If an individual is suspected to have bladder cancer, detailed investigations are required to establish the diagnosis and stage the disease, which in turn helps in selecting an appropriate treatment option.
Following are the INVESTIGATIONS for diagnosis and staging of bladder cancer.
- Urinalysis: In this test, a urine sample (collected from the patient with symptoms of bladder cancer) is tested in a laboratory for the presence of blood cells (RBCs and WBCs). Apart from this, urine culture is also performed to exclude any possibility of urinary tract infection that can also produce symptoms similar to that of bladder cancer.
With the advancement of science, newer tests are now available to check the presence of certain markers in the urine which may suggest bladder cancer. For example, Telomerase (an enzyme usually found in cancer cells), bladder tumor-associated antigen (BTA), carcinoembryonic antigen (CEA), and NMP22 protein.
- Urine Cytology: In this test, a urine sample is checked for the presence of abnormal (precancerous or cancerous) cells using a microscope. Presence of abnormal cells suggests the diagnosis of cancer in the urinary tract. Further investigation is required to find the location of the tumor.
- Cystoscopy: Cystoscopy is a diagnostic technique which uses a cystoscope – a long, flexible, slender tube usually equipped with a camera, a light source, and some special instruments for biopsy or surgery. This enables to look inside the bladder by passing the cystoscope into the bladder via urethra to determine the presence and extent of the disease. Positive cytology but negative cystoscopy indicates an upper tract involvement that requires further investigation using imaging techniques.
- Transurethral resection of bladder tumor (TURBT): If the abnormal area(s) are observed during cystoscopy, biopsy samples are collected from the abnormal area through a transurethral resection of bladder tumor (TURBT) or transurethral resection (TUR) technique. The tumor along with underlying muscle tissue is removed to check the extent of invasion into the bladder wall. Multiple biopsies may be obtained depending upon the cystoscopy observations. This technique helps in establishing the stage of the disease.
- Laboratory Tests for Biopsy Samples: Biopsy samples contain a small number of cells or a tiny piece of tissue, collected from the affected area with the help of a biopsy instrument. These samples provide very useful information about the cancer cells such as the type of cancer, the severity of cancerous changes involved, depth of invasion by tumor, etc.
- Imaging Tests: These tests are generally employed after the establishment of the pathological diagnosis. They help to detect the spread of disease to distant body parts and assess the stage of the disease so that an appropriate treatment option can be selected. Alternatively, these tests are employed after treatment to evaluate the treatment efficacy and to detect disease response, progression, or recurrence.
Intravenous pyelogram (IVP): In this technique, various x-ray images are taken of the urinary system after injecting a contrast (dye) into patient’s vein. The dye outlines the complete urinary system on the x-ray images and is excreted in the urine by kidneys. This helps the doctor to examine the urinary tract for any abnormal areas.
Computed tomography (CT) scan: In this technique, detailed cross-sectional images of body organs are generated using x-rays, with or without a contrast medium. It can help diagnose the spread of disease to nearby/distant lymph nodes and other organs, and may also be used to guide a biopsy needle into the affected area.
Magnetic resonance imaging (MRI) scan: This technique provides detailed images of tissues inside the body using radio waves, strong magnetic field, and gadolinium contrast. It can accurately diagnose the extent of invasion and spread of disease to nearby/distant body parts.
Bone Scan: In this test, a radioactive material is injected into the vein of the patient, which gets accumulated in the areas of bones affected by the disease, which are then detected with the help of radioactivity detectors. In this way, it may help to detect the spread of cancer to bones.
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Watch the video below to understand the INVESTIGATIONS required for diagnosis and staging.
CancerBro, what are the bladder cancer diagnosis/investigations?
Urine analysis is a useful investigation to diagnose bladder cancer. It helps in detecting the presence of blood, malignant cells, and tumor markers in urine. Next important investigation for the diagnosis of bladder cancer is cystoscopy.
In this technique, a hollow tube called a cystoscope which is fitted with a camera is inserted into the urethra and is slowly advanced into the bladder. It helps to confirm the presence of a bladder tumor and see it’s number, location, and extent. Also, it helps in transuretheral resection of bladder tumor which is both, diagnostic as well as therapeutic.
As you can see in this figure, only cancer containing superficial layers of the bladder is removed, without damaging the deeper layers. The next imaging modality used for diagnosis of bladder cancer is Intravenous Pyelogram. In this technique, a dye is injected into the arm vein and then a series of X-ray pictures are taken of the urinary tract. In some cases, we may require a Retrograde Pyelogram in which a dye is injected into the ureter with the help of cystoscope, followed by a series of images.
Pyelogram may be complemented with other imaging modalities, like CT scan or MRI, which help in better delineating the urinary tract. Also, CT scan or MRI of the abdomen and pelvis helps to understand the local extention of the tumor to other structures and the involvement of reginal lymph nodes.
It also helps to diagnose the metastatic involvement of other structures. Imaging of the chest with X-ray or CT scan may be required if clinically indicated. Also, a bone scan may be done if there is a clinical suspicion of bone metastases.
These were the investigations required to confirm the diagnosis of bladder cancer and stage the disease.