How We Diagnose Bladder Cancer

Beginning with your first appointment at the Lank Center for Genitourinary Oncology at Dana-Farber Brigham Cancer Center, you will be matched with specialists and researchers who study genitourinary cancers exclusively. We are home to the largest team of genitourinary specialists in the world, and are one of the few clinical centers globally with a team focused on genitourinary cancers. Our team is at the forefront of bladder cancer research, educating and improving the understanding of bladder cancer worldwide.

Finding the right team of pathologists and radiologists to manage your bladder cancer diagnosis is key to developing a successful treatment plan. Dana-Farber Brigham Cancer Center experts have built an extensive database of over 8,000 genitourinary cancer tissue samples used to study and diagnose your specific type of bladder cancer. Patients have the opportunity for tumor assessment using OncoPanel, a screening test that carefully identifies known and unknown genetic mutations. This means we can precisely identify genetic mutations and cellular patterns in the DNA of cancer cells, which in some cases allows us to tailor treatment specifically to your needs.

Diagnosing Bladder Cancer

Approximately 70 to 80 percent of patients with newly diagnosed bladder cancer have early-stage cases. When diagnosed and treated in the early stages, bladder cancer is generally highly treatable. However, if you have been diagnosed with bladder cancer at any stage, it's important to be treated as soon as possible. Early diagnosis can improve your chances for successful treatment and recovery.

Tests to Diagnose Bladder Cancer

If bladder cancer is suspected, these tests may be performed to diagnose the disease:

  • Physical exam
  • Blood test: Blood samples are used to measure certain substances released into the blood by organs and tissues in the body. An unusual amount of a substance (higher or lower than normal) can be a sign of disease in the organ or tissue that makes it.
  • Urine test: A test to check the color of urine and its contents, such as sugar, protein, red blood cells, and white blood cells.
  • Cystoscopy: One of the most useful tests, in which a tiny tube with a camera is inserted into the bladder through the urethra. The cystoscope can also be used to take a small tissue sample (biopsy) and treat early stage tumors without surgery. Cystoscopy is best used in combination with other tests to confirm early-stage or small tumors.
  • Biopsy: The removal of a small tissue sample for review under a microscope. This procedure is usually performed only if the tests above suggest bladder cancer.

Tests to Determine the Stage of Bladder Cancer

If bladder cancer is found after a biopsy or cystoscopy, tests may be conducted to determine if the cancer cells have spread beyond the bladder to other parts of the body. The process used to find out if, and how far, the cancer has spread is called staging. It is important to know the stage of the cancer — in other words, how far the cancer has progressed or is likely to progress — in order to plan treatment. The following tests and procedures may be used in the diagnostic and staging process:

  • PET/CT (CAT) scan of the abdomen or pelvis: A painless procedure in which a small amount of radioactive glucose (sugar) is injected into a vein, and a scanner is used to trace and create computerized pictures of the solution inside your body. The procedure has no side effects.
  • MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. The procedure is similar to a CT scan, except the MRI does not deliver radiation.
  • Bone scan: A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones and is detected by a scanner.

Stages of Bladder Cancer

The stage of bladder cancer is the most important factor in determining your treatment plan. These stages — or categories — are based on the size and spread of cancer beyond the bladder and into other places in the body (metastasis), such as the lymph nodes, blood, or other organs.

Cancer that is present only in the lining of the bladder is called superficial bladder cancer. Invasive bladder cancer begins in the cells that line the inside of the bladder, which proceed to invade the muscle wall (muscle-invasive) of the bladder or spread to nearby organs and lymph nodes (metastasized). Early-stage bladder cancer rarely grows into the muscular wall of the bladder, and rarely spreads.

  • Stage 0 indicates that abnormal cells are found in the tissue lining the inside of the bladder. These cells may become cancerous and spread, or they may not. This stage is considered superficial.
    • In Stage 0a (also known as papillary carcinoma), cells or lesions may look like tiny mushrooms growing from the lining of the bladder.
    • Stage 0is (also known as carcinoma in situ) is a flat tumor on the tissue lining the inside of the bladder.
  • In stage I, cancer cells have formed and spread to the layer of tissue under the lining of the bladder. Stage I is considered superficial.
  • Stage II means the cancer has spread to the wall of the bladder and into the muscle. This stage generally means the cancer is muscle-invasive and localized to the bladder.
  • Stage III indicates that the cancer has spread from the bladder wall to the muscle, as well to the fatty layer of tissue surrounding it. Stage III indicates muscle-invasive cancer, and may suggest the cancer has spread to the reproductive organs (prostate, uterus, or vagina).
  • In stage IV, the disease has spread from the bladder to the wall of the abdomen or pelvis. In this stage, the cancer may have spread to one or more lymph nodes or other parts of the body, as well. Stage IV is generally considered metastatic bladder cancer.

Classification of Bladder Cancer

Bladder cancer is also classified based on the type of cancer cells found in the tumor. The classification of your cancer cell type may also impact the type of treatment you receive. Unlike at other cancer centers, the bladder cancer team at the Lank Center has advanced skill and expertise in treating very rare or complicated cases. Cell types for bladder cancer include:

  • Transitional cell: About 90 percent of bladder cancers are transitional cell carcinomas, which means the cancer began in the cells that line the inside of the bladder. Cancer that is confined to the lining of the bladder is called non-invasive bladder cancer.
  • Squamous cell: This type of bladder cancer begins in squamous cells, which are thin, flat cells that may form in the bladder after long-term infection or irritation. These cancers are more rare than transitional cell cases, but they may also be more aggressive.
  • Adenocarcinoma: This is a rare type of bladder cancer that develops in the inner lining of the bladder as a result of chronic irritation and inflammation. This type of bladder cancer tends to be aggressive.

Second Opinions

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Consultations and Second Opinions

Our diagnostic team provides second opinions and we are happy to consult with you, your primary care physician, or other specialists. We are frequently asked for second opinions from oncologists all over the country. You may want to consider a second opinion:

  • To confirm your diagnosis
  • To have original biopsies or other tissue diagnosis confirmed
  • For details on the type and stage of cancer
  • To better understand your treatment options
  • To learn if you are eligible for clinical trials

Phone: 877-442-3324
Online: Complete the Appointment Request Form

Can't travel to Boston? Our Online Second Opinion service lets patients from all over the world receive expert second opinions from Dana-Farber oncologists.

For Referring Physicians

Because the patient's primary care physician or community specialist is an integral part of the patient's care team, we are committed to collaborating in the care of your patient.

If you are a physician and have a patient with bladder cancer, we look forward to working with you.

Find out more about how to refer a patient to Dana-Farber Brigham Cancer Center.

Find out about Physician Gateway, our portal that helps you keep track of patients you have referred for care. Physician Gateway is available for primary care providers, referring providers, and your authorized office staff.