Bladder Cancer

Bladder cancer diagnosis and Urine cytology

Bladder Cancer Diagnosis

Anyone who manifests signs and symptoms of bladder cancer should be evaluated. Specific pelvic regions that need evaluation are kidneys, bladder, and urethra, especially if the individual is over 40 years of age. This examination includes one or more urine tests, cystourethroscopy and an imaging test of the kidneys and ureters.

The following are important urine tests to take if cancer in the bladder is suspected:

  • Urinalysis is a test that employs a chemical indicator that changes color in the presence of certain features in the urine like white blood cells, red blood cells and glucose (sugar). The urine is also examined with a microscope.
  • Urine cytology is conducted by a pathologist who examines the sample of the urine under a microscope to check for abnormal-appearing cells that shed from the lining of the bladder.
  • Urine culture is when a sample is placed in a growth medium and monitored for signs of bacterial growth. The bacteria can be identified and the diagnosis may show an infection rather than cancer.

Imaging tests help detect any lumps or abnormalities in the kidneys, ureters, bladder or the urethra. The optimal imaging assessment (with computed tomography [CT] scan, magnetic resonance imaging [MRI], intravenous pyelogram [IVP], or kidney ultrasound) is necessary to stage the disease and formulate subsequent treatment plan.

  • CT Scan: A CT scan is an imaging test that examines the structure of the kidneys, ureters and the bladder. This helps determine if there is a blockage in the urinary tract, and determine if the cancer has spread to regions of the body outside the bladder. CT scans are conducted with the help of a contrast dye.
  • Pyelogram: This is a contrast dye injected into the bladder either by a vein or by a direct catheter. The dye outlines the bladder and associated organs, making any tumors visible on the X-rays.
  • Ultrasound and sonography: There determine the size and the spread of the tumor. They particularly use sound waves to image abnormalities.
  • MRI: A magnetic resonance imaging of the kidneys, ureters, and bladder is employed to evaluate the urinary tract. This imaging may provide useful information in staging of the bladder cancer.
  • IVP: Here a radiopaque dye (one that is visible on X-ray) is injected into the vein. The dye collects in and is excreted by the kidneys. As the dye passes through the urinary drainage system any abnormal lumps may be detected on X-ray images. It might be useful to note that there is a small risk of having an allergic reaction to the dye. People who are allergic to contrast dye, iodine or shellfish should let the radiologist know.
  • Cystoscopy: A cystoscopy is a procedure that is done to directly visualise the lining of the urethra and bladder. It can be conducted by a urologist/oncologist in an operating room. Also known as the cystourethroscopy, an anesthetic gel is applied to the urethra to avoid discomfort and a small tube with a camera (cystoscope) is then inserted into the bladder through the urethra.

Biopsy

Apart from these imaging tests, a biopsy exclusively for the examining of abnormal tissue can be taken. This may be examined in a laboratory or an operating room. Biopsy is usually done as an office procedure by cystoscopy.

Transurethral resection of bladder tumor(TURBT)

Upon diagnosis of bladder cancer, imaging tests are performed. This is followed by resection of bladder mass by cystoscopy under anesthesia to confirm the extent of tumor, a procedure called TURBT. Further the tumor can be classified as invading the muscle or not which has a bearing on further treatment planning.

Bladder cancer staging

The treatment and prognosis of bladder cancer depend upon its stage, its grade, and the risk that the cancer will recur. After diagnosis of bladder cancer, the doctor sets out to determine if it has spread and how far it has spread. This process is called staging of cancer. Staging is important to determine what treatment plan needs to be drawn out and if it will be successful.
Bladder cancer staging is based upon how far the cancer has penetrated into the tissues of the bladder, whether the cancer involves lymph nodes near the bladder, and if the cancer has reached nearby organs and distant sites. Staging is dependent on the physical examinations, imaging tests, and biopsies that have been listed out at length above.

Understanding the stages of bladder cancer

The American Joint Committee on Cancer (AJJCC) has developed a system of staging called the TNM staging which is based on three important elements of the cancer.

T determines the extent to which the (primary) tumor has grown through the bladder wall and whether it has grown into nearby tissues.

N indicates if the cancer has spread to lymph nodes near the bladder. Lymph nodes are bean-sized collections of immune system cells, to which cancers often spread first.

M indicates if the cancer has spread (metastasized) to other organs in distant sites like the lungs or liver, or lymph nodes that are not near the bladder.

Number stages also aid in determining the spread of the cancer.

Stage 0

The cancer is in the origin of its site in the inner layer of the bladder lining (stage 0a) or R there are very early, high grade cancer cells only in the inner layer of the bladder lining (stage 0is).

Stage 1

The cancer has started to invade the connective tissue beneath the bladder lining.

Stage 2

The cancer has metastasized through the connective tissue layer into the muscle of the bladder wall.

Stage 3

The cancer has spread beyond the muscle into the fat layer and may have spread to the prostate, womb or vagina or lymphnodes.

Stage 4

The cancer has spread to the wall of the tummy (abdomen) or between the hips (pelvis), to other distant parts of the body like the bones, lungs or liver.