This page was reviewed under our medical and editorial policy by
Maurie Markman, MD, President, Medicine & Science
This page was updated on May 18, 2022.
A thorough and accurate diagnosis is the first step in developing a bladder cancer treatment plan. Bladder cancer experts use a variety of tests and tools for diagnosing this disease and developing a customized treatment strategy for each patient. Throughout treatment, imaging and laboratory tests are used to track the size of the tumor(s), monitor the response to treatment. and modify the treatment plan when needed.
Doctors may suspect cancer if a patient has bladder cancer symptoms such as blood in the urine or pain when urinating—or if lab tests done for another reason show abnormal results.
To find bladder cancer, doctors may run tests to see whether there are certain substances—such as blood—in the urine. Tests may include:
For patients who have symptoms or have had bladder cancer in the past, newer tests that look for tumor markers in urine may include:
Researchers don’t know yet whether these tests are reliable enough to be used for screening, but they may help find some bladder cancers.
Most doctors recommend a cystoscopy to find bladder cancer, and it’s often performed without anesthesia. During this procedure, the doctor inserts a long, thin tube with a camera into the urethra to see the inside of the bladder for growths and collect a tissue sample (biopsy). The tissue is studied in a lab to search for cancer and obtain more information. During a cystoscopy, doctors may also perform a fluorescence cystoscopy, or blue light cystoscopy, inserting a light-activated drug into the bladder to see whether any cancer cells glow when they shine a blue light through the tube.
Doctors may also order imaging tests to see whether the cancer has spread. The most common imaging tests include the following.
Magnetic resonance imaging (MRI) uses magnets and radio waves to take pictures of the inside of the body. Before the test, a contrast medium (dye) is administered orally or by injection to help make the scan clearer.
Computed tomography (CT) scan uses X-rays to take pictures of the inside of the body. The patient may get a contrast medium injected into a vein to make the scan clearer.
Ultrasound uses sound waves to take pictures of the inside of the body.
While working to get a full picture of the diagnosis, doctors may order a transurethral resection of bladder tumor (TURBT), a surgery to remove the tumor and muscle near it for testing. This procedure helps provide more details about the type of tumor, how deeply it’s grown into the bladder and other important factors that may help determine treatment.
Two important pieces of information to know about this specific cancer are its invasiveness and grade.
Invasive and high-grade cancers may be harder to treat than noninvasive and low-grade ones. They may also require a different kind of treatment.
It’s also important to know the stage of bladder cancer, or how much the cancer has spread. If the cancer has spread to other parts of the body, it’s called metastatic.
Invasiveness describes how deep the cancer is in the bladder wall, which is crucial to determining treatment. If the cancer is in the inner cell layers, it’s noninvasive or superficial. If it’s grown into deeper bladder layers or spread to other organs or lymph nodes, it’s invasive.
Grade describes how bladder cancer cells look under a microscope. Low-grade cancers, also called well-differentiated cancers, resemble regular bladder cells. High-grade, poorly differentiated or undifferentiated cancers don’t look as much like normal bladder cells, and they’re more likely to become invasive or spread to other body parts.
There isn’t a test yet that is able to screen the general population for bladder cancer. Doctors may recommend specific tests to screen for bladder cancer based on known risk factors.
Because bladder cancer causes urinary symptoms such as blood in the urine, it may be found early. However, because blood in urine is caused by a lot of conditions other than cancer, urinalysis isn’t a useful screening test for the general population.