How is bladder cancer diagnosed ?
The average age for diagnosing bladder cancer is 70. When bladder cancer is suspected, the diagnosis is often confirmed by an urologist, a specialist in the urinary system of both men and women and the male genital tract.
The clinical examination and medical interview
Before performing a clinical examination, the urologist will ask the patient about their medical history, such as the presence of blood in the urine, urinary infections, or urinary issues.
They will inquire whether the patient is a smoker or former smoker and if they may have been exposed to bladder-toxic substances in their occupation. The urologist will also ask about any history of chemotherapy or radiotherapy to the abdomen or pelvis. A thorough clinical examination, including a rectal and vaginal examination, will be conducted. Often, this clinical examination will be normal and will need to be supplemented with additional tests.
Supplementary examinations
The first of these tests is urinary cytology, which determines whether the cells naturally shedding in the bladder are normal or cancerous.
This cytology can be performed on cells present in the urine or obtained during a cystoscopy (see the “Early Detection” chapter).
An ultrasound of the bladder will also be performed. This can detect small tumors of 5 to 6 mm and assess whether the bladder wall is infiltrated. If a tumor is observed during the cystoscopy or ultrasound, the urologist will perform a cystoscopy with or without a transurethral resection of the bladder.
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Cystoscopy is performed in the operating room under either regional anesthesia of the lower body ( spinal anesthesia ) or general anesthesia . It requires a short hospital stay.
A thin, rigid tube called a cystoscope is inserted into the bladder through the urethra . The cystoscope is equipped with a light source and a small camera at its tip, allowing the urologist to visualize any lesions.
It can also have a small metal loop ( resectoscope ) that allows for the removal of a tissue sample ( biopsy ) and/or the complete removal of lesions ( transurethral bladder resection or TURB ).
A dye that binds to tumors is sometimes injected before resection to enhance visualization and enable as complete removal as possible. This is known as fluorescence-guided TURB .
The cells and tissues collected will be examined under a microscope by a pathologist, a specialist in cells, tissues, and organs. The pathologist will determine whether the cells are normal or cancerous and will specify the exact type of tumor cells (histological type). More than 90% of bladder cancers originate from the cells lining the interior of the bladder1. The pathologist will also determine the histological grade of the tumor cells.
Histological grade
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The histological grade of tumor cells indicates the degree of abnormality in the cells. Grade 1 cancers (well-differentiated cancers) have cells that appear relatively normal and divide slowly. Grade 3 cancers (poorly differentiated cancers) have highly undifferentiated cells that divide rapidly. Grade 2 cancers (moderately differentiated cancers) have characteristics intermediate between those of Grade 1 and Grade 3 cancers.
The pathologist will also specify the extent of tumor invasion, noting whether or not the tumor has invaded the muscular tissue of the bladder wall. This helps differentiate between Non-Muscle-Invasive Bladder Tumors (NMIBC) and Muscle-Invasive Bladder Tumors (MIBC).
In the case of confirmed cancer, a pre-treatment assessment must be conducted.
For non-muscle-invasive bladder tumors, a scan that examines the entire urinary tract (urography) or an MRI of the urinary tract (uro-MRI) will be prescribed, along with a thoraco-abdomino-pelvic CT scan or an abdominal-pelvic MRI.
If liver metastases are suspected, a liver scan or hepatic ultrasound may be requested. If bone involvement is suspected, a bone scintigraphy will be prescribed. This imaging test uses a mildly radioactive material to visualize the skeleton and detect any anomalies.
These various tests will help determine the stage of the cancer.
Different stages of the cancer
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Determining the stage of cancer is primarily important for
therapeutic purposes
, as understanding the stage helps establish the most appropriate treatment for the patient.
It also helps predict the most likely progression of the disease ( prognostic value ). The stage of cancer is determined based on three criteria.
The first criterion is based on the characteristics of the tumor ( T ); the second criterion is based on the number of affected lymph nodes N for Node ]; the third criterion is based on the presence of metastases and the number of organs affected by them ( M ). These three criteria are used to define the stage of cancer according to an internationally recognized classification system ( TNM classification ).
The first criterion is based on the characteristics of the tumor (T); the second criterion is based on the number of affected lymph nodes N for Node]; the third criterion is based on the presence of metastases and the number of organs affected by them (M). These three criteria are used to define the stage of cancer according to an internationally recognized classification system (TNM classification).
1 Dyrskjøt, L. et al. Bladder cancer. Nat Rev Dis Primers 9, 58 (2023).
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Article updated on Jan 20, 2025
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