Diagnosis & staging
The bladder has many layers lining it. The deeper the cancer has grown into these layers, the harder the cancer is to treat and the greater the chance of it spreading.
Urothelial cells (also known as the urothelium transitional cells) line the inner surface of the bladder. This lining begins in the kidneys and goes through the ureters towards the bladder. The ureters connect the kidneys to the bladder.
Urine exits the body through a tube called the urethra. The urethra is also lined with urothelial cells.
In people with a prostate, the urethra goes through the prostate gland. In people with a vagina, the urethra is within the vaginal wall.
Cancer of the urothelial cell is the most common type of bladder cancer. This is also called urothelial cancer. 90% (90 out of 100) of bladder cancer cases are urothelial cancers.
Some symptoms of bladder cancer are also symptoms of a bladder infection. This can be confusing and may delay a diagnosis.
Symptoms of bladder cancer may include:
- Blood in your urine. You may see this when you urinate (go pee), or it may only be seen under a microscope. Even if this only happens one time, it may still be a sign. This is called hematuria.
- If you have blood in your urine, the colour of your urine may be smoky, rusty, bright red or deep red.
- Having to urinate more often.
- Pain in your bladder or when you urinate.
- Needing to urinate urgently (feeling as if you have to go right away and cannot hold it in).
- If the cancer is advanced, symptoms include weight loss, loss of appetite, weakness and general discomfort.
If you have any signs or symptoms that you are worried about, please talk to your family doctor or nurse practitioner.
These are tests that may be used to diagnose bladder cancer:
- Vaginal or rectal exam: a doctor or nurse practitioner examines the vaginal area or rectal area.
- Urinalysis: a lab test where your urine is looked at under the microscope to check for blood or cancer cells.
- Urine cytology: cells in your urine are examined. These are cells from your bladder wall or tumour.
- Cystoscopy: a cystoscope (thin tube with a camera and light on the end) is put up your urethra and into your bladder. A doctor uses it to examine your bladder and can also use it to take small samples of tissue. Some cancers can be partly or totally removed using a cystoscope.
- Biopsy: a small amount of tissue is removed. A specialist (pathologist) will examine the tissue.
- IVP (intravenous pyelogram): a special dye is injected into your bloodstream. The dye goes into your urine and allows your doctor to see your urinary system with an x-ray machine.
- Computed tomography (CT scan): used to see the tumour and if cancer has spread.
The most common type of bladder cancer is urothelial (transitional cell) cancer.
- Squamous cell carcinomas
- Mixed cell
- Superficial: cancer is only in the lining of the bladder. It is early stage and has not spread outside the lining.
- Invasive: cancer has invaded (spread deeper into) the bladder wall.
- Low grade: usually grow slowly and are less likely to spread. Cancer cells look different but are arranged a lot like normal cells.
- High grade: usually grow more quickly and more likely to spread. Cancer cells do not look normal and are not arranged like normal cells.
Superficial papillary tumours are only in the lining of the bladder. They are usually low grade.
Carcinoma in situ is a superficial high grade disease. It is more likely to be aggressive. It can be treated but if the treatments are not working, a cystectomy (removing the bladder) may be needed.
Staging describes the cancer. Staging is based on how much cancer is in the body, where it was first diagnosed, if the cancer has spread and where it has spread to.
The stage of the cancer can help your health care team plan your treatment. It can also tell them how your cancer might respond to treatment and the chance that your cancer may come back (recur).
- Stage 0: Tumour is only in the lining of the bladder.
- Stage 0A: also called non-invasive papillary carcinomas. Tumour looks like a mushroom.
- Stage 0is: also called carcinoma in situ. Tumour is flat.
- Stage 1: Tumour has grown into the connective tissue later of the bladder.
- Stage 2: Tumour has grown into the muscle layer of the bladder.
- Stage 3A: One of the following:
- Tumour has grown into nearby tissues outside of the bladder but has not grown into the pelvic wall or abdominal wall.
- Cancer has spread to one lymph node in the pelvis.
- Stage 3B: Cancer has spread to two or more lymph nodes in the pelvis or to one or more common iliac lymph nodes (just above the pelvis).
- Stage 4A: Tumour has grown into the pelvic wall or abdominal wall.
- Stage 4B: Cancer has spread to other parts of the body (distant metastasis), such as the lungs, liver or bone. This is called metastatic bladder cancer.
The grade of the cancer describes how different the cancer cells look from normal cells and how fast the cancer cells are growing. A pathologist will give the cancer a grade after looking at the cells under a microscope.
Bladder cancer can be grade 1, 2 or 3. The lower the number, the lower the grade.
Low grade: cells are abnormal but look a lot like normal cells. Low grade cancers usually grow slowly and are less likely to spread.
High grade: cells are abnormal and do not look like normal cells. High grade cancers usually grow more quickly and are more likely to spread.
grade of the cancer can help your health care team plan your treatment.