but they may be used if you are at very high risk. Risk factors that may lead to screening include having had bladder cancer in the past, certain defects of the bladder, and perhaps working with certain chemicals. If you are at high risk of bladder cancer, your doctor might suggest certain tests such as urine tests or cystoscopy. These tests are explained below.

If you don’t have any known risk factors, the best advice is to contact your doctor if you have any symptoms that might be caused by bladder cancer.

Signs and symptoms of bladder cancer

Blood in the urine: In most cases, blood in the urine is the first sign of bladder cancer. Sometimes there is enough blood to change the color of the urine. The urine may be very pale yellow-red, pink or – less often – darker red. In other cases, the color of the urine is normal but small amounts of blood can be found by urine tests that were done because of other symptoms or as part of a check-up.

But blood in the urine does not mean you have bladder cancer. Much more often it is caused by other things, such as infection, benign tumors, or stones in the kidney or bladder.

Changes in bladder habits: Having to urinate more often, feeling pain or burning when going, or feeling as if you need to go right away even when your bladder is not full can be symptoms of bladder cancer. But these problems are more often caused by something other than cancer.

Other symptoms: Bladder cancers that have grown large enough may cause more symptoms, such as lower back pain or being unable to urinate.

Tests to find bladder cancer

If there is a reason to suspect you might have bladder cancer, the doctor will use one or more of the methods below to find out if the disease is really there.

Medical history and physical exam: Your doctor will ask you about your medical history to check for risk factors and learn more about your symptoms. If there is a tumor, the doctor might check the rectum and vagina (in women) to help figure out how big it is and how far it may have spread. If the results of the exam are not normal, your doctor will likely refer you to a urologist (a doctor who treats problems of the urinary system) for further tests and treatment.

Cystoscopy: A cystoscope is a thin tube with a lens and a light on the end. The doctor puts it into the bladder through the urethra. The area may be numbed first, or drugs may be used to put you into a deep sleep. With the cystoscope the doctor can see the inside of the bladder. If there is anything that doesn’t look normal, a small piece of tissue is removed (biopsied) and looked at under a microscope. (Read further for more about biopsies.)

Urine cytology: In this test, urine or cells “washed” from the bladder during cystoscopy are sent to the lab to see if cancer cells (or pre-cancer cells) are present. This test can help find some cancers, but it is not perfect. Not finding cancer on this test doesn’t always mean you are cancer-free.

Urine culture: A sample of your urine is sent to the lab to see if germs grow in it, which can show if you have an infection. An infection can sometimes cause symptoms like those from bladder cancer. It may take a few days to get the results of this test.

Urine tumor marker tests: These tests look for certain substances released by cancer cells into the urine. Some doctors use these tests (along with cytology), but most think that cystoscopy is still the best way to find bladder cancer.

Biopsy: When a piece of tissue is removed to see if it contains cancer cells, the test is called a biopsy. Bladder biopsy samples are most often taken during cystoscopy.

This test can tell if bladder cancer is present, what type of cancer it is, and how deep it has grown into (invaded) the bladder wall. It’s important for the doctor to know whether cancer cells have spread into the bladder’s muscle layers.

Bladder cancers are given a grade based on how they look under the microscope. Low-grade cancers look more like normal tissue and tend to grow more slowly. A high grade means the cancer looks less like normal tissue and is more likely to spread outside the bladder. These cancers can be harder to treat.

If imaging tests (see the next section) suggest the cancer may have spread outside of the bladder, a biopsy is the only way to be sure. In some cases, biopsy samples of suspicious areas are taken during the surgery to remove the bladder cancer. Or a thin, hollow needle may be used to take a small piece of tissue from the abnormal area. This is known as a needle biopsy, and it allows the doctor to take samples without an operation.

Imaging tests

Imaging tests are done to allow your doctor to “see” your bladder and other organs. If you have bladder cancer, your doctor may order some of these tests to find out whether the cancer has spread to tissues near the bladder, to nearby lymph nodes, or to distant organs.

Intravenous pyelogram (IVP): An IVP is an x-ray of the urinary system taken after putting a special dye into a vein. The dye passes into the ureters and bladder. This more clearly outlines these organs on x-rays and helps find tumors. Some people are allergic to the dye, so be sure to tell your doctor if you have any allergies or have ever had any reactions to x-ray dyes.

Retrograde pyelogram: For this test, a thin, flexible tube called a catheter is put through the urethra and up into the bladder or into a ureter. Then a dye is put through the catheter to make the lining of the bladder, ureters, and kidneys easier to see on x-rays. Like IVP, this test can be used to find tumors in the urinary tract.

Computed tomography (CT): The CT scan is a special kind of x-ray that gives detailed pictures of your insides. It can help find tumors in your bladder, kidneys, and other organs, as well as show any swollen lymph nodes that might contain cancer.

A CT scanner has been described as a large donut, with a narrow table in the “hole”. You will need to lie still on the table while the scan is being done. CT scans take longer than regular x-rays, and you might feel a bit confined by the ring while the pictures are being taken. CT scans take longer than regular x-rays, but newer, faster machines (called spiral or helical CTs) are now used in many medical centers.

Before any pictures are taken, you may be asked to drink a liquid dye that helps to better outline your organs. You may also need an IV line through which you will get a different kind of contrast dye. The dye can cause some redness and warm feeling. A few people are allergic to it and get hives. Rarely, people have more serious problems like trouble breathing and low blood pressure. Be sure to tell the doctor if you have ever had a reaction to any contrast dye used for x-rays.

CT scans can also be used to guide a biopsy needle into a tumor. This is not used to biopsy tumors within the bladder, but it might be used to take tissue samples from places where the cancer may have spread.

Magnetic resonance imaging (MRI): MRI scans can be used to look at the urinary system or to look for signs that the cancer has spread outside of the bladder into nearby tissues or lymph nodes.

This test is like a CT scan, but it uses strong magnets and radio waves instead of x-rays to make very detailed pictures. For some scans, a contrast material (dye) may be put into your vein to help show some structures better.

MRI scans take longer than CT scans–often up to an hour. Also, for most MRI scans you will be inside a tight tube-like machine. This can upset people with fear of enclosed spaces. If you are worried about this, talk to your doctor about it before the test. Newer, more open MRI machines can sometimes be used instead. The machine makes buzzing and clicking noises that you may find annoying. Some places will give you earplugs to help block these noises out.

Ultrasound: Ultrasound uses sound waves to make pictures of your insides. It can help show the size of a bladder cancer and whether it has spread beyond the bladder. It can also be used to look at the kidneys.

This is an easy test to have. You simply lie on a table while a kind of wand is placed on the skin over the part of your body being looked at. No radiation is used. Ultrasound can also be used to guide a biopsy needle into an area where cancer may have spread.

Chest x-ray: A chest x-ray may be done to look for spread of bladder cancer to the lungs. This test is not needed if a CT scan of the chest has been done.

Bone scan: A bone scan can help look for cancer that has spread to bones. For this test, a small amount of a radioactive substance is put into a vein. This substance collects in areas of bone that are damaged. A scanner can spot these places and show them on a picture. Doctors don’t usually order this test unless you have symptoms such as bone pain, or if blood tests show the cancer may have spread to the bones.


Last Medical Review: 12/03/2012
Last Revised: 04/17/2014