What Tests Will I Have If My Doctor Suspects Bladder Cancer Or Another Urinary Problem
Your doctor will want to analyze your urine to determine if an infection could be a cause of your symptoms. A microscopic examination of the urine, called cytology, will look for cancer cells.
A cystoscopy is the main procedure to identify and diagnose bladder cancer. In this procedure, a lighted telescope is inserted into your bladder from the urethra to view the inside of the bladder and, when done under anesthesia, take tissue samples , which are later examined under a microscope for signs of cancer. When this procedure is done in the doctors office, local anesthesia gel is placed into the urethra prior to the procedure to minimize the discomfort.
If the diagnosis of bladder cancer is made, then the next step is to remove the tumor for detailed staging and diagnosis.
Transurethral resection is a procedure done under general or spinal anesthesia in the operating room. A telescope is inserted into the bladder and the tumor is removed by scraping it from the bladder wall , using a special cystoscope . This procedure is diagnostic as well as therapeutic.
This often can be done as an outpatient procedure, with patients discharged from hospital the same day. After removal, the tumor is analyzed by a pathologist, who will determine the type of tumor, the tumor grade and the depth of invasion. The purpose of the procedure is to remove the tumor and obtain important staging information .
To Complement Not Replace
Out of 10,006 women who enrolled in the study, 26 eventually received a diagnosis of cancer first detected by the blood test.
| Women Who Enrolled in the Study | 10,006 |
| Women Found to Have Cancer First Detected by the Blood Test | 26 |
Of those 26 cancers, 14 were in organs such as the ovaries, kidney, and lymphatic system, for which no approved screening tests exist. Nine of these were cancers that had not yet spread from their original location.
Such cancers have a higher chance of successful treatment, compared with cancers that have already spread widely, said Dr. Papadopoulos.
During the trial, 24 additional cancers not identified by the blood test were picked up by standard screening: 20 breast cancers, 3 lung cancers, and 1 colorectal cancer. Of the 24 cancers, 22 were early-stage cancers.
In addition, 46 women in the study received a diagnosis of cancer that was detected neither by the blood test nor standard screening. Most of these 46 diagnoses occurred after a woman reported symptoms.
“So, can such a test be performed safely, without triggering a large number of futile, invasive follow-up tests based on the test results? Yes,” said Dr. Papadopoulos.
Another presentation during the same session at AACR highlighted an additional liquid biopsy test under development that successfully detected cancer in people already undergoing testing for a suspected cancer.
Complete Blood Count And Chemistry Panel
On the complete blood count , the presence of anemia or an elevated white blood cell count warrants further investigation for an explanation.
The chemistry panel should include liver function studies. Although BCG is administered intravesically, systemic absorption of this agent can produce acute hepatitis. Performing baseline liver function tests before initiating therapy and repeating these tests during the course of therapy is important to help prevent serious adverse events and to determine when therapy should be stopped. In patients with suspected metastasis to liver or bone, liver function tests and measurement of the bony fraction of alkaline phosphatase should be performed.
Kidney function should be evaluated prior to the initiation of therapy because patients with marginal or abnormal kidney function may have an obstruction or some type of renal disease that may worsen with intravesical therapy. Kidney function can be evaluated with serum creatinine measurements or technetium scans of the kidneys.
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Complete Blood Count: Getting The Big Picture
To get a general overview of a patients health, many doctors order a complete blood count first. After taking blood, physicians can analyze the number of red blood cells, white blood cells, platelets and hemoglobin in the sample to detect abnormalities. Many diseases, including cancers, alter these levels, changing the proportion of white blood cells to red blood cells, for example.
One major aspect of the CBC is called a white cell differential. White blood cells, or leukocytes, are part of your immune system. They take on most of the responsibility in responding to infectious diseases, but abnormalities in their levels can also be a sign of some blood cancers. White cell differential is also a helpful indicator in judging a patients response to chemotherapy.
How Can You Learn More About Our Tests
Whether you’re a physician deciding how to best help your patients, or a patient worried about having bladder cancer yourself, we know choosing a reliable test can feel daunting. At Cxbladder, we aim to provide all the information you need to make a confident decision.
In one large clinical assessment, Cxbladder Detect outperformed other urine tests and cytology. When used in combination with cystoscopy, Cxbladder Detect found 97 percent of all high-grade tumors. With comparatively high accuracy, Cxbladder tests offer useful guidance and peace of mind.
On our website, you’ll find resources tailored to the unique needs of physicians and their patients. Whether you’re looking for information on bladder cancer signs and symptoms or seeking detailed information on our tests and their accuracy, we can help.
You can read more about our full suite of bladder cancer test products or reach out to a Cxbladder representative to request more information today.
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Transurethral Resection Of A Bladder Tumour
If abnormalities are found in your bladder during a cystoscopy, you should be offered an operation known as TURBT. This is so any abnormal areas of tissue can be removed and tested for cancer .
TURBT is carried out under general anaesthesia.
Sometimes, a sample of the muscle wall of your bladder is also taken to check whether the cancer has spread. This may be a separate operation within 6 weeks of the first biopsy.
