Diagnosing bladder cancer

Tests and procedures used to diagnose bladder cancer may include:

• Cystoscopy. To perform cystoscopy, your doctor inserts a small, narrow tube (cystoscope) through the urethra. The cystoscope has a lens that allows your doctor to see the inside of your urethra and bladder, to examine these structures for signs of disease.
• Biopsy. During cystoscopy, your doctor may pass a special tool through the scope and into your bladder to collect a cell sample (biopsy) for testing. This procedure is sometimes called transurethral resection of bladder tumor (TURBT). TURBT can also be used to treat bladder cancer.
• Urine cytology. A sample of your urine is analyzed under a microscope to check for cancer cells in a procedure called urine cytology.

• Imaging tests. Imaging tests, such as computerized tomography (CT) urogram or retrograde pyelogram, allow your doctor to examine the structures of your urinary tract.

  During a CT urogram, a contrast dye injected into a vein in your hand eventually flows into your kidneys, ureters and bladder. X-ray images taken during the test provide a detailed view of your urinary tract and help your doctor identify any areas that might be cancer.

  Retrograde pyelogram is an X-ray exam used to get a detailed look at the upper urinary tract. During this test, your doctor threads a thin tube (catheter) through your urethra and into your bladder to inject contrast dye into your ureters. The dye then flows into your kidneys while X-ray images are captured.

Determining the extent of the cancer

After confirming that you have bladder cancer, your doctor may recommend additional tests to determine whether your cancer has spread to your lymph nodes or to other areas of your body.

Tests may include:

• CT scan
• Magnetic resonance imaging (MRI)
• Bone scan
• Chest X-ray

Your doctor uses information from these procedures to assign your cancer a stage. The stages of bladder cancer are indicated by Roman numerals ranging from 0 to IV. The lowest stages indicate a cancer that's confined to the inner layers of the bladder and that hasn't grown to affect the muscular bladder wall. The highest stage — stage IV — indicates cancer has spread to lymph nodes or organs in distant areas of the body.

The cancer staging system continues to evolve and is becoming more complex as doctors improve cancer diagnosis and treatment. Your doctor uses your cancer stage to select the treatments that are right for you.

Bladder cancer grade

Bladder cancer tumors are further classified based on how the cancer cells appear when viewed through a microscope. This is known as tumor grade, and your doctor may describe bladder cancer as either low grade or high grade:

• Low-grade bladder tumor. This type of tumor has cells that are closer in appearance and organization to normal cells (well-differentiated). A low-grade tumor usually grows more slowly and is less likely to invade the muscular wall of the bladder than is a high-grade tumor.
• High-grade bladder tumor. This type of tumor has cells that are abnormal-looking and that lack any resemblance to normal-appearing tissues (poorly differentiated). A high-grade tumor tends to grow more aggressively than a low-grade tumor and may be more likely to spread to the muscular wall of the bladder and other tissues and organs.