How to diagnose bladder cancer

Bladder cancer refers to the malignant overgrowth of cells in the bladder. Do you know how to diagnose bladder cancer? Next, I will share with you the diagnosis method of bladder cancer.

How to diagnose bladder cancer

1. Ultrasound examination

Ultrasound examination can be performed through three routes (transabdominal, transrectal, and transurethral), and can simultaneously examine the kidneys, ureters, prostate, and other organs (such as the liver, etc.). Transrectal ultrasound shows the bladder trigone, bladder neck, and prostate more clearly. Transurethral ultrasound is not widely used and requires anesthesia, but the image is clear and the staging accuracy is high. Foreign reports on transurethral ultrasound determination of tumor staging and compared with pathological staging showed that the accuracy of non-muscle-invasive tumors was 94%-100%, and the accuracy of muscle-invasive tumors was 63%-96.8%. Color Doppler ultrasound can also show blood flow signals at the base of the tumor, but the blood flow signs of bladder tumors are not very helpful for preoperative tumor staging and grading. Ultrasound examination can not only detect bladder cancer, but also help staging bladder cancer and understand whether there is local lymph node metastasis and invasion of surrounding organs. It is especially suitable for those who are allergic to contrast agents.

2. Urinary system plain film and intravenous urography (KUB+IVU)

Urinary system plain film and intravenous urography have always been considered routine examinations for bladder cancer patients. This examination can evaluate the urinary tract from both morphological and functional aspects. For bladder cancer patients, it is mainly to understand and discover coexisting upper urinary tract tumors. However, the necessity of this examination in the initial diagnosis is currently questioned because it obtains less important information.

3. CT examination

Conventional CT (plain scan + enhanced scan) has a certain value in diagnosing bladder tumors. It can detect larger tumors and distinguish them from blood clots. Although the resolution of spiral CT has been greatly improved, smaller tumors (such as <5mm) and carcinoma in situ are still not easy to detect. The condition of the ureter cannot be understood, the staging accuracy is not high, and enlarged lymph nodes cannot be distinguished as metastasis or inflammation. It cannot accurately distinguish whether the tumor is confined to the bladder or invades outside the bladder. In addition, patients with a history of tumor resection may have an over-staging due to the illusion caused by local inflammatory reactions. CT examination can be performed if cystoscopy finds that the tumor is solid (without pedicles), there is a possibility of infiltration into the muscle layer, or to understand whether there are lesions in the liver.

4. MRI

Conventional MRI has no obvious advantages in the examination of bladder cancer. MRI examination can understand the spread of tumors to adjacent fat, lymph node metastasis, and bone metastasis, and can even evaluate the invasion of adjacent organs other than the prostate. It is helpful for tumor staging. Dynamic MRI is more accurate than CT or non-enhanced MRI in showing whether urothelial carcinoma exists and the degree of muscle layer invasion.

In terms of staging, the use of enhancement agents for MRI examinations can distinguish between non-muscle-invasive tumors and muscle-invasive tumors and the depth of invasion, and can also detect whether normal-sized lymph nodes have metastatic signs. The use of iron as an enhancement agent can identify whether lymph nodes have metastases. The sensitivity of MRI in detecting bone metastasis is much higher than CT, and even higher than radionuclide bone scanning.

5. Bone scan

It is not generally used routinely. It is only used when patients with invasive tumors have bone pain and suspected bone metastasis.

Early symptoms of bladder cancer

1. Frequent urination and urgency

If cancer cells invade the trigone of the bladder, irritation of the bladder may occur earlier, and if urination pain occurs, it is no longer in the early stage. If urination pain suddenly occurs for unknown reasons, it is a symptom of early bladder cancer.

2. Bladder irritation symptoms

The infiltration of the tumor itself, ulceration, necrosis, infection and blood clots of cancerous tissue can all become stimuli that cause the bladder muscles to contract and produce the urge to urinate; frequent urination (8%), urgency (8%), pain when urinating (5%) and persistent feeling of urinating, persistent distension and pain in the waist, and urinary incontinence occur when the tumor invades the sphincter.

3. Symptoms of upper urinary tract obstruction

When the tumor invades the ureteral orifice, it causes the renal pelvis and ureteral orifice to expand and accumulate water, or even become infected, causing varying degrees of backache, back pain, fever, etc. If both sides of the ureteral orifice are invaded, symptoms of acute renal failure may occur.

4. Lower abdominal mass

About 3% of patients have this as the first symptom of bladder cancer, most of which are adenocarcinomas at the top of the bladder or solid bladder cancers with high malignancy in other parts. Rectal (or vaginal) digital examination or dissection of uneven masses can be used to understand the scope and depth of tumor infiltration into the bladder wall, which is helpful for tumor staging estimation.