Smoking, environmental chemical exposure, a high-fat diet, infection and aging are risk factors for developing the disease. If bladder cancer is suspected, a physician can use a range of diagnostic tests that include an abdominal computed tomography (CT) scan, ultrasound, bladder biopsy and urinalysis. Other diagnostic tests performed might include cystoscopy, intravenous pyelogram (IVP) and urine cytology. Bladder cancer tests can confirm the presence of a tumor, the type of cells present and the stage of the cancer.
The first bladder cancer tests are primarily screening tests. If a patient complains of symptoms such as blood in the urine, frequent urination, pain during urination or lower back pain, a physician will first complete a physical examination of the patient, which includes a rectal and pelvic exam to check for lumps. A urinalysis will be performed to detect and measure urine compounds, including the presence of blood and/or infection. A urinalysis cannot confirm a diagnosis of bladder cancer but can rule out other potential causes of the symptoms.
A urine cytology test can be performed to check for abnormal cells. After a sample of urine is obtained, it is examined under a microscope. A pathologist will not conclusively diagnose bladder cancer from this test, but the results can aid the physician when used in combination with the results of other bladder cancer tests and procedures.
An ultrasound examination of the bladder can detect tumors or other potential sources of urinary tract bleeding. It might also detect swelling in the kidneys, which can indicate the presence of a tumor blocking the flow of urine in the ureters. A transducer is placed on the abdomen, and high-frequency sound waves are emitted that create an image of the internal organs. The test is non-invasive and can be performed in a physician’s office.
Abdominal CT scans are diagnostic tests that use X-rays to create cross-sectional pictures of the abdominal area, including the bladder. A contrast dye is infused into the body through a vein in the hand or forearm. The patient is placed inside the CT scanner, lying on his or her back with the arms raised above the head so as not to interfere with the images. Inside the scanner, the X-ray beam rotates and delivers several images, called slices. The CT scan can detect smaller tumors in the kidneys or bladder than cannot be detected by ultrasound.
A physician might also perform a more specialized form of X-ray known as an intravenous pyelogram. This series examines the kidneys, ureters and bladder using an iodine-based contrast dye that is injected into the veins. A compression belt might be used to keep the contrast material in the kidneys. The patient will be asked to urinate before the last image to ensure that the bladder empties sufficiently.
If all of these bladder cancer tests indicate that a more invasive study is warranted, a bladder biopsy will be performed during a cystoscopy. A thin tube connected to a camera and light source is passed through the urethra into the bladder. The cystoscope is used to inspect the inside walls of the bladder and is usually equipped with a tool to remove tissue samples that can be examined under a microscope to detect the presence of cancer cells. The advantage of cystoscopy is that the procedure can detect small, flat lesions that might not be visible using other methods.
After the presence of bladder cancer has been confirmed, a CT scan or magnetic resonance imaging (MRI) test might be ordered to determine the stage of cancer. Other staging bladder cancer tests might include a bone scan or chest X-ray. These tests can check for metastasis, which is the spread of the cancer to other organs.
