Tests such as physical exams, urine tests, and imaging can help doctors diagnose bladder cancer. Doctors may also use a biopsy or cystoscopy to confirm a diagnosis.

The American Cancer Society predicts that around 82,290 people will receive a diagnosis of bladder cancer in 2023.

There is no standard screening test for bladder cancer. However, if a person has a high risk of this disease or has had the disease in the past, a doctor will recommend a routine test even if the person is not experiencing symptoms.

This article explains how medical professionals diagnose bladder cancer and the types of tests they use to do so. We also provide guidance about what to expect after a diagnosis, answers to frequently asked questions, and more.

A doctor examining an MRI scan to diagnose bladder cancer.Share on Pinterest

A person may receive a bladder cancer diagnosis after experiencing symptoms. Sometimes, doctors may find bladder cancer when performing a routine test for another reason.

If they suspect bladder cancer, a doctor may recommend urine tests, imaging tests, and cystoscopy. The results of these tests will help them determine whether a biopsy is necessary to confirm a diagnosis.

The doctor will also ask the person about their symptoms and medical history to help confirm a diagnosis. If they discover cancer, they may carry out more tests to determine the extent and stage of the cancer.

The following sections examine the main tests healthcare professionals may use to diagnose bladder cancer.

A doctor may ask a person to collect a sample of their urine for testing.

Using this sample, healthcare professionals may perform several types of tests in a lab:

  • Urine cytology: This involves looking for cancerous and precancerous cells in the urine. However, a negative result does not always guarantee that a person does not have cancer.
  • Urine culture: This shows signs of bacterial growth, such as fungi and yeast. It can help a doctor rule out conditions such as urinary tract infections.
  • Urine tumor marker tests: These tests look for specific substances cancer cells release that might indicate bladder cancer. There are multiple types of urine marker tests. A doctor will provide a person with more detail.

A cystoscopy is important in diagnosing bladder cancer.

In this procedure, a doctor uses a cystoscope to examine the inside of the urethra and bladder. A cystoscope is a narrow tube that contains a camera and lighting system to provide a complete view of the bladder.

Healthcare professionals can perform a cystoscopy in a doctor’s office. In more complex cases, a surgeon may do the procedure in a hospital, but a person will usually not need to stay overnight.

The person may receive a general or local anesthetic, so the procedure will be painless. They may be awake or unconscious. The surgeon will discuss this with the person beforehand.

During the procedure, the surgeon inserts a cystoscope into the urethra. They may fill the bladder with a saline solution to make it easier to see the inside.

They look for solid masses in the urethra, bladder, or ureters, as well as blockages and abnormal tissue.

During a cystoscopy, a doctor may find abnormal tissue in the bladder and perform a biopsy to determine whether the sample contains cancerous cells.

A biopsy involves taking a sample of tissue from the suspected tumor or abnormal tissue. A pathologist then looks at the tissue sample under a microscope to assess the presence or absence of cancer.

A biopsy can also help a doctor determine how advanced the cancer is. This information will guide treatment decisions.

After a biopsy, doctors may perform a surgical procedure called transurethral resection of bladder tumor.

They will remove any tumors and a portion of the surrounding tissue for biopsy and analysis. This test can confirm a bladder cancer diagnosis and check for tumor spread into the muscle layer of the bladder wall.

If bladder cancer is present, the results can show how deeply the cancer has grown into the bladder wall. This is very important, as invasive cancers are more likely to spread and need aggressive treatment.

The doctor will then assign the bladder cancer a grade. High grade cancers are more likely to grow faster and to spread outside the bladder.

If healthcare professionals do not diagnose bladder cancer early, cancerous cells may spread outside the bladder.

In such cases, doctors can use imaging tests after a diagnosis to check for enlarged lymph nodes and tumors in tissues and organs throughout the person’s body.

The following types of imaging tests can also provide information about the original tumor:

  • CT scan: A doctor can use a CT scan to look at a person’s ureters, bladder, kidneys, and nearby lymph nodes. This scan provides information about a bladder cancer tumor’s location, shape, size, and spread.
  • Intravenous pyelogram: A medical professional will inject X-ray dye into the bladder. This dye will outline the organs, making any tumors visible on an X-ray.
  • Ultrasound: A doctor can use an ultrasound to determine the size of any tumors and decide whether the cancer has spread beyond the bladder to nearby tissue or organs.
  • MRI scan: MRI scans use magnets to capture detailed images of soft tissues in the body. They can show how deep the tumor extends into the bladder and whether the cancer has spread into nearby tissues or lymph nodes.
  • Bone scan: If a person is experiencing bone pain, doctors may recommend a bone scan to find out whether cancer has spread to the bones.
  • Chest X-ray: A doctor may perform a chest X-ray to determine whether cancer has spread to a person’s lungs.

When a person has a confirmed bladder cancer diagnosis, a doctor may recommend additional tests to find out whether the cancer has spread to other parts of the body.

It may take a few days for a person to receive their results, but once they do, it is important that they discuss the results with their doctor or the pathologist who prepared the report.

These healthcare professionals can explain what the test results mean and answer questions the person may have.

They can also work with the person to discuss a treatment plan. Bladder cancer is treatable and often curable in its early stages, when surgery can remove it.

What happens if it is not bladder cancer?

If a doctor is not sure what is causing the symptoms, they will usually refer a person to a urologist for further tests. A urologist is a doctor who specializes in urinary, bladder, and kidney health.

This section answers some frequently asked questions about bladder cancer and how best to detect the disease early.

Is it possible to detect bladder cancer early?

Doctors can sometimes detect bladder cancer early. Blood in the urine and other urine-related symptoms can be the first indications of bladder cancer and may prompt healthcare professionals to begin testing.

In most cases, blood in the urine, or hematuria, is the first symptom of bladder cancer. Finding cancer early offers the best chance for successful treatment.

What is the best test to detect bladder cancer?

A cystoscopy is the key diagnostic test for bladder cancer. It involves inserting a thin, flexible tube with a camera into the bladder.

Doctors may perform a biopsy as part of a cystoscopy if they find abnormal tissue during the test.

Performing a few types of tests is the most reliable way for doctors to make a formal diagnosis of bladder cancer.

Early diagnosis of bladder cancer significantly improves the chance of successful treatment, but treatment is possible even in the later stages of bladder cancer.