Diagnosis of bladder cancer, a disease in which a cancerous tumor occurs in the bladder, requires undergoing medical exams. Procedures that a doctor might use in bladder cancer diagnosis include cystoscopy, biopsy and urine cytology. In addition, other procedures that can assist in bladder cancer diagnosis are a physical exam and imaging tests. After diagnosis and before treatment, the doctor will need to stage the disease, meaning he will assess its spread.
Cystoscopy is a procedure in which the doctor uses an instrument called a cystoscope to view inside the bladder. The cystoscope, a narrow tube with a lens and light, enables the doctor to do this procedure, during which the patient is usually under anesthesia so that he is more comfortable. During cystoscopy, the doctor might also perform a biopsy or urine cytology, especially if he sees abnormal areas within the bladder.
Biopsy is a procedure in which the doctor collects tissue samples for analysis. The patient might feel a pinch as the doctor takes the sample and a burning sensation as the doctor seals the blood vessels to deal with bleeding. Before a biopsy, the doctor might ask the patient to urinate. If the doctor is also performing a urine cytology on the patient, this might be when he does this part.
Urine cytology is a procedure in which the doctor collects a sample of the patient’s urine for analysis. As with a biopsy sample, the analysis will occur under a microscope. An analysis of the sample will reveal abnormal cells. Bladder cancer diagnosis cannot rely solely on urine cytology.
In addition to cystoscopy, biopsy and urine cytology, a physical exam and different imaging tests also help in bladder cancer diagnosis. During a physical exam, the doctor might give the patient a pelvic and rectal exam. As for imaging tests, an intravenous pyelogram or a computerized tomography (CT) scan can enable the doctor to see the urinary tract. The doctor will also use imaging tests when staging the disease.
A bone scan, chest x-ray and magnetic resonance imaging (MRI) scan are examples of imaging tests that will allow the doctor to view how far the disease has spread. There are five different stages of bladder cancer, ranging from stage 0, in which the cancer is present in only the bladder lining, to stage IV, in which the cancer has spread to lymph nodes and to other areas of the body, such as the bones or liver. In between, stage I is when the cancer is in the bladder lining, but not in the bladder’s muscle layer, stage II is when the cancer is in the bladder’s muscle layer but still present in only the bladder, and stage III is when the cancer spreads through the bladder’s muscle layer and into surrounding tissue, such as the prostate or uterus.