What Tests Determine Cancer Spread?

Reviewed by: HU Medical Review Board | Last review date: September 2017.

When a patient is diagnosed with bladder cancer, healthcare providers may carry out further tests to find out if the bladder cancer cells have spread to other organs or parts of the body.1,2 Bladder cancer that has spread (metastasized) is called metastatic bladder cancer. Healthcare providers usually use a combination of imaging tests and biopsies to examine the patient and check for signs that the cancer has metastasized.

Whether bladder cancer spreads to other parts of the body depends on many factors, including the type of cancer cells involved and how much the bladder cancer has grown before it was diagnosed.

Where can bladder cancer spread?

Bladder cancer can spread through the tissue to nearby organs, such as the prostate (men) or vagina (women). It can also spread through the lymph system, by traveling through lymph vessels to lymph nodes in different parts of the body. It can also spread through the body’s blood vessels and form tumors in other parts of the body, such as the bones or lungs.

Imaging tests to determine if cancer has spread

Healthcare providers may use imaging tests to look for signs that the bladder cancer has spread.1-3

Intravenous or retrograde pyelograms

For example, intravenous or retrograde pyelograms are types of x-rays that use a special dye to highlight the organs of the urinary tract. This can make it possible to detect cancer that has spread to the kidneys, ureters, or other parts of the urinary tract. If healthcare providers suspect that the bladder cancer may have spread to the patient’s lungs, then a chest x-ray may be used.

CT scans

Computed tomography (CT or CAT) scans use computer technology to combine multiple x-rays into a more detailed, three-dimensional image of the inside of the body. To check if bladder cancer has spread, CT scans may be used to create images of the entire urinary tract (including the kidneys) as well as lymph nodes, other organs in the abdomen, and the lungs.


Magnetic resonance imaging (MRI) scans use magnetic fields and radio waves to create detailed pictures of the inside of the body. They can also be used to see if bladder cancer has spread to any other organs in the body. An ultrasound uses sound waves to create a picture of the inside of the body, which can be used to see if bladder cancer has spread to the kidneys or areas near the bladder.

Bone scan

A bone scan is a procedure that is used to check whether bladder cancer has spread to the bones. This is usually recommended for patients who are experiencing bone pain or other signs that cancer may have spread to the bones. During the procedure, a patient receives an injection of a small amount of radioactive substance, which is absorbed by areas of bone that may be damaged by cancer or some other cause. A camera is used to detect any areas that may be damaged, and other types of imaging can be used to examine the area more closely for signs of cancer.

Biopsies can confirm if cancer has spread

If imaging shows that there are tumors in other organs, for example, then biopsies can be used to confirm the diagnosis.1,2 Biopsies are small samples of tissue taken from the body and then analyzed in a laboratory to check for the presence of cancer cells.

How are biopsies taken?

In some cases, biopsies are taken during surgical procedures, such as transurethral resection of bladder tumor (TURBT). In other cases, healthcare providers can use a needle to take a biopsy without requiring surgery. Imaging technology can be used to help make a needle biopsy more precise. For example, CT-guided needle biopsy can be used to help a healthcare provider guide the needle into other organs or parts of the body where cancer might have spread. Ultrasound imaging can also be used to help take a needle biopsy from the pelvis or abdomen.

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