Which tests are performed in the diagnosis of bladder cancer?

Updated: Feb 23, 2021
  • Author: Kara N Babaian, MD, FACS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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The following studies are used in the diagnosis of bladder cancer:

  • Urinary cytology
  • Urinary tract imaging
  • Cystoscopy
  • Histologic examination of specimens obtained by transurethral resection of the bladder tumor (TURBT)

For diagnostic evaluation of muscle-invasive bladder cancer (MIBC), EUA guidelines recommend the following [144] :

  • In patients with confirmed MIBC, use computed tomography (CT) of the chest, abdomen, and pelvis as the optimal form of staging.
  • For upper tract evaluation and for staging, perform CT urography; use diagnostic ureteroscopy and biopsy only in cases where additional information will impact treatment decisions.
  • Use magnetic resonance urography when CT urography is contraindicated for reasons related to contrast administration or radiation dose.
  • Use CT or magnetic resonance imaging (MRI) for staging locally advanced or metastatic disease in patients in whom radical treatment is considered.
  • Use CT to diagnose pulmonary metastases. CT and MRI are generally equivalent for diagnosing local disease and distant metastases in the abdomen.

Novel molecular and genetic markers have been studied for the diagnosis of urothelial carcinoma (see Urine Tumor Markers in Bladder Cancer Diagnosis) but have not been shown to effectively replace urine cytology and cystoscopy. The AUA and EAU do not currently recommend the use of urinary tumor markers during initial hematuria workup due to high cost and poor specificity. However, urinary tumor markers can be used in addition to cystoscopy and cytology in patients undergoing surveillance for bladder cancer. [64]  The NCCN guidelines advise that urinary biomarker testing with US Food and Drug Administration (FDA)–approved fluorescence in situ hybridization (FISH) or nuclear matrix protein 22 (NMP-22) assays may be used in the monitoring or surveillance for bladder cancer recurrence. [1]

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