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 before
  • Certain defects of the bladder
  • 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.

Signs and symptoms of bladder cancer

Even without screening, bladder cancer can often be found early because it causes blood in the urine or other symptoms. Many of these symptoms often have less serious causes, but it’s important to have them checked by a doctor right away so the cause can be found and treated, if needed. If the symptoms are caused by bladder cancer, finding it early gives you the best chance of treating it successfully.

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 orange, pink or – less often – darker red. Sometimes, the color of the urine is normal but small amounts of blood are 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. But it’s important to have it checked by a doctor.

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.

Symptoms of advanced bladder cancer

Bladder cancers that have grown large enough or have spread to other parts of the body may cause other symptoms, such as:

  • Not being able to urinate
  • Lower back pain on one side
  • Loss of appetite and weight loss
  • Swelling in the feet
  • Bone pain

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. The doctor might check the rectum and vagina (in women) to feel for a tumor. If the results of the exam are not normal, your doctor will probably order blood and urine tests and might 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 light and a lens or tiny video camera 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 tests

Urinalysis: This is a simple test to check for blood and other substances in the urine, which might point toward bladder cancer or other problems.

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: For this test, 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 of 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 small piece of body tissue is removed and sent to the lab to see if it contains cancer cells, it is called a biopsy. Bladder biopsy samples are most often taken during cystoscopy.

This test can tell if bladder cancer is present and what type of cancer it is. It can also tell other important features of the cancer.

Invasiveness: A biopsy can show how deep the cancer has grown into (invaded) the bladder wall. It’s important for the doctor to know if cancer cells have grown into the bladder’s muscle layers.

Grade: 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 has 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 make pictures of the inside of your body. They let your doctor “see” your bladder and other organs. If you have bladder cancer, your doctor may order some of these tests to find out if 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 a special dye is put 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 show the lining of the bladder, ureters, and kidneys on x-rays. Like IVP, this test can be used to find tumors in the urinary tract.

Computed tomography (CT) scan: The CT scan is a special kind of x-ray that makes 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 that slides in and out of the “hole”. You will need to lie still on the table while the scan is done.

Before any pictures are taken, you may be asked to drink a liquid called oral contrast. 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. Some people are allergic to the contrast. Be sure to tell the doctor if you have any allergies or 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 outside the bladder if the cancer may have spread.

Magnetic resonance imaging (MRI): MRI scans use radio waves and strong magnets instead of x-rays to make detailed pictures. They 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.

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. Newer, more open MRI machines can sometimes be used instead.

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: 06/23/2014
Last Revised: 06/26/2014