Understanding The Workup For Bladder Cancer
- Bladder cancer is one of the most common types of genitourinary cancers.
- For most patients, the disease first presents as blood in the urine, which might be visible to the person themselves or discovered during an unrelated urine analysis done by a primary care doctor or urologist.
- When a doctor suspects bladder cancer, they will order a series of tests which may include additional urine tests (urinalysis or urine cytology), a cystoscopy to visualize the inside of the bladder, and/or a CT urogram.
- Doctors may also perform a transurethral resection of bladder tumor (TURBT), a surgery that is both a diagnostic procedure (to confirm cancer) as well as a treatment procedure (to remove visible tumor).
- Though muscle-invasive bladder cancer is considered a more advanced stage of the disease, the workup will generally involve a similar series of tests.
Though muscle-invasive bladder cancer is considered a more advanced stage of the disease, the bladder cancer workup will generally involve a similar series of tests.
Read MoreUrine Testing
Urine tests help identify infection and may look for abnormal cells.Urine tests used to help detect bladder cancer may include:
- Urinalysis: This checks for blood, infection, and other abnormalities.
- Urine Cytology: A pathologist examines urine under a microscope to look for cancer cells. It is especially good at detecting high-grade (more aggressive) cancers. A normal result does not completely rule out cancer.
Sometimes additional urine molecular tests may be ordered, depending on your situation.
Cystoscopy (The Key Test)
Cystoscopy is the most important diagnostic step.
“Cystoscopy is an office-based procedure where you put a scope, a small camera inside the bladder. You do that in men or women. It’s done with the patient awake in the office and you can visualize the inside of the bladder,” Dr. Matthew Mosannen, a urologist at Brigham and Women’s Hospital, explains.
Generally, local numbing gel is used and you may feel pressure or burning. If a suspicious area is seen, the next step is a biopsy.
Transurethral Resection of Bladder Tumor (TURBT)
This is both a diagnostic procedure (to confirm cancer) as well as a treatment procedure (to remove visible tumor).
“You’re taken to the operating room, you’re given general anesthesia, and the urologist goes in there and uses an instrument to scrape out and remove the tumor,” Dr. Mosannen explains. “Depending on how deep the tumor is invading in the wall of the bladder, if it’s muscle invasive, we know then what your tumor stage is.”
The pathology report is critical as it tells your doctor not only if you have a bladder cancer but also what type, how aggressive, and how deep it goes into the bladder. The depth of muscle invasion is especially important as it changes treatment management.
Imaging Studies
Your doctor may also order a CT urogram, the most common imaging test for these cases. It is a special CT scan that looks at the kidneys, ureters, and bladder. You receive IV contrast dye unless there is a medical reason not to. This test helps rule out tumors higher in the urinary tract and other causes of bleeding. If you cannot receive contrast, alternatives like MRI or ultrasound may be used.
Additional CT scans of the chest, abdomen, and pelvis may also be ordered depending on how advanced the bladder cancer is thought to be and if it has spread to other organs.
The workup for bladder cancer is structured and evidence-based. While it may seem like many steps, each test builds a clearer picture so your care team can recommend the safest and most effective treatment for you.
Questions To Ask Your Doctor
- What standard workup tests do I need?
- What can I or do I need to do to prepare for each test?
- Are there any side effects I should be aware of?
- What should I expect from TURBT recovery?
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