You should also be offered a dose of chemotherapy after the operation. This may help to prevent the bladder cancer returning, if the removed cells are found to be cancerous.
See treating bladder cancer for more information about the TURBT procedure.
Next Steps After Urine Lab Tests
Depending on the results of the patients physical examination and urine laboratory tests, healthcare providers may need to carry out further testing to help make a diagnosis.1,2 The tests can also be used in patients who have already been diagnosed with bladder cancer to help gather more information about the cancer and develop the patients treatment plan.
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To Confirm The Diagnosis
Urine microscopyA sample of urine can be sent to the laboratory to look for cancerous cells under the microscope. This test may detect cancer cells. However, if no cancer cells are seen it does not rule out bladder cancer. Further tests are done to confirm or rule out the diagnosis if symptoms suggest bladder cancer.
CystoscopyCystoscopy is commonly done to confirm a bladder tumour. Having a cystoscopy entails a doctor or nurse looking into your bladder with a special thin telescope called a cystoscope. The cystoscope is passed into your bladder via your water pipe . A cystoscopy which is done just to look into your bladder is normally carried out under local anaesthetic. If a procedure is done, such as removing a tumour via a cystoscope, a general anaesthetic is usually used.
During cystoscopy a doctor or nurse can:
- See any areas on the lining of your bladder which look abnormal.
- Take small samples of suspicious areas. A small sample of tissue is removed from a part of the body and then examined under the microscope to look for abnormal cells.
- Remove a superficial tumour with instruments which can be passed down a side channel of the cystoscope.
See the separate leaflet called Cystoscopy for more details.
Ultrasound scanThis is a safe and painless test which uses sound waves to create images of organs and structures inside your body. An ultrasound scan may be used to diagnose a bladder cancer.
Dog Bladder Cancer Clinical Trials
There is a close similarity between TCC in dogs and high-grade invasive bladder tumors in humans therefore, canine bladder cancer is an area of research interest for doctors and veterinarians alike . As such, you may be asked if you would like your dog to be part of a veterinary clinical trial, which can give you access to experimental treatments that are otherwise unavailable.
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Blood Test For Bladder Cancer
Get information on having blood tests. A blood test can help measure how well your kidneys are working.
Blood tests can:
- check your general health, including how well your liver and kidneys are working
- check numbers of blood cells
- help diagnose cancer and other conditions
Your blood sample gets sent to the laboratory. Specialist technicians and doctors look at your sample under a microscope.
They can see the different types of cells and can count the different blood cells. They can also test for different kinds of chemicals and proteins in the blood.
Implications For Research And Practice
This study suggests that some patients with bladder or renal cancer could have their diagnosis expedited if abnormal tests led to definitive cancer investigation. Similar diagnostic windows for both abnormal generic and organ-specific tests were found, suggesting that there may be opportunities to initiate earlier investigations for both types of abnormal tests depending on the clinical context. For the eight blood tests that demonstrated a rise in their baseline rates before diagnosis, at least one-quarter of the patients had the abnormality first detected in the early diagnostic window and prior to 3 months before diagnosis, a diagnostic interval threshold that could negatively affect survival in some patients with bladder and renal cancer.31,32
When considering the generic tests, earlier investigations could nevertheless be triggered in at least some patients, given that about one-quarter of patients with an abnormal generic blood test also had the abnormality first detected in the early half of the diagnostic window. It is possible that the generic tests representing markers of inflammation might be associated with more symptomatic disease, and are more likely to result in further active monitoring or investigations that subsequently led to a cancer diagnosis.
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If Youve Been Diagnosed With Bladder Cancer Seek Out A Team Of Experts
Most people require a combination of therapies to treat bladder cancer successfully. The best plan is different for each person, says Dr. Donat. This customized treatment approach requires the expertise of multiple specialists.
At MSK, most people with bladder cancer meet with a urologic surgeon and medical oncologist as well as a radiation oncologist when needed. This close collaboration helps ensure that MSK patients receive the best care possible. The benefit of MSK is that we bring world-class expertise in each type of treatment to bear for every individual we care for, and we are on the forefront of developing new treatments, says Dr. Donat.
Its also important to know that expert bladder cancer care means not only lifesaving treatments but preserving your quality of life and, if possible, your bladder. We want all of our patients female and male to feel their best after bladder cancer surgery, says Dr. Donat. As surgeons, we do that through a variety of techniques, including minimally invasive approaches and other specialized techniques to preserve or reconstruct the bladder and to maintain sexual function.
What Does Cancer Fatigue Feel Like
The fatigue felt by people with cancer is different from the fatigue of daily life and different from the tired feeling people might remember having before they had cancer. People with cancer might describe it as feeling very weak, listless, drained, or washed out that may decrease for a while but then comes back.
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Urine Tumor Marker Tests
Different urine tests look for specific substances made by bladder cancer cells. One or more of these tests may be used along with urine cytology to help see if you have bladder cancer. These include the tests called NMP22® , BTA Stat®, Immunocyt® , and UroVysion®, which are discussed in Can Bladder Cancer Be Found Early?
