Bladder Cancer Diagnosis

If you have symptoms, your doctor is likely to run some urine and blood tests. If the tests come back abnormal, your doctor will need to find out if cancer is present. A urologist is the most common type of specialist to help identify the cause of your symptoms. They will:

• Ask about your personal and family medical history to learn more about your symptoms and possible risk factors for bladder cancer.
• Run urine and blood tests again, or possibly additional tests that weren’t run before, to be sure the first tests were accurate. 
• Possibly look inside your bladder with a cystoscope. This is a lighted instrument that allows the doctor to see inside the bladder and check for any growths or other conditions that could be causing symptoms. A blue light cystoscopy may be used if they specifically suspect cancer. With this process, a light-activated drug is put into the bladder which is taken up by cancer cells, if present. When the urologist shines a blue light through the cystoscope, any cancer cells containing the drug will glow (fluoresce). This allows the doctor to see more than they can with regular white light.

If during the cystoscopy the urologist notes areas that look abnormal, it’s likely that a biopsy will be performed. It can be done right away or scheduled in the near future. The biopsy for the bladder is called a transurethral resection of bladder tumor (TURBT). The urologist will remove the area that looks abnormal along with some of the bladder muscle to be tested for cancer. 

If bladder cancer is detected, more tests are needed to see if it’s spread outside of the bladder. These can include some or all of the following:

• Intravenous pyelogram (IVP): A series of x-rays of the kidneys, ureters, and bladder to find out if cancer is present in these organs. A contrast dye is injected into a vein. As the contrast dye moves through the kidneys, ureters, and bladder, x-rays are taken to see if there are any blockages.
• CT scan (CAT scan): A procedure that takes pictures of the inside of the body using x-rays taken from different angles. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
• MRI: This can be used to see if the cancer has spread to the lymph nodes or soft tissue outside of the bladder.
• Ultrasound: Sometimes used to look at the size of the bladder, the shape of the tumor and to look at the kidneys for signs of cancer.
• Chest x-ray: If there is reason to believe the cancer has spread outside of the bladder, your chest area will be x-rayed to see if the cancer has spread there.
• Bone scan: To determine if cancer has grown into the bones.

After your diagnostic tests have been completed, your oncologist will review the results with you. If the diagnosis is cancer, the next step will be to determine its extent (stage). Learn about staging.