Bladder Cancer: Diagnosis

How is bladder cancer diagnosed?

If your healthcare provider thinks you might have bladder cancer, you’ll need certain tests and scans to be sure. Diagnosing bladder cancer starts with your healthcare provider asking you questions. You'll be asked about your health history, symptoms, risk factors, and family history of disease. A physical exam, which may include a rectal or vaginal exam, will be done. This is done to check for tumors that are large enough to be felt.

What tests might I need?

You may get one or more of these tests:

• Urinalysis and urine culture

• Urine cytology test

• Urine tests for bladder cancer tumor markers

• Cystoscopy

• Intravenous pyelogram (IVP)

• CT scan

• Bladder biopsy

Urine tests

Urinalysis and urine culture

This test is done to look for signs of infection or other problems that may be causing your symptoms. You'll need to urinate in a cup for this test. Then your urine is sent to a lab to be tested for blood, certain chemical levels, and signs of infection. The urine is also cultured to see if organisms, such as bacteria, grow. It takes a few days for the test results to come back.

Urine cytology test

For this lab test, your urine is looked at with a microscope. The cells are checked to see if any of them look like cancer or pre-cancer cells.

Urine tests for bladder tumor markers

These tests are used to look for markers or substances that bladder cancer cells make and release into your urine.

Imaging tests

Cystoscopy

This procedure lets your healthcare provider look at the inside of your bladder. It’s the best test for diagnosing bladder cancer.

A very thin, flexible tube is slid through your urethra into your bladder. The tube (called a cystoscope) has a tiny camera and light in it. Saltwater is put into your bladder through this same tube. This fills your bladder so your healthcare provider sees the inside wall or lining. If a change is seen that looks like it might be cancer, a tiny piece may be taken out through the tube and sent for testing. Your provider may also take a urine sample with a bladder wash during a cystoscopy. This is when the saltwater is removed, saved, and checked for cancer cells.

Intravenous pyelogram (IVP)

In this test, a dye is put into your blood through a vein in your arm or hand. As the dye moves through and outlines your kidney, ureters, and bladder, a series of X-rays is taken.

This test is used to find things like tumors, kidney stones, or any blockages. It’s also used to measure blood flow through your kidneys. This test can help to rule out other diseases or check for cancer in other parts of the urinary tract.

CT scan

A CT scan uses a series of X-rays to make pictures of the inside of your body from many angles. CT scans are more detailed than regular X-rays. A CT scan of the abdomen and pelvis may be used to check for bladder cancer.

During the test, you lie still on a narrow table as it slides through the center of the ring-shaped CT scanner. Then the scanner sends beams of X-rays to your body. A computer uses the X-rays to create many pictures of the inside of your body. These are put together to create a 3-D picture. You may be asked to hold your breath once or more during the scan. You may be asked to drink a contrast dye after the first set of pictures is taken. This dye can help get clearer images. It will pass out of your body over the next day or so through your bowel movements. If the dye is put into your blood through an IV (intravenous) line in your arm, it may cause a feeling of warmth in your body for a few minutes. In rare cases, it can also cause hives or other allergic reactions. Tell the technician if you don’t feel well during the test.

Bladder biopsy

A biopsy is a tiny piece (called a sample) of cells and tissue. A bladder biopsy is often done during a cystoscopy. If your healthcare provider sees something that looks like cancer, a small sample of that tissue can be removed.

Any removed tissue is sent to a special healthcare provider called a pathologist. This provider looks at the tissue under a microscope and does tests on it to check for cancer.

If there is cancer, the biopsy can help tell whether it's just on the inner lining of the bladder or if it’s gone into the deeper layers of the bladder wall.

It takes several days for biopsy results to come back. A biopsy is the only sure way to know if you have cancer and what kind of cancer it is.

Getting your test results

When the results of your biopsy are back, your healthcare provider will contact you. Your provider will talk with you about other tests you may need if bladder cancer is found. Make sure you understand the results and what follow-up you need.