Bladder cancer is most commonly diagnosed when a person is investigated for the cause of bleeding in the urine. Some investigations that are useful for diagnosis of bladder cancer include:
Urinalysis: Urine test (microscopic analysis or the examination under a microscope) can confirm if there is blood in your urine. It can also provide other information such as the presence of an infection and existence of any abnormal cells etc. Urine test is one of the first tests that are done in a person with blood in the urine (hematuria). It does not confirm the diagnosis of bladder cancer, but can help your doctornarrow down the potential causes of bleeding.
Urine cytology: If your urine analysis shows abnormality, a sample of your urine may be further analysed to check for cancer cells through a procedure called urine cytology. In this test, urine sample is centrifuged and the sediment is examined under a microscope for the presence of abnormal cells. This is based on the idea that in many patients, malformed cancerous cells may be shed into the urine by a type of cancer. If the test is positive, it is quite specific to be cancer (there is a high degree of certainty that cancer is present in the urinary system). A negative test, however, does not rule out bladder cancer.
Ultrasound: Ultrasound can help detect bladder tumours and other conditions such as the presence of swelling in the kidneys, stones in the urinary system or prostate enlargement. It is a painless and non-invasive test, which uses high-frequency sound waves to detect abnormal or normal structures inside the body. These sound waves cannot be heard by human ears. The pattern of the echoes produced when the sound waves are reflected from the internal structure, creates a picture called a sonogram. The radiologist can differentiate healthy tissues and abnormal patterns on this picture.
CT scan/MRI: These are also painless and non-invasive tests that provide greater visual detail than an ultrasound exam and can detect smaller tumours in the kidneys or bladder. Both the imaging techniques take a series of detailed pictures of part of the body that is being examined and can show cancerous growth, regional spread of tumour or tumour in other places in the abdomen. These imaging techniques may be used to locate the site of tumour and to check the stage of the tumor (extent of spread and size of tumor).Staging is useful to determine the extent of the disease (size and spread of cancer) and helps to decide a treatment and predict the prognosis.
Cystoscopy and biopsy: This is the most important investigation in a person with suspected bladder cancer. The cancer may be missed by imaging investigations (ultrasound/CT/MRI), urine cytology etc; hence, experts recommended that all patients with bleeding in the urine and with an undiagnosed cause should have a cystoscopy. By virtue of this procedure, a special instrument with a small fiber-optic camera is passed through the urethra into the bladder and the inner surface of the bladder is visualized on a video monitor. This test can show small or flat tumours that cannot be seen on other investigations. Your doctor may take a piece of bladder tissue (bladder biopsy) for examination under the microscope.