Diagnosis

Doctors use many tests to diagnose cancer and determine if it has metastasized. Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has metastasized. Your doctor may consider these factors when choosing a diagnostic test:

• Age and medical condition
  
  
• The type of cancer suspected
  
  
• Severity of symptoms
  
  
• Previous test results

The earlier bladder cancer is found, the better the chance for successful treatment. However, there is not yet a test that is accurate enough to screen the general population for bladder cancer, so most people are diagnosed with bladder cancer once they have symptoms. As a result, some patients have more advanced disease when the cancer is first found, although more than 70% of those diagnosed have noninvasive bladder cancer.

The following tests may be used to diagnose bladder cancer:

Physical examination. A doctor can sometimes detect lumps in the wall of the bladder by examining the rectum and the pelvis. Areas where the cancer has spread may also be found during a physical examination.

Cystoscopy and biopsy. The doctor places a cystoscope (a small, hollow viewing tube) through the urethra (urinary opening) to look into the bladder. If abnormal tissue is detected, the doctor will do a biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The sample removed during the biopsy is analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease).

Urine tests. The doctor tests a urine sample to determine if it contains tumor cells. If a patient is undergoing a cystoscopy (see above), an additional test may be performed that involves rinsing the bladder and collecting the liquid through the cystoscope or through another small tube that is inserted into the urethra. The sample can be tested in a variety of ways. The most common way is to look at the cells under a microscope, called urinary cytology. Urine passed out of the body during normal urination can also be examined by cytology. There are other urine cancer tests using molecular analysis that can be done with or instead of urinary cytology.

Intravenous pyelogram (IVP), also called intravenous urogram (IVU). In this x-ray test, a dye containing iodine is injected into a patient’s vein and filtered through the kidneys. The dye enters the urine. This helps the bladder to appear more clearly on an x-ray and can provide an outline of a tumor in the bladder wall. The patient should tell the staff giving this test if he or she is allergic to iodine or other contrast mediums (special dyes).

Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows abnormalities or tumors. Sometimes, a contrast medium is injected into a patient’s vein to provide better detail. The patient should tell the staff giving this test if he or she is allergic to iodine or other contrast mediums.

Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. A contrast medium may be injected into a patient’s vein to create a clearer picture.

To learn more about what to expect during common diagnostic tests, read Cancer.Net: Tests and Procedures.

To learn about the terms used in this section, read the Cancer.Net Feature: Cancer Terms to Know: Newly Diagnosed.