How Is Bladder Cancer First Diagnosed?

Early diagnosis of bladder cancer is crucial for successful treatment. Unfortunately, there is no specific test available for screening asymptomatic people for the disease. So diagnosis of the cancer primarily relies on the presence of symptoms.  

Working from symptoms

In fact, most cases of bladder cancer are diagnosed when patients report having blood in urine to their doctors. It is at this point that a urine test, called urinalysis, is often ordered to confirm the presence of blood in urine.  

Of course, having blood in urine does not necessarily imply that there is bladder cancer since bleeding can also be due to urinary tract infections, kidney stones, bladder stones, kidney disease, or a non-cancerous tumor. Hence, when blood is present, the urologist will go the extra mile to find out the underlying course.

Apart from blood in urine, your doctor may also suspect bladder cancer if you have urinary symptoms, such as frequent urination, burning sensation during urination, weak urine stream, nocturia, or inability to urinate.

Although occurrence of symptoms is usually the first basis for suspecting bladder cancer, it has various limitations. For instance, there are no symptoms that are specific to the cancer. This may lead to a misdiagnosis of the cancer as another disease with similar symptoms.

Also, many cases of bladder cancer show no symptoms in the early stages. So by the time you’re going to a doctor because of some symptoms, it may already be too late and the cancer could have spread to various organs and become difficult to treat.

Urinary tests

Regular urinary tests can help to detect early-stage bladder cancer. For when there is persistent blood in your urine, your urologist will be prompted to order for further tests.  Usually, when there is any amount of blood in your urine, your doctor will recommend a urine cytology test.

Urine cytology testing uses a random urine sample to check if the urine contains tumor cells. The sample is examined under a microscope to look for the cancer cells. Alternatively, the urine sample can be subjected to molecular analysis, which will detect the presence of various proteins or genes associated with cancer cells. 

Cystoscopy

This is a key bladder cancer diagnostic procedure that allows a urologist to see inside the body with the help of a thin, flexible, lighted tube called a cystoscope.  The cystoscope is inserted into the bladder through the urethra and has a camera to help the doctor clearly view the bladder. 

Apart from assessing the bladder, a cystoscope can be used to take a small tissue sample (biopsy) or to treat early-stage tumors without surgery.  Cystoscopy is a simple outpatient procedure performed in the doctor’s office, and is quite effective in detecting growths in the bladder and determining if there is need for biopsy or surgery.

Biopsy

If your doctor finds abnormal growth in your bladder during cystoscopy, a biopsy is the next and most definitive step. Also called transurethral resection of bladder tumor (TURBT), a biopsy involves the removal of a small amount of tissue from the bladder for examination under the microscope.

Usually the tumor, together with a sample of bladder muscle near the tumor, is removed. But additional biopsies of other parts of the bladder may also be necessary depending on the cystoscopy results. The tissue samples obtained during TURBT are analyzed by a pathologist to confirm bladder cancer, identify the type of tumor, and to find out how deeply it has spread into the layers of the bladder.