A diagnosis of bladder cancer includes urological tests and imaging tests. A complete medical history is used to identify potential risk factors, such as smoking, exposure to dyes and chemicals, and diet.
Laboratory tests: Laboratory tests may include; NMP22®BladderChek®, which detects elevated levels of tumor markers in the urine. The NMP22®BladderChek® is a urine test used to detect elevated levels of a nuclear matrix protein (called NMP22®). Bladder cancer increases levels of this protein in the urine, even during early stages of the disease; a urinalysis, to detect microscopic hematuria; urine cytology, which detects cancer cells by examining cells flushed from the bladder during urination; and urine culture, to rule out urinary tract infection. Results of this test, which is noninvasive and is performed in a physician's office, are available during the patient's office visit. Studies have shown that when used with cystoscopy, NMP22®BladderChek® may be more effective than other diagnostic tests (such as urine tests or cystoscopy alone).
Imaging tests: Various imaging tests may also be performed. Intravenous pyelogram (IVP) is the standard imaging test for bladder cancer. In this procedure, a contrast agent (called a radiopaque dye) is administered through a vein (intravenously or IV) and x-rays are taken as the dye moves through the urinary tract. IVP provides information about the structure and function of the kidneys, ureters, and bladder. Other imaging tests include computerized tomography (CT scan), magnetic resonance imagine (MRI scan), x-ray, and bone scan.
Computerized tomography (CT): Computerized tomography (CT) is essentially a highly detailed X-ray that allows the doctor to see the bladder in two-dimensional slices. Computer processing creates these images while a series of thin X-ray beams pass through the body. In many cases, a contrast dye will be injected into a vein before the test. The dye makes it easier for the doctor to see the organs and to determine if anything abnormal is present that might suggest cancer. The greatest risk with this procedure is a possible allergic reaction to the dye.
Magnetic resonance imaging (MRI): Instead of X-rays, this test uses a powerful magnetic field and radio waves to create images of the urinary tract. During the test, the patient is enclosed in a cylindrical tube that can seem confining to some people. The machine also makes a loud thumping noise. In most cases the person will be given earplugs to help block out the noise. If claustrophobic, an open scan or some mild sedation may be an option.
Bone scan: A bone scan is used to determine whether cancer has spread to the bones. During the procedure, a small amount of a radioactive substance that collects in bone is injected into a vein in the arm. A special scanner then takes pictures of all the bones. The radioactive substance highlights areas of abnormal bone.
Chest x-ray: A chest x-ray test may help detect cancer that has spread to the lungs.
Biopsy: If bladder cancer is suspected, cystoscopy and biopsy are performed. Local anesthesia is administered and a cystoscope is inserted into the bladder through the urethra to allow the doctor to detect abnormalities. A cystoscope is a thin, telescope-like tube with a tiny camera attached. In biopsy, tissue samples are taken from the
lesion(s) and examined for cancer cells. If the sample is positive, the cancer is staged using the tumor, node, metastases (TNM) system.
hybridization (FISH): Fluorescence in situ hybridization (FISH) is used for bladder cancer can detect certain chromosomal abnormalities often found in transitional cell cancer, the most common type of bladder cancer. This test may help detect recurrent cancer cells before a tumor becomes visually apparent. This newer test is not routinely available, and more studies are needed before it can be considered standard.
signs and symptoms
There may be no signs or symptoms in the early stages of bladder cancer. The primary symptom of bladder cancer is hematuria, or blood in the urine. Blood may be visible to the naked eye or visible only under a microscope. Hematuria is usually painless. Other symptoms include polyuria, or frequent urination and dysuria, or pain upon urination.
More common conditions, such as a urinary tract infection, kidney disease, kidney or bladder stones, and prostate problems, can also cause hematuria. These conditions can also cause other symptoms similar to those of bladder cancer, such as pelvic pain, pain during urination, frequent urination, inability to urinate, and slowing of the urinary stream.
