To find out whether you have bladder cancer, the first thing your doctor probably will do is a complete medical history. They’ll ask you about your overall health, as well as anything that increases your risk, like having a family member who had bladder cancer.
Next, they’ll probably do a physical exam. This may include a pelvic exam (for women) or a digital rectal exam (DRE). In this procedure, your doctor will put on a glove and insert one finger into your rectum. This may allow them to feel a tumor in your bladder. It may also give them an idea of how big it is or whether it has spread.
If your doctor finds something that’s not normal, they’ll order lab tests. They might also send you to see a urologist. That’s a doctor who focuses on diseases affecting the urinary system (kidneys, bladder, etc.) and male reproductive system. Your urologist may run the following tests to get a better idea of what’s going on:
When you pee in a cup at your doctor’s office, there are a number of things they and other health professionals can look for:
- Urinalysis. Your doctor will check to see if there’s any blood, or other substances, in your urine.
- Urine cytology. Your doctor will use a microscope to check your urine for cancer cells.
- Urine culture. Your doctor will send your urine to a lab. After a few days, lab technicians will check to see what kinds of germs grow in it. These results will tell your doctor if you have a bladder infection.
- Urine tumor marker tests. These look for substances that are released by bladder cancer cells. Your doctor may use one or more of these along with a urine cytology to see if you have the disease.
Your doctor will place a cystoscope through the opening of your urethra -- the duct that you pee through -- and into your bladder.
The cytoscope is a thin tube with a light and video camera on the end. Your doctor will inject salt water through the tube and into your bladder. This will allow them to see the inner lining of your bladder with the camera. Blue and white types of cystoscopy used with imaging agents are particularly effective with helping to detect invasive bladder cancer.
They may give you medicine to numb your urethra and bladder. If the procedure is done in the operating room, you’ll be given anesthesia so you won’t be awake.
Transurethral Resection of Bladder Tumor (TURBT)
If your doctor finds something that doesn’t look right during your cystoscopy, they’ll take a sample of it (biopsy) to see whether it’s cancer.
During a TURBT, your surgeon will remove the tumor and some of the bladder muscle near it. They’ll be sent to the lab to check for cancer.
These use X-rays, magnetic fields, sound waves, or radioactive substances to create pictures of what’s happening inside your body. Here are just a few of the imaging tests your doctor may use to see if you have bladder cancer:
- Intravenous pyelogram (IVP). This is an X-ray of your urinary system. Your doctor will inject dye into your vein. It’ll highlight tumors in your urinary tract.
- Retrograde pyelogram. Your doctor will insert a thin tube (catheter) into your urethra and bladder. They’ll inject dye through the catheter so they can see the lining of the bladder. If there are any tumors in your urinary tract, they’ll show up here.
- CT scan. This will give your doctor an image of your kidney, bladder, and ureters (tubes that carry pee from your kidneys to your bladder). It’ll show tumors in your urinary tract. It can also show lymph nodes that contain cancer.
- MRI. This test uses radio waves and sound magnets to create images of your urinary tract.
- Ultrasound. Sound waves create pictures of your urinary tract. It allows your doctor to see how big a bladder tumor is.
- Chest X-ray. If cancer in your bladder spread to your lungs, this test will allow your doctor to see it.
- Bone scan. Cancer that has spread from your bladder to your bones will be visible through this scan.