Bladder Cancer Diagnosis
If you have symptoms that may signal bladder cancer, your doctor will examine you and ask you questions about your health; your lifestyle, including smoking and drinking habits; and your family medical history.
One or more of the following tests may be used to find out if you have bladder cancer and if it has spread. These tests also may be used to find out if treatment is working.
Blood and urine tests: These tests can help doctors diagnose bladder cancer or identify other conditions that may be causing the symptoms, such as kidney stones, a urinary tract infection or an enlarged prostate.
Cystoscopy: This is the most frequent and reliable test for bladder cancer. It is sometimes paired with transurethral resection (TUR), a procedure to remove cancer cells from the bladder.
During a cystoscopy procedure, a thin tube with a camera on the end (cystoscope) is inserted into the bladder through the urethra. The cystoscope can be used to take a tissue sample and treat superficial tumors without surgery. Pathologists can then study the tissue cells under a microscope in order to make a diagnosis. However, cystoscopy is not always accurate when performed alone. Flat lesions (carcinoma in situ) and small papillary tumors can be missed. MD Anderson recommends that cystoscopy be combined with other tests for the most accurate diagnosis.
MD Anderson can offer cystoscopy with the patient under general anesthesia. This allows doctors to perform a more thorough exam of the bladder when needed.
MD Anderson also uses blue light cystoscopy to aid the detection of bladder tumors. During this procedure, the bladder is filled with a solution that is absorbed by cancer cells, then lights up when exposed to a blue light during a cystoscopy.
Imaging tests: Imaging exams for bladder cancer include:
- CT urogram. This is the most commonly used imaging test for bladder cancer.
- MRI (magnetic resonance imaging) scans. MRI may be used when a patient has poor kidney function and cannot take the contrasting dye required in a CT urogram.
- PET (positron emission tomography) scans
- Bone scan
- Chest X-ray or chest CT
Getting a second opinion at MD Anderson
The pathologists at MD Anderson are highly specialized in diagnosing and staging every type of bladder cancer. We welcome the opportunity to provide second opinions.
In rare cases, bladder cancer can be passed down from one generation to the next. Genetic counseling may be right for you. Visit our genetic testing page to learn more.
What is a cystoscopy?
A cystoscopy is a medical procedure in which a doctor uses a slender, flexible scope to look inside the bladder. It’s the best way we have right now to fully examine the bladder for tumors and to see whether or not bladder cancer has come back.
We insert the scope through the urethra in the same way as a Foley catheter, a device that allows urine to be drained from the body. Both tubes are about the same size, but a cystoscope is very flexible and has a tiny camera at its tip. This allows us to turn it in any direction and examine the bladder’s entire lining.
Below are answers to some of the most common questions I hear about cystoscopies.
How painful are cystoscopies?
Women generally have an easier time tolerating cystoscopies than men. One reason is the length of the urethra: a man’s can be up to five times longer than a woman’s. Another is that the prostate gland is reportedly where most of the sensation comes from, and women don’t have one.
But we have ways to help reduce discomfort for all of our patients. One is to have a screen that faces the patient in each of our cystoscopy rooms. We’ve found that if people can watch their cystoscopy procedures in real-time, it decreases the tension levels in their pelvis and, by extension, any feelings of discomfort. We also use lubricating jelly that contains a local anesthetic.
How long does a cystoscopy take?
Unless someone has unusual anatomy, the cystoscopy itself only takes a few minutes. This is a very quick procedure. A doctor can normally look around the entire bladder and urethra in under five minutes.
Preparing for a cystoscopy usually takes a bit longer. It requires getting undressed, putting on a surgical gown, lying down on an exam table and placing your legs up in stirrups.
The urethral opening and the area around it are then cleaned to decrease the risk of infection, and we apply a lubricant containing lidocaine (a topical anesthetic) to the urethra to numb it. We normally give that a minute or two to take effect before we start the procedure.
Is general anesthesia ever necessary for a cystoscopy?
No, not really. Patients with extremely sensitive urinary tracts might find it too uncomfortable to have one without general anesthesia. Others might consider the anxiety caused by the prospect of having a procedure done in such a private area too much to bear while they’re awake. But those are very, very rare situations.
At MD Anderson, we perform about 16 cystoscopies per day. That’s more than 4,000 a year. Out of those, maybe five patients need general anesthesia to tolerate the procedure.
How does a regular cystoscopy differ from a blue-light-aided cystoscopy and Trans-Urethral Resection of Bladder Tumor (TURBT)?
Diagnostic and surveillance cystoscopies are usually performed in a doctor’s office. They use local anesthetic, are very quick, and the patient is awake the whole time.
That type of cystoscopy is very different from those done alongside a surgical procedure, such as a Trans-Urethral Resection of a Bladder Tumor (TURBT). Those are performed with a larger scope that can accommodate instruments such as an electrical loop of wire used to remove tissue for biopsy and cauterize blood vessels. So, they have to be done in an operating room while the patient is under general anesthesia.
What are the risks of a cystoscopy?
The biggest risk of a cystoscopy is infection, though even that is very low. The most commonly quoted estimate is that fewer than 5% of cystoscopy patients might develop an infection. But in reality, it’s probably much lower than that.
Any time you manipulate or insert something into the urinary tract, you run the risk of introducing bacteria there. But infections happen very rarely now after cystoscopies.
The only other risk is a very, very small chance of developing scar tissue in the urethra, due to irritation from the scope. But that’s not normally something you see unless someone is scoped very frequently, or more than 50 times in their entire life.
Do cystoscopies have any side effects?
Some patients report a burning sensation with urination afterward, but it’s normally mild and self-limiting. Most patients have few to no side effects.
If you develop fever and chills alongside pain with urination, though, those could be signs of infection, so be sure to mention them to your doctor.
Neema Navai, M.D., is a urologic surgeon who specializes in bladder cancer and other cancers of the genitourinary tract.
Request an appointment at MD Anderson online or call 1-877-632-6789.