To determine whether bladder cancer may be the cause of your urinary symptoms, your health professional will evaluate your:

• Physical symptoms. A physical exam may include a rectal exam, a prostate exam for men, or a pelvic exam for women.
• Medical history, including your smoking history and your possible exposure to cancer-causing chemicals.
• Family history of cancer.
• A urine test and urine culture, to determine the presence of blood, infection, and other abnormal cells.

Initial diagnostic tests will include a cystoscopy, a test that allows your doctor to look at your bladder with a thin lighted scope (cytoscope). Small tissue samples (biopsies) of any abnormal areas are taken and looked at under a microscope to determine whether cancer cells are present and what the cells look like (grade). Information from the biopsy, cytoscopy, and sometimes other tests is used to determine the size and extent of the cancer (stage). Cancer stage and grade tell the size and shape of cancer cells and whether they have spread to other body areas. Knowing the stage and grade helps you and your doctor make treatment decisions.

Other diagnostic tests that may be done include:

• A complete blood count (CBC), to determine whether you have anemia.
• A chemistry screen, to evaluate kidney, liver, and bone functions.
• An intravenous pyelogram or computed tomography (CT urogram) to look for a mass near the kidneys, ureters, or bladder.
• A pelvic ultrasound, to determine whether a mass is present in or around the bladder and/or the kidneys.

If bladder cancer is diagnosed, more tests may be needed to determine whether the cancer has spread (metastasized).

• A CT scan or MRI may be done to determine whether the cancer has spread to lymph nodes, the lungs, the liver, or other abdominal organs.
• A chest X-ray may be done to determine whether the cancer has spread to the lungs.
• A barium enema or colonoscopy may be done to determine whether the cancer involves the intestines.
• A bone scan may be done to determine whether the cancer has spread to the bones.

Early detection of returning cancer

After you have been treated for bladder cancer, it is important to have regular examinations and cystoscopies to detect any recurrence early so that additional treatment can begin immediately. Researchers are studying ways to identify low-grade cancer cells without the need for a cystoscopy. Some tests for specific proteins in cancer cells (tumor markers), such as BTA and NMP22, have been approved by the U.S. Food and Drug Administration (FDA) to use to detect recurrent cancer.⁸ More research is being done on these screening methods because they are not as accurate as a cystoscopy at this time.⁹