Diagnosing Bladder Cancer

What are the signs and symptoms of bladder cancer?
What types of tests will the doctor conduct to determine if I have bladder cancer?
What is a cystoscopy?
What are the types of bladder cancer tumors that may form?

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For more information about these and other questions, see our Ask the Doctor Archive

What are the signs and symptoms of bladder cancer?
The most common clinical sign of bladder cancer is painless gross hematuria, blood in the urine that can easily be seen. Two features that tend to influence patients to postpone seeking immediate medical care are 1) the bleeding may be occasional and short-lived; and 2) there is likely to be no pain associated with the bleeding. In addition, it may be that the tumors do not produce enough blood for a patient to see (microscopic hematuria) and are only detected with the help of special chemicals and/or a microscope after a urine test is done by a physician.

However, blood in the urine does not necessarily mean a diagnosis of bladder cancer. Infections, kidney stones and other conditions as well as aspirin and other blood-thinning medications may cause bleeding. In fact, the overwhelming majority of patients who have microscopic hematuria do not have cancer.

Irritation when urinating, urgency, frequency and a constant need to urinate may be symptoms a bladder cancer patient initially experiences. Oftentimes, though, these are merely symptoms of a urinary tract infection and antibiotics become the first line of treatment. To make the necessary distinction between an infection and something more serious, it is critical that a urinalysis and/or culture are done to detect any bacteria in the urine. If the culture is negative for bacteria, patients should be referred to a urologist for further testing.
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What types of tests will the doctor conduct to determine if I have bladder cancer?
Ultrasound, CT scans (computed tomography), MRI scans (magnetic resonance imaging), and IVPs (intravenous pylogram) can detect irregularities in the bladder wall, which would suggest a possible cancer. The urologist will also look inside the bladder with a cystoscope to visually examine your bladder and remove samples of any suspicious areas for biopsy as a part of the standard evaluation. Urine cytology may be performed to detect cancer cells in the urine. A number of other tests are also available. These urine-based markers detect cells or substances in a urine sample that are relatively specific to bladder cancer. Patients should check with their urologists to learn which tests are appropriate for them.
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What is a cystoscopy?
Although the radiological tests provide important information about the kidneys and the ureters, cystoscopy is still the best method of evaluating the bladder and the urethra. The cystoscope is inserted through the urethra. Today with the widespread use of the flexible cystoscope most of the diagnostic cystoscopies are done in the outpatient setting with little or no discomfort.

As the urologist looks through the cystoscope, the locations where there appears to be abnormal features are noted and recorded. During the cystoscopy, the urologist may choose to take a small piece of what appears to be abnormal tissue (biopsy) and send it to the pathologist to read and analyze. In addition, a sample of the urine from inside the bladder is frequently sent for analysis (cytology) to determine if there are any cancer cells. The biopsy specimen as well as the urine sample will help the doctor make recommendations about the patient’s future care.

Patients will go home after the cystoscopy if it is done in the doctor’s office. Patients should expect that there may be some minor bleeding and possible irritative bladder symptoms following the cystoscopy. Seeing blood in the urine may be very troubling for the patient – a small amount of blood can affect the color of the urine dramatically making it seem that a large volume of blood is being lost.  In fact, it is very unlikely to have significant blood loss due to bleeding in the bladder. This is why urologists usually reassure patients not to worry about blood in the urine as long as the appropriate diagnostic workup is in progress and there aren’t clots forming that cause blockage of the flow of urine through the urethra.

Check out our Patient Tipsheet on Cystoscopy (PDF), filled with advice from patients who have experienced it.

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What are the types of bladder cancer tumors that may form?
Three types of bladder cancer may form, and each type of tumor can be present in one or more areas of the bladder, and more than one type can be present at the same time:

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The information and services provides by the Bladder Cancer Advocacy Network (BCAN) are for informational purposes only. The information and services are not intended to be substitutes for professional medical advice, diagnosis or treatment. If you are ill, or suspect that you are ill, seek professional medical attention immediately! BCAN does not recommend or endorse any specific physicians, treatments, procedures or products even though they may be mentioned on this site