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Bladder Cancer Diagnostic Tests

A thorough work-up is needed to come to an accurate diagnosis using bladder cancer diagnostic tests. Once the family physician has noticed blood in the urine and there is a suspicion of bladder cancer, a quick referral to a urologist should be made. The specialist will do a number of tests aimed at determining where the blood is coming from. In the case of bladder cancer the specialist will also want to determine the extent of it. Here is a list of tests that likely will be done (see below).

Diagnostic tests for bladder cancer


urine cytology


bimanual examination

adequate biopsy of cancer and punch biopsy of other sites

CT scan of entire urinary tract

bone scan

chest X-rays

ultrasonography or MRI scan

CT scan of abdomen and pelvis

genetic tests


Here is what these tests are designed to do: The urine cytology helps the urologist to know whether or not there are cancer cells present in the urinary tract. Also, after successful removal of one lesion it might indicate whether or not there are other lesions in the urinary tract.

 Bladder Cancer Diagnostic Tests (Cystoscope)

Bladder Cancer Diagnostic Tests (Cystoscope)

Using cystoscopy the specialist can look into the bladder and do procedures such as biopsies and removal of smaller cancers or polyps. Bimanual examination, rectal eamination and all the other tests such as CT scans, bone scans, MRI scans and ultrasonography will tell the urologist how widespread the cancer is. This is important to know as the final outcome (called “prognosis”) is determined by the exact extent of the disease (called “stage”) at the time the cancer was initially diagnosed. As treatments vary for different stages of cancer, it makes sense to carefully investigate first at what stage the bladder cancer is.

 Bladder Cancer Diagnostic Tests (Cystoscopy)

Bladder Cancer Diagnostic Tests (Cystoscopy)

There is another test that might be considered to be done by the pathologist.This is a genetic test looking for chromosomal abnormalities in the cancer tissue. For instance, in Ref. 3 the authors showed that there is a link between chromosome 9 anomalies and the recurrence of superficial bladder cancer.

Often patients are annoyed or angry when they are told that cancer has been diagnosed, but a few more tests have to be done prior to treatment.

This is understandable from the patient’s point of view who wants to get on with it and have it treated. From the urologist’s and oncologist’s point of view,however, one has to know what kind of cancer it is, low grade or high grade; what the spread of it is, whether it is in the pelvic lymph glands, in the lymph glands beside the aorta (called “paraaortic lymph nodes”), or even lung metastases. In the one case there might have to be surgery first followed by radiotherapy. In another case the urologist likely would decide to use combination chemotherapy first followed by radiotherapy. These decisions have far reaching implications for longterm survival and cannot be made lightly. The best results are achieved when all of the evidence about the cancer is collected first and a strategy of therapy is developed.



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Last modified: October 15, 2014

This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.