The bladder is a pelvic organ but can be palpated in the abdomen when filled with urine. It is the storehouse for urine after its production in the kidneys and the urethras arises from it. It is also a potential site for cancer to occur and is currently the 2nd most common urological cancer encountered in clinical practice after prostate cancer.
The pathology of the formation of bladder cancer is the change in the epithelial lining of the bladder caused by the chronic irritation and defect in the repair mechanism of the epithelium.
Bladder cancer diagnosis
The procedure for bladder cancer detection starts with consulting a physician. A urine sample is collected to check whether or not it contains blood. The urine sample will be sent to a lab for further testing. If required, the patient will be sent to the hospital for x-rays, in addition to expert advice on treating infection from a urologist. In detecting cancer, the most common method used is a biopsy, which provides definite confirmation of cancer. If this test is not available, imaging tests can be done to check whether or not cancer has metastasized (spread to other organs). Here are some factors that are considered for bladder cancer diagnosis:
- The age and the medical condition of the patient
- Cancer type suspected
- Different types of symptoms
- History of treatments
If the cancer is found in its early stages, it can be treated successfully. Keep in mind that there is not a single test that can help identify bladder cancer in the first place.
The bladder can be physically checked to detect any abnormal growth. The rectum and vagina are very close to the bladder, so this greatly helps the doctor to feel any changes. The rectum can be checked for any disparity in males, and in the case of females, the vagina is checked.
For the diagnosis of bladder cancer, blood tests are taken. A blood sample may be collected to check your health, and also to find the blood count and to witness the functioning of your liver and kidney.
Imaging techniques that are used for bladder cancer diagnosis are as follows:
1) Ultrasound Scan
In this type of test, sound waves are produced to build up an image of the inside of the body. It can easily detect and show any abnormalities found in the urinary system. Usually, the doctors ask the patients to drink 2 -3 glasses of water until the bladder is full so that the organ can be clearly seen. An ultrasound scan has no radiation.
When your bladder is full, you have to lie down on your back. A gel is applied to the abdomen. A device resembling a microphone is passed over the abdomen, emitting sound waves. These sound waves are picked up when bounced back as echoes from the internal organs in the body. It is these echoes that are made into black and white pictures by the computer. The scan will take about 15-20 minutes and is usually painless.
2) CT scan
CT scan is just like an X-ray test, producing cross-sectional images of your body. It is a type of scan that helps produce a clear and detailed image of the body part. In a CT scan, multiple images are taken at once as the machine rotates around your body. Then a computer combines these images together to make the final picture.
You will be asked to drink 1-2 pints of oral contrast (liquid) before taking the picture. It will help to outline the intestine clearly so that no mistakes are made while searching for cancer cells. Sometimes this liquid may also be given through the veins in the form of an injection to see clearly the blood vessels in your body. It can cause allergic reactions in some patients or even lead to breathing trouble and low blood pressure. The doctor must be informed if you encounter any such reactions.
Nowadays, spiral (helical) CT scan is most commonly used in hospitals for bladder cancer diagnosis. This technology produces clearer cut pictures. This machine is faster, reduces radiation, and gives detailed pictures. If a CT scan of the urethra, kidney, and the bladder is taken, it is called the CT urogram. The image can provide information on the size, shape, and position of any tumor in the urinary area.
3) Intravenous Urogram (IVU)
Intravenous Urogram, which is also known as IVU, usually helps to identify any problem in the urinary system. This test takes about 1 hour to complete. A dye is injected into the blood vessels, and then doctors watch the monitor understand how it is passing through the urinary system. It can help detect any problems in your urinary system. Allergies and other reactions must be reported to the doctor.
4) The Retrograde Pyelogram
In this kind of procedure, a catheter (a thin tube) is passed through the urethra and into the bladder. After that, a dye is passed through the catheter to make the linings of a bladder, kidney, and the ureters visible. An x-ray scan is then done to see it clearly. Those who have allergic reactions to IVP can make use of this test to look for any tumors in the urinary tract.
5) Chest X-Ray
A chest x-ray is done to find tumors in the lungs that might have spread from cancer in the bladder.
6) MRI Scan
MRI scan is somewhat similar to CT scan, but here radio waves and strong magnets are used. Radio waves produce much clearer images of soft tissues present in our body. Gadolinium, a contrast material, is injected into the body by vein before this test. MRI can become unpleasant for many patients as it takes about an hour to complete and makes buzzing sounds that can make the patient uncomfortable; earplugs are provided under these circumstances. Through MRI, we can find where cancer has spread from the bladder. MRI urogram can be used to get detailed information on the bladder, ureters, and kidneys. It can also be used in place of IVP.
The MRI is a magnet, and this magnet is used to gather detailed images of the body. Before going for the scan, the doctors will provide you with a checklist. It usually contains the following.
- Have you ever worked in any metal industry?
- Is there any metal on your body? It can be anywhere, so you have to make sure that there is no metal in your body. If by chance you happen to have worked in the metal industry, or you have pins in the bone, you cannot get an MRI scan.
7) Bone Scan
A bone scan is usually done to check whether or not cancer has entered the bones. This bladder cancer diagnosis test is done if you have pain in the bones, or if cancer has spread to the bone. In a bone scan, a small quantity of radioactive material is injected into the vein. The material will precipitate in the damaged area of the bone in the body, and a picture of the skeleton will be taken with a special camera.
Bones with abnormality will absorb more radioactive material than normal bones. The presence of cancer in the bone attracts radioactivity, but this can also happen in other diseases of the bone, such as arthritis. This test is not usually combined with the bladder tests, but if you are having bone pain as well, a bone scan will be performed.
8) Pet scan
This type of scan is used to identify how active the cells are. Those cells that are very active usually use huge amounts of energy. Due to this energy, they start to show up on the PET scan device.