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Special Focus on Bladder Cancer – Part 3: Diagnosis

A general practitioner might suspect a person of having bladder cancer if they have some of the symptoms of bladder cancer or if something suspicious shows up during an assessment. Symptoms of bladder cancer can include blood in the urine (hematuria), frequent need to urinate, an intense need to urinate, trouble urinating, and burning sensation or pain during urination. People may not experience any symptoms during the early stages of bladder cancer.

I consider myself very lucky, because I had a proactive family doctor who referred me to a urologist even though there weren't many signs of bladder cancer.

Anonymous, bladder cancer survivor

Late signs and symptoms develop as the cancer spreads to other parts of the body. These symptoms include the following:

  • loss of appetite;
  • weight loss;
  • anemia;
  • fever;
  • change in bowel habits;
  • pain in and around the rectum, anus, pelvis and pubic bones;
  • lump in the pelvis; and
  • swelling in the legs, scrotum or vulva.

 

It is important to remember that other health conditions can cause symptoms similar to those of bladder cancer, so appropriate diagnostic tests must be done to rule out other reasons for a health problem before making a bladder cancer diagnosis.

I would have liked to been able to talk to someone who had bladder cancer, [but] no forums or support groups were available when I was first diagnosed in 2005.

Anonymous, bladder cancer survivor

 

To gather additional information, a doctor may collect a more focused history from the person and perform a physical exam focused on areas of concern. In addition, the following tests are usually needed to confirm whether or not a person has bladder cancer.

  • Cystoscopy: cystoscopy allows doctors to look inside the urinary tract through the use of an endoscope. During this procedure, doctors can examine the bladder for any abnormalities, take samples for biopsy and remove small tumours. In some cases, a dye called porphyrin and blue light may be used to help make cancer cells more visible.
  • Urinalysis and urine culture: urine colour, content and appearance are examined for abnormalities during urinalysis. If blood is found, it may be indicative of either an infection or cancer along the urinary tract. To rule out infection as the potential diagnosis, a urine culture is completed. This test involves collecting and incubating urine samples for several days before using microscopic examination to see if any bacteria are present.
  • Urine cytology: this test involves looking at the cells in urine collected from the bladder, kidneys and ureters to determine if there is any abnormal cell growth. Cells that are examined can be collected during a cystoscopy or from a urine sample.

My family doctor kept treating me for a urinary tract infection. I don't think I would have got a referral [to] a urologist if I didn't ask.

Anonymous, bladder cancer survivor

 

Before people receive a diagnosis, they typically will be referred to a specialist (a urologist) to help with the diagnostics. Cancer Care Ontario recently released its pathway map for bladder cancer, which begins with a person’s journey through the diagnostic phase of care with bladder cancer. For more information on the bladder cancer pathway map, see the Bladder Cancer Diagnosis, Treatment & Follow-up Care Pathway Map.

Although little is known about the personal experience of people diagnosed with bladder cancer, a recent systematic review based in the United Kingdom highlights some of the first-hand experiences faced by people with bladder cancer. Many of them experienced initial feelings of frustration as their symptoms were minimized and often misdiagnosed; after diagnosis, those feelings were replaced by fear, shock and devastation [1]. About half of respondents reported that they did not have an active role in decisions regarding treatment after their diagnosis, but these respondents did not see this as an area of concern. Despite this, open communication during the treatment process was noted as being important [1].

We were fortunate that his general practitioner did not think it was just another bladder infection. Most practitioners will think bladder infection and put people on a course of antibiotics, delaying the whole diagnostic process

Anonymous, family member

 

Appropriate testing

As with other medical conditions, it is necessary to ensure that people undergoing a diagnosis for a bladder issue are receiving appropriate testing in a timely manner. Given the similarity of symptoms for bladder cancer and urinary tract infections (UTIs), initial misdiagnosis can occur: a study based in Austria and Italy found that 14.6% of men and 26.3% of women were treated for a UTI 1 or 2 times before being treated for bladder cancer [2].

There are currently no appropriate screening tests that can be used to detect bladder cancer prior to the development of signs or symptoms. However, researchers globally are working to identify urine markers that could be used to detect bladder cancer.

Overall, there is a need to ensure the timely diagnosis and treatment of bladder cancer through the use of appropriately timed testing to enhance patient outcomes. For example, a study from the United Kingdom identified that women with a lower socioeconomic status are typically diagnosed with a more advanced stage of bladder cancer. This trend may be due to faster growing tumours or delays in diagnosis and subsequent treatment among this population (the latter being the more probable). For that reason, it is essential that all individuals receive appropriately timed testing [3].

What I would like to see change is that when a female has blood in [her] urine, it is not treated as a recurring infection. Diagnosis for females is delayed because of the lag time from when they first show symptoms to when they see a urologist.

Anonymous, bladder cancer survivor

 

Staging

If someone is diagnosed with bladder cancer, the next step is to determine the stage of the cancer. Staging describes how far a cancer has progressed, based on the size of the tumour, the extension of the original tumour and how far it has spread in the body. Knowing the stage of the disease, along with the type of bladder cancer, helps physicians plan appropriate treatment and determine its likely outcome or course. For more information on cancer staging, see “Reporting of Cancer Stage at Diagnosis.”

Based on several studies, roughly 30% to 50% of people with bladder cancer are under-staged at the time of cystectomy. This means that the individual is diagnosed with a less advanced stage of bladder cancer than they actually have. In many cases, under-staging has been tied to a decreased 5-year overall survival rate [4].

The evolution of screening and awareness regarding [bladder cancer] has changed so much in the last 15 years. There should be more awareness of the risks and possible symptoms of bladder cancer, because early diagnosis is very important for this particular disease site.

Anonymous, family member

Notes

  1. Edmondson AJ, Birtwistle JC, Catto JW, Twiddy M. The patients’ experience of a bladder cancer diagnosis: a systematic review of the qualitative evidence. J Cancer Surviv. 2017;11(4):453–461.
  2. Henning A, Wehrberger M, Madersbacher S, Pycha A, Martini T, Comploj E, et al. Do differences in clinical symptoms and referral patterns contribute to the gender gap in bladder cancer? BJU Int. 2013;112(1):68–73.
  3. Moran A, Sowerbutts AM, Collins S, Clarke N, Cowan R. Bladder cancer: worse survival in women from deprived areas. British J Cancer. 2004;90(11):2142–4.
  4. Jacobs BL, Lee CT, Montie JE. Bladder cancer in 2010: how far have we come? CA Cancer J Clin. 2010;60(4):244–272.