Diagnosis
If a patient has symptoms that suggest bladder cancer, the doctor may check general signs of health and may order lab tests. The person may have one or more of the following procedures:
Physical exam -- The doctor feels the abdomen and pelvis for tumors. The physical exam may include a rectal or vaginal exam.
Urine tests -- The laboratory checks the urine for blood, cancer cells, and other signs of disease.
Intravenous pyelogram -- The doctor injects dye into a blood vessel. The dye collects in the urine, making the bladder show up on x-rays.
Cystoscopy -- The doctor uses a thin, lighted tube (cystoscope) to look directly into the bladder. The doctor inserts the cystoscope into the bladder through the urethra to examine the lining of the bladder. The patient may need anesthesia for this procedure.
The doctor can remove samples of tissue with the cystoscope. A pathologist then examines the tissue under a microscope. The removal of tissue to look for cancer cells is called a biopsy. In many cases, a biopsy is the only sure way to tell whether cancer is present. For a small number of patients, the doctor removes the entire cancerous area during the biopsy. For these patients, bladder cancer is diagnosed and treated in a single procedure.
A patient who needs a biopsy may want to ask the doctor some of the following questions: Why do I need to have a biopsy? How long will it take? Will I be awake? Will it hurt? How soon will I know the results? Are there any risks? What are the chances of infection or bleeding after the biopsy? If I do have cancer, who will talk with me about treatment? When?
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Staging If bladder cancer is diagnosed, the doctor needs to know the stage, or extent, of the disease to plan the best treatment. Staging is a careful attempt to find out whether the cancer has invaded the bladder wall, whether the disease has spread, and if so, to what parts of the body.
The doctor may determine the stage of bladder cancer at the time of diagnosis, or may need to give the patient more tests. Such tests may include imaging tests -- CT scan, magnetic resonance imaging (MRI), sonogram, intravenous pyelogram, bone scan, or chest x-ray. Sometimes staging is not complete until the patient has surgery.
These are the main features of each stage of the disease:
Stage 0 -- The cancer cells are found only on the surface of the inner lining of the bladder. The doctor may call this superficial cancer or carcinoma in situ.
Stage I -- The cancer cells are found deep in the inner lining of the bladder. They have not spread to the muscle of the bladder.
Stage II -- The cancer cells have spread to the muscle of the bladder.
Stage III -- The cancer cells have spread through the muscular wall of the bladder to the layer of tissue surrounding the bladder. The cancer cells may have spread to the prostate (in men) or to the uterus or vagina (in women).
Stage IV -- The cancer extends to the wall of the abdomen or to the wall of the pelvis. The cancer cells may have spread to lymph nodes and other parts of the body far away from the bladder, such as the lungs.
