Bladder cancer can be diagnosed by cystoscopy, imaging or cytology procedures. People considered at high risk should undergo one or more of these procedures on a regular basis so that the cancer is found at an early, more treatable stage.
People at high risk for bladder cancer are:
- At least 50 years old with hematuria (blood in the urine)
- Under age 50 with visible hematuria
Cystoscopy is the most common and reliable test for bladder cancer. A thin tube with a camera (cystoscope) is inserted into the bladder through the urethra to view the suspicious area. The cystoscope can also be used to take a tissue sample for biopsy, and to treat superficial tumors without surgery. However, cystoscopy is not perfect. Flat lesions (carcinoma in situ) and small papillary tumors can be missed. Imaging studies such as a CT scan, ultrasound or intravenous pyelogram (IVP) supplement the information provided by cystoscopy. IVP involves injecting a dye that shows up on an X-ray as it travels through the urinary system.
Urine-based tests use a urine sample to determine the presence of cancer. Cytology is the oldest urine test, which involves looking at the sample under a microscope for the presence of abnormal cells. There are several types of urine tests available that focus on specific bladder cancer "markers." The urologist will choose the most appropriate urine test for each patient.