How Doctors Diagnose Bladder Cancer

Medically Reviewed By William C. Lloyd III, MD, FACS

Written By Sarah Lewis, PharmD on March 26, 2021

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  What to Expect With Bladder Cancer Diagnostic Tests

  If your doctor suspects you may have bladder cancer based on your signs and symptoms and other factors, specific bladder tests and procedures are necessary to confirm a bladder cancer diagnosis and rule out other possible causes. About half of bladder cancer cases are diagnosed in the early stages, when cancer is most treatable. From discussing your symptoms with your doctor to preparing for medical procedures, knowing what to expect can help you prepare for the possible results and next steps.
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  Medical History

  To diagnose bladder cancer, your doctor will start with a medical history. Your doctor will review your risk factors and ask about your symptoms. This includes urinary symptoms, such as blood in the urine, frequent or urgent urination, pain or burning with urination, and trouble urinating. Be sure to mention any other symptoms you are having, such as appetite loss, fatigue, or weight loss.
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  Physical Exam

  A physical exam lets your doctor look for signs of bladder cancer or other problems. For men, this may include a digital rectal exam, or DRE. Women may need a pelvic exam as well as a DRE. Your doctor may be able to feel bladder tumors on these exams. They can also identify other problems with a man’s prostate or with a woman’s reproductive organs that can cause urinary symptoms.
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  Urine Tests

  Your doctor will likely order urine tests, especially if you are having urinary symptoms. Testing your urine can help rule out other conditions with similar symptoms, such as a urinary tract infection (UTI). Typically, testing will include a urinalysis and urine culture to see if UTI is the cause. The lab may look at a urine sample under a microscope to see if cancer cells are present. Urine tests can also look for tumor markers—substances cancer cells release into the urine.
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  Cystoscopy

  Cystoscopy involves inserting a thin fiber-optic tube into your urethra and bladder. Your doctor will numb your urethra so you are comfortable. In some cases, you will have a general anesthetic to put you to sleep during the procedure. Your doctor examines the lining of the bladder and takes a biopsy if necessary. Sometimes, doctors use a light-activated drug to help identify cancerous cells. This is fluorescence cystoscopy, or blue light cystoscopy.
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  Biopsy

  A biopsy removes a small tissue sample, and then a pathologist examines the sample and runs tests on it. Taking a biopsy is the only way to know for sure if cancer is present. Your doctor will take a biopsy if cystoscopy shows something suspicious. The procedure for removing the sample is transurethral resection of bladder tumor (TURBT). It does not require an incision in your belly. Your doctor will use the same instrument—a cystoscope—as for the cystoscopy. Sometimes, the doctor can remove the entire tumor during TURBT. The pathologist still analyzes a sample of the tumor because the information can help determine what treatments offer the best chance of success.
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  Imaging Exams

  If a biopsy confirms bladder cancer, your doctor will order imaging exams. This includes special X-rays of the urinary tract, such as an intravenous pyelogram (IVP) and retrograde pyelogram. An IVP is the more common test. Your doctor injects a dye into a vein to better view the urinary tract. The dye circulates through your blood vessels and collects in your kidneys, ureters and bladder before your body expels it in urine. Your doctor may also need a CT scan, MRI, ultrasound, chest X-ray, or bone scan. These exams help your doctor determine whether cancer has spread and how far.
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  What Happens Next

  Your doctor will use all of this information to make a complete diagnosis, including the stage of the bladder cancer. Staging helps your doctor plan your treatment and predict how successful it will be. The size and aggressiveness of the cancer and your overall health can also affect your doctor’s treatment recommendations. Ask your doctor to explain all the factors influencing your treatment options. Together, you can decide on the best approach for you.

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