How Is Bladder Cancer Diagnosed?

Diagnosing bladder cancer is a process that involves multiple steps. Many patients diagnosed with bladder cancer experience symptoms related to urination— visible blood in the urine is the most common symptom—and visit their primary healthcare provider to have their symptoms checked. Other patients have not noticed symptoms, but their healthcare provider finds a sign of bladder cancer during a routine check-up and carries out further testing.

Should I be screened for bladder cancer?

Screening involves testing a patient for a condition even if the patient has no symptoms.¹ Bladder cancer screening is not routinely recommended for the general public. However, some healthcare providers may recommend screening for patients who have a high risk of bladder cancer, such patients who have already had bladder cancer, who have certain bladder-related birth defects, or who are exposed to specific types of toxic substances in the workplace.

What are first steps in diagnosing bladder cancer?

The first step in diagnosing bladder cancer usually involves a visit to a primary healthcare provider about symptoms a patient has had, such as blood in the urine.² The healthcare provider will typically ask about the patient’s symptoms and general health habits, as well as asking about risk factors for bladder cancer, such as smoking or a family history of bladder cancer.

The healthcare provider usually performs a physical examination to check the patient’s overall health and to find out if some other health condition may be causing the symptoms. The physical exam may include a digital rectal exam (for men and women) or a pelvic exam (for women) to check for signs of cancer or other health conditions.

How are urine tests used to detect cancer?

Patients with symptoms that may be caused by bladder cancer are usually asked to provide a urine sample for testing in the laboratory.³ The results of the test can indicate if there is blood or other contents in the urine (urinalysis testing), as well as indicating if the symptoms may be caused by a urinary tract infection (urine culture testing). Other types of urine testing can be used to check for the presence of cancer or pre-cancer cells (urine cytology testing), or for the presence of substances that are often associated with cancer cells (urine tumor marker testing).

What procedures are used to diagnose bladder cancer?

Based on the results of the physical examination and urine laboratory testing, healthcare providers may recommend that patients undergo procedures that can be used to help make a diagnosis of bladder cancer or to rule out bladder cancer as the cause of the patient’s symptoms.²

Some of these procedures include physical examination of the patient’s bladder while the patient is under anesthesia, cystoscopy, and transurethral resection of bladder tumor (TURBT). Cystoscopy involves inserting a very thin, flexible tube, with a tiny camera on the end of it, into the patient’s bladder to examine the bladder’s inner lining.

If signs of cancer are found, then a procedure called transurethral resection of bladder tumor can be used to take samples of tissue from the bladder to be further analyzed in the lab to confirm a diagnosis of bladder cancer.

How are imaging tests used to diagnose and detect cancer spread?

If the results of the diagnostic examinations, tests, and procedures have resulted in a diagnosis of bladder cancer, then healthcare providers may recommend different types of imaging tests to learn more about the patient’s bladder cancer and to help find out if the cancer has spread to other parts of the body.^2-4

Imaging tests use technology to capture images of the inside of the body. Imaging techniques that can be used to help diagnose and stage bladder cancer include:

• Intravenous pyelogram (IVP)
• Retrograde pyelogram
• Computed tomography (CT/CAT) scan
• Magnetic resonance imaging (MRI)
• Ultrasound

Imaging tests can also be used together with biopsies to find out if a patient has bladder cancer that has spread to other parts of the body, such as the liver, bones, or lungs.

What are the stages of bladder cancer?

A process called staging is used to describe a patient’s specific type of bladder cancer after diagnosis.⁵ This provides detailed information about the cancer and helps the patient’s cancer care team to determine the best possible treatment options.

There are five stages used to describe bladder cancers. The earliest stage is Stage 0 and the most advanced stage is Stage IV:

• Stage 0: cancer cells have grown in the bladder lining
• Stage I (1): cancer cells have grown through the bladder lining into connective tissue
• Stage II (2): cancer cells have grown into the muscle layer of the bladder wall
• Stage III (3): cancer cells have spread beyond the bladder muscle
• Stage IV (4): cancer cells have spread beyond the bladder and into other areas