Some doctors find these urine tests useful in looking for bladder cancers, but they may not help in all cases. Most doctors feel that cystoscopy is still the best way to find bladder cancer.
Some of these tests are more helpful for finding bladder cancer that has come back in someone who has already had it, rather than first diagnosing it.
Biopsies To Look For Cancer Spread
If imaging tests suggest the cancer might have spread outside of the bladder, a biopsy might be needed to be sure.
In some cases, biopsy samples of suspicious areas are taken during surgery to remove the bladder cancer.
Another way to get a biopsy sample is to use a long, thin, hollow needle to take a small piece of tissue from the abnormal area. This is known as a needle biopsy, and by using it the doctor can take samples without surgery. Sometimes a CT scan or ultrasound is used to help guide the biopsy needle into the changed area.
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Magnetic Resonance Imaging Scan
Like CT scans, MRI scans show detailed images of soft tissues in the body. But MRI scans use radio waves and strong magnets instead of x-rays.
MRI images are very useful in showing cancer that has spread outside of the bladder into nearby tissues or lymph nodes. A special MRI of the kidneys, ureters, and bladder, known as an MRI urogram, can be used instead of an IVP to look at the upper part of the urinary system.
Understanding Invasiveness And Grade
Two important pieces of information to know about this specific cancer are its invasiveness and grade.
Invasiveness describes how deep the cancer is in the bladder wall, which is crucial to determining treatment. If the cancer is in the inner cell layers, its noninvasive or superficial. If its grown into deeper bladder layers or spread to other organs or lymph nodes, its invasive.
Grade describes how bladder cancer cells look under a microscope. Low-grade cancers, also called well-differentiated cancers, resemble regular bladder cells. High-grade, poorly differentiated or undifferentiated cancers dont look as much like normal bladder cells, and theyre more likely to become invasive or spread to other body parts.
Invasive and high-grade cancers may be harder to treat than noninvasive and low-grade ones. They may also require a different kind of treatment.
Its also important to know the stage of cancer, or how much the cancer has spread. If the cancer has spread to other parts of the body, its called metastatic.
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Tumor Marker Tests: Mixed Results
Technically, tumor markers are chemicals produced by cancerous cells that end up floating around in a patients blood. Some tumor markers are also made by healthy cells in the presence of cancers. That sounds like a clear sign of malignancy, but its not. Lots of people without cancer have elevated levels of tumor markers and the use of these tests in cancer diagnosis is still controversial.
Doctors usually look for proteins that accompany cancer, but recently, physicians have also started analyzing abnormalities in DNA and gene expression as tumor markers, too, according to the National Cancer Institute.
Theres no tumor marker that all cancers produce as a rule, at least not one thats been identified yet. But researchers have found proteins that specific types of tumor seem to produce:
- Alpha-fetoprotein, a blood protein produced by amniotic fluid during normal fetal development, may be elevated in the presence of liver cancer and germ cell tumors like ovarian cancer and testicular cancer.
- CA 19-9 is an antigen, a protein that may be manufactured by cancer cells and causes an immune system response. CA 19-9 levels are usually studied to manage pancreatic cancer, but a patients levels may also be elevated because of colorectal or esophageal cancer.
Finding cancer markers in blood work isnt enough to diagnose cancer, or screen patients for developing malignancies.
Tumour Markers Blood Test
Tumour markers are substances that might be raised if there is a cancer. Theyre usually proteins. They can be found in the blood, urine or body tissues.
Some tumour markers are only produced by one type of cancer. Others can be made by several types. Some markers are found in non cancerous conditions as well as cancer.
Doctors might use tumour markers to help diagnose a cancer. And if you have cancer they can also help to monitor how well your cancer treatment is working or check if the cancer has come back.
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Bladder Cancer Clinical Trials
What about Clinical Trials?
You may hear about clinical trials for your bladder cancer. Clinical trials are research studies that test if a new treatment or procedure is safe and effective.
Through clinical trials, doctors find new ways to improve treatments and the quality of life for people with disease. Trials are available for all stages of cancer. The results of a clinical trial can make a major difference to patients and their families. Please visit our clinical trials research webpage to learn more.
Tests That Might Be Used To Look For Bladder Cancer
Tests for bladder cancer look for different substances and/or cancer cells in the urine.
Urinalysis: One way to test for bladder cancer is to check for blood in the urine . This can be done during a urinalysis, which is a simple test to check for blood and other substances in a sample of urine. This test is sometimes done as part of a general health check-up.
Blood in the urine is usually caused by benign problems, like infections, but it also can be the first sign of bladder cancer. Large amounts of blood in urine can be seen if the urine turns pink or red, but a urinalysis can find even small amounts.
Urinalysis can help find some bladder cancers early, but it has not been shown to be useful as a routine screening test.
Urine cytology: In this test, a microscope is used to look for cancer cells in urine. Urine cytology does find some cancers, but it’s not reliable enough to make a good screening test.
Urine tests for tumor markers: Newer tests look for certain substances in urine that might be a sign of bladder cancer. These include:
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