If any of these symptoms are present, health care professionals recommend seeing a doctor.
risk factors and causes
Smoking: Smoking appears to be the single greatest risk factor for bladder cancer. Carcinogens, or cancer-causing chemicals, in tobacco can become concentrated in the urine and eventually damage the lining of the bladder. This damage can increase the chances of a cancer-causing genetic mutation. Smokers are at least twice as likely to develop bladder cancer as nonsmokers are. The risk increases with the number of cigarettes smoked a day and the number of years the individual has smoked.
Occupational risk factors: Repeated exposure to chemicals used in the manufacture of dyes, rubber, leather, textiles, and paint products may increase the risk of developing bladder cancer. Workers at increased risk include hairdressers, machinists, printers, painters, truck drivers, and workers in rubber, chemical, textile, metal, and leather industries. Smokers who work with toxic chemicals are at an especially high risk of bladder cancer.
Age: Incidence of bladder cancer increases with age. Individuals over the age of 70 develop the disease two to three times more often than those aged 55-69 and 15-20 times more often than those aged 30-54.
Race: Bladder cancer is more prevalent in Caucasians than in African Americans and Latinos. Asian individuals have an even lower incidence of developing bladder cancer.
Sex: Men are about four times as likely to get bladder cancer as women are. This may be in part due to hormonal imbalances.
Chemotherapy and radiation therapy: Treatment with the anti-cancer drugs cyclophosphamide (Cytoxan®) and ifosfamide (Ifex®) increases the risk of developing bladder cancer. Clinical studies of women treated with radiation therapy for cervical cancer have reported an elevated risk for developing bladder cancer.
Chronic bladder inflammation: Chronic or repeated urinary infections or cystitis (inflammation of the urinary tract) may increase the risk of developing squamous cell carcinoma of the bladder. In some parts of the developing world, especially North Africa, a chronic parasitic infection (Schistosoma haematobium) can contribute to the development of squamous cell carcinoma. Both this infection and squamous cell carcinoma are uncommon in the U.S.
Genetics: Several genes including FGFR3, HRAS, RB1, TP53, TSC1, Tp53, Rb, CDKN2A, and cyclin D1 (CCND1),have been linked to bladder cancer. These genes help regulate cell division by preventing uncontrolled cell growth. If one or more of these genes are mutated, it may increase the risk of developing bladder cancer.
Many patients with bladder tumors are missing all or part of chromosome 9. Therefore, researchers suspect that chromosome 9 may contain several genes involved with cell growth. Studies are ongoing in this area.
If one or more of the immediate relatives (such as a parent or sibling) has a history of bladder cancer that also may increase the risk. However, it is rare for bladder cancer to run in families. This is because most genetic mutations linked to bladder cancer are not present at birth. Instead, they happen during a person's lifetime.
A family history of hereditary nonpolyposis colorectal cancer (a type of colon cancer, or HNPCC) may increase the risk of cancer in the urinary tract.
In addition, some people may inherit a reduced ability to break down some chemicals, making them more prone to the cancerous effects of some harmful chemicals. For example, evidence suggests that the NAT1, NAT2, and GSTM1 genes may increase the risk of bladder cancer associated with cigarette smoking.
Personal history: An individual who has been diagnosed with bladder cancer in the past makes it more likely that it will develop again. Tumors may recur in the ureters or urethra as well as in the bladder itself.
Arsenic exposure: Drinking water containing high levels of arsenic has been associated with bladder cancer. Individuals with well water should have their water tested for contaminants such as arsenic. Local health departments can be a source of testing.
Bladder birth defect: Rare birth defects of the bladder may lead to an unusual form of bladder cancer called adenocarcinoma.
Diet: A clinical study found that the risk of bladder cancer increased by 37% with a high fat intake, by 40% with low fruit consumption, and by 16% with diets low in vegetables.
Others: Consumption of Aristolochia fangchi, a Chinese herb found as an adulterant in some weight-loss formulas, may lead to kidney diseases such as bladder cancer. Aristolochia plant species contains aristolochic acid, a known cause of kidney damage.
Bladder cancer can lead to anemia (or the lack of red blood cells to carry adequate oxygen to the tissues), urinary incontinence (uncontrolled urine flow), and hydronephrosis or a blockage of the ureters that prevents urine from draining normally into the bladder.
The most serious complication from bladder cancer is metastasis (spreading) to other organs such as bones, the liver, and kidneys.