The James Buchanan Brady Urological Institute
SCREENING & DIAGNOSIS
There are several tests that can determine the diagnosis of bladder cancer.
- The most efficient, non-invasive and inexpensive test is a urinalysis/cytology.
Here, a sample of urine is taken from the patient and it is evaluated for red and white blood cells (which fight urinary tract infections) and microscopic hematuria or infection. Hematuria is also a sign of possible tract infection.
- If abnormalities are found a biopsy will be performed in which a pathologist examines tissue for the presence of cancer cells. A urine culture fails to turn up bacteria or other organisms in the urinary tract, additional testing may be needed.
There are also a series of imaging tests that can be done.
- An IVP (Intravenous Pyelogram) is when contrasting dye is injected into the patient and then looked with an x-ray. This x-ray will look at the collecting system of the kidneys to determine the presence of any irregularities. This is good for seeing small cancer locations and the upper urinary tract, especially detailing kidneys, ureters and bladder.
- CT Scans (Computer axial tomographic [CAT] scanning) are another form of x-ray which create a more detailed image of the body and organs. This is used to locate kidney or bladder blockages, determine staging and therapy and if cancer has metastasized.
Fig 2. A CT scan of the pelvis indicates a large bladder tumor invading the base of this patient's bladder. The bladder is visible at the bottom center of the scan. The tumor tissue appears as cloudy material within the bladder, while remaining space in the bladder is eclipsed - seen here as the dark area just right of center. The tumor appears to be muscle invasive based on this CT scan.
- MRI (Magnetic Resonance Imaging) is also another imaging form which creates very high quality and detailed images of bladder tumor(s) in addition to adjacent organs such as the chest, pelvis and abdomen to locate any metastasis.
An MRI scan demonstrates a large bladder tumor involving the bladder wall in the patient depicted in this study. The bladder is visible as the oval object in the center; the white tumor material grows out of the bladder wall like a bloom and appears to obstruct most of the bladder's interior.
- Ultrasound imaging is noninvasive without side effects or radiation which looks primarily at the bladder and kidneys. It can locate small tract blocks and stones and also measure the bladder wall thickness.
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The "gold standard" for the evaluation of the lower urinary tract is direct visual examination called a cystoscopy. This is a routine outpatient procedure which examines the lower urinary tract and bladder lining using a specialized instrument called a cystoscope. Cystoscopes are either rigid or flexible. Fiber optics allow for images of the bladder lining to be created. If abnormalities such as tumors, stones, or patches of abnormal appearing tissue are discovered during cystoscopy, a biopsy may be taken. The biopsy specimen will then be evaluated for the presence of cancerous cells by a pathologist.
- Occasionally, the urologist will take a biopsy during a TURBT procedure (TransUrethral Resection of bladder tumor) which will be schedule for a future appointment. This is an endoscopic or scope procedure that does not involve making an incision in the body.
The entire removal of a bladder tumor can be accomplished through an operative scope which passes through the urethra into the bladder.
