Bladder cancer is the tenth most common cancer worldwide.1 In Australia, bladder cancer is the eleventh most common cancer type diagnosed, with approximately 3100 new cases and 1000 related deaths estimated to occur annually.2 In New Zealand, bladder cancer is the twelfth most common cancer type diagnosed, with 477 new cases and 248 related deaths occurring in 2020.3
Bladder cancer occurs when cells from the bladder wall begin to grow and spread in an uncontrolled way. This abnormal cell growth may lead to the formation of a malignant tumour, which can spread beyond the bladder wall into other regions of the bladder and nearby tissues, and eventually to the lymph nodes and other parts of the body.
About half of bladder cancer cases are detected at an early stage. Early detection is critical as this increases the number of treatment options and the likelihood that they will be successful.
What are the signs and symptoms of bladder cancer?
Blood in the urine, which is referred to as haematuria, is the most common early symptom of bladder cancer. Other early symptoms can include a change in urination habits (such as having to urinate more often) and/or symptoms of urinary irritation (such as pain or burning during urination).
While these early symptoms are most likely attributed to less serious causes (for example, a urinary tract infection), it is important to visit your doctor to obtain relief from uncomfortable symptoms and to exclude causes such as bladder cancer.
Signs and symptoms of more advanced bladder cancer include pain on one side of the lower back, bone pain, loss of appetite, and weight loss.
How is bladder cancer diagnosed?
Bladder cancer is often first suspected based on an individual’s signs and symptoms, once other more common causes have been eliminated. However, exams and tests are needed to confirm the diagnosis. If cancer is found, more tests will be conducted to determine the characteristics of the cancer.
Initially, the doctor will take details of medical history and perform a physical examination. These can reveal other connected symptoms and risk factors that may be increasing the likelihood of bladder cancer. They’ll also help confirm other diagnoses.
Are there screening tests to detect bladder cancer?
Screening tests look for cancer before an individual has symptoms and therefore may help identify cancer at an early stage, which can improve the chances of successful treatment. As things stand, there is no standard or routine screening test for bladder cancer, so it’s important to recognise and act on the early signs and symptoms.
What tests and procedures are available to detect or diagnose bladder cancer?
Several tests and procedures are available to determine whether an individual has bladder cancer or to establish an alternative diagnosis. Some of these clarify the presence of symptoms (such as haematuria) and others identify alternative causes of these symptoms (such as an infection). Importantly, some or all of these tests and procedures are used in combination to determine an overall diagnosis.
Tests and procedures used in the detection or diagnosis of bladder cancer can include:
- Urinalysis: A preliminary lab test that determines whether blood or other substances are present in a urine sample.
- Urine cytology: This test involves examining a urine sample under a microscope to determine if cancer or pre-cancer cells are visible.
- Urine culture: This test examines whether an infection is the cause of urinary symptoms. Although bladder cancer and bladder infections can cause similar symptoms, infections occur much more commonly. If urine culture indicates that an infection is present, appropriate antibiotic treatment can be undertaken. (Of note, culture cannot determine the presence or absence of cancer.)
- Genomic urine tests: urine tests that look for specific substances or genes made by bladder cancer cells. For instance, Cxbladder is a non-invasive genomic urine test that measures five biomarker genes to improve overall bladder cancer detection accuracy or help rule out the disease.
- Cystoscopy: This procedure is usually recommended if bladder cancer is suspected. Cystoscopy involves inserting a thin tube with a light and camera through the urethra to look inside the bladder. If an abnormal area is seen during the procedure, a biopsy can be taken to help confirm the diagnosis (in some instances, several biopsies may be needed). Additionally, bladder washings can be obtained for cytology assessment.
- Ultrasound: An ultrasound uses high frequency sound waves to produce images of internal organs and it can be used to differentiate between fluid-filled cysts and solid tumours but it cannot determine if a tumour is cancerous.
- CT or computed tomography scan: A CT scan uses x-rays to obtain cross sectional images of the body. A CT scan of the kidneys, ureters and bladder, which is referred to as a CT urogram, can determine if there are abnormalities in the urinary tract and characteristics of a tumour such as its shape, size, and location.
What tests are used to determine if the cancer has spread?
Diagnostic imaging is often used in individuals in the process of being diagnosed to see where the cancer is located and to determine if it has spread to other parts of the body.
Imaging tests that can be used to inform a bladder cancer diagnosis include:
- Ultrasound: can help visualise if the bladder cancer has spread to nearby organs or tissues.
- CT or computed tomography scan: takes cross-sectional images of the body to determine if abnormalities are present or if there are enlarged lymph nodes that may contain cancer
- MRI or magnetic resonance imaging scan: assesses if the cancer has spread to tissues or lymph nodes near the bladder.
- Bone scan: determines if the cancer has spread to the bones.
- X-ray: when performed on the chest, can visualise if the cancer has spread to the lungs.
- Other: specific diagnostic imaging techniques that help in the assessment of the urinary tract are also available (e.g., x-ray pyelogram, CT urogram, and MRI urogram).
Biopsies of suspicious areas may also be needed to confirm that the cancer has spread. For example, biopsies may be obtained during surgery to remove a tumour or by using a long, thin, hollow needle inserted into the abnormality (referred to as a needle biopsy).
What is the best test to diagnose bladder cancer?
No single test is best able to diagnose bladder cancer. Rather, a combination of tests and procedures are used as part of a specialist assessment, informed by clinical guidelines. A number of factors influence which specific tests and examinations are selected including their availability, patient characteristics, and whether the patient has a history or risk of bladder cancer. In general, the choice of detection method and their use in combination is based on a patient’s risk profile.
Can recurrence of bladder cancer be monitored?
Bladder cancer has a high risk of recurrence so patients who have been treated have unique monitoring needs to protect against the threat of the disease returning.
Besides monitoring for signs and symptoms of bladder cancer, a cystoscopy to examine the inside of the bladder and urethra is recommended every 3–12 months for several years after completing bladder cancer treatment, depending on the risk of recurrence. For many patients, the frequency of cystoscopy required can be reduced with the use Cxbladder, a non-invasive genomic urine test that combines clinical risk factors with gene expression markers to accurately detect or rule out bladder cancer.
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- World Cancer Research Fund. Global cancer statistics for the most common cancers
- Cancer Australia. Bladder cancer statistics in Australia
- International Agency for Research on Cancer. New Zealand. Source: Globocan 2020
- American Cancer Society. Bladder Cancer Signs and Symptoms
- American Cancer Society. Can Bladder Cancer Be Found Early?
- American Cancer Society. CT Scan for Cancer
- American Cancer Society. Cystoscopy
- American Cancer Society. Tests for Bladder Cancer
- American Cancer Society. Ultrasound for Cancer
- American Cancer Society. What Causes Bladder Cancer?
- Cancer.Net. Bladder Cancer: Follow-Up Care
- Cancer.Net. Computed Tomography (CT) Scan
- Chang SS et al. Diagnosis and treatment of non-muscle invasive bladder cancer: AUA/SUO guideline. J Urol 2016;196:1021
- Guys and Thomas. Treatment for bladder tumours – transurethral resection of a bladder tumours
- Maxim LD et al. Screening tests: a review with examples. Inhal Toxicol. 2014;26:811–828.
- National Cancer Institute. Bladder and Other Urothelial Cancers Screening (PDQ®)–Patient Version
- NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Bladder Cancer. NCCN Evidence BlocksTM. Version 1.2021. March 9, 2021.
- Urology Care Foundation. What is Muscle Invasive Bladder Cancer (MIBC)?
Last Updated: 04 May 2023 05:22 pm
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