Diagnosis

Preparing for Your Appointment with Your Doctor

If you notice signs or symptoms that worry you (blood in the urine, back pain, pain in the pelvic area), first consult your general practitioner or family doctor. They will suggest possible tests or examinations to get to the bottom of your symptoms.

If your doctor suspects that it could be bladder cancer, they will refer you to a specialist in diseases of the urinary tract (= urologist).

Since time is often limited during specialist appointments and there is a lot to discuss, prepare yourself in advance for your appointment. The following information is intended to help you with this:

Tests and Diagnosis

Diagnostics in Suspected Bladder Cancer:

• Cystoscopy
  During a cystoscopy, your doctor inserts a thin tube (cystoscope) into the urethra. The cystoscope is a device with a small camera that allows your doctor to examine the inside of your urethra and bladder using a fiber optic light system. Usually, a local anesthetic is applied to the urethra before the examination.
• Biopsy
  During a cystoscopy, your doctor has the possibility to take a cell sample (biopsy) from your bladder using a special instrument. This procedure is also called transurethral resection of bladder tissue (TURB) and can also be used for the treatment of bladder cancer. As a rule, TURB is performed under general anesthesia.
• Urine Cytology
  With a urine cytology, your urine is examined under the microscope for cancer cells.
• X-ray Test
  An X-ray test allows your doctor to examine the condition of your urinary tract. One variant of this is the so-called intravenous pyelography (IVP). This requires a contrast agent, which is injected into a vein shortly before the examination. As a result, the kidneys, urinary tract, and bladder become more visible in the X-ray image. As an alternative to X-ray urography, a computed tomography (CT) scan of the abdomen can also be performed to examine your urinary tract and the surrounding tissue.

Staging of Bladder Cancer Tumor

If the suspicion of bladder cancer is confirmed, your doctor will order further examinations to determine the exact stage of the cancer.

The following examinations may be performed:

• Computed tomography (CT)

• Magnetic resonance imaging (MRI)

• Bone scan

• Chest X-ray

The tumor stage can be classified as follows:

• Stage I
  Bladder cancer in stage 1 is limited to the inner lining of the bladder and has not yet invaded the muscle layer of the bladder (non-muscle-invasive).
• Stage II
  In this stage, the cancer has already invaded deeper layers of the bladder but is still confined to the bladder itself (muscle-invasive).
  Stage III
  The cancer has spread through the bladder wall to surrounding tissue.
• Stage IV
  If bladder cancer has reached this stage, lymph nodes, bones, and other organs (liver, lungs) are already affected by metastases.