If your laboratory test results suggest bladder cancer, you may need to go through additional testing to get a bladder cancer diagnosis. The first tests for bladder cancer may happen at your primary care provider’s office. However, you may be referred to a urologist (urinary disease specialist) for further testing to diagnose bladder cancer. This article will review some common bladder cancer tests and how they work.

1. Medical History

Your medical history includes information about your health now and in the past. Your health care provider may ask you about any symptoms you have. Common symptoms of bladder cancer include blood in your urine or changes in your bladder habits.

Information about your medical history may help your provider discover other causes of your symptoms and understand your risk factors for bladder cancer. Your health care provider may ask you questions, such as:

• What other health conditions do you have?
• Have you ever been diagnosed with another type of cancer?
• What medications do you take?
• Do you smoke?
• What do you do for work?
• How much water do you drink every day?
• Do you have a family history of bladder cancer or any other type of cancer?

2. Physical Exam

During a physical exam, your health care provider will look for signs of bladder cancer, such as a tumor or lump in the bladder. In early-stage bladder cancer, there may not be any signs of cancer with a physical exam.

According to the American Cancer Society, men may need a digital rectal exam (DRE), where a provider inserts a finger into the rectum to feel the prostate and bladder. Women may need a pelvic exam so the doctor can check their reproductive organs.

3. Urine Laboratory Tests

Urine laboratory tests check for health problems using a sample of your urine. You’ll pee into a cup to provide the sample.

A urinalysis is a common urine lab test you may have at a routine medical exam to check for blood and other substances in your urine. A urine culture is a test to check for bacteria causing a urinary tract infection (UTI). This is important because UTIs can cause many of the same symptoms as bladder cancer.

Urine cytology is a test that looks for cancer cells in your urine using a microscope. This test isn’t able to find all cases of bladder cancer. If cancer cells aren’t found in your urine, it may not mean that you don’t have bladder cancer.

Other urine tests can help find substances made by cancer cells — called biomarkers or tumor markers. These genes or proteins help predict how well you may respond to certain treatments. Urine tumor marker tests may be useful in diagnosing new bladder cancer or finding recurrent bladder cancer (disease that came back after treatment).

Urine tumor marker tests may include:

• UroVysion — Looks for genetic changes common in bladder cancer
• Bladder tumor antigen (BTA) test — Checks for BTA, a protein made by some bladder cancer cells, in the urine
• ImmunoCyt — Looks for mucin and carcinoembryonic antigens, commonly found on the outside of cancer cells
• Nuclear matrix protein 22 (NMP22) BladderChek — Looks for NMP22 protein, which is often high in people with bladder cancer

4. Cystoscopy

Cystoscopy allows your health care provider to see the inside of your bladder and urethra. This procedure is usually done by a urologist at their office or an outpatient clinic.

Your urine test results, combined with your symptoms, may lead your urologist to suspect bladder cancer. However, these tests can’t be used to diagnose bladder cancer. A cystoscopy helps your urologist make the initial bladder cancer diagnosis.

During this procedure, you’ll get medication to numb your urethra — the end of the tube that carries urine out of your body. Then, a long, thin instrument with a camera on the end (called a cystoscope) is inserted through your urethra and into your bladder. The urologist can use the camera to find areas of the bladder wall that look abnormal.

To help find bladder cancer, your urologist may perform additional tests during a cystoscopy. In blue light cystoscopy, the urologist puts a drug into the bladder that makes cancer cells glow under ultraviolet light. This can help urologists find cancer cells that might have been missed. A bladder washing with salt water can also be done during cystoscopy to check for cancer cells. A sample of abnormal bladder tissue, called a biopsy, can also be taken for further testing.

5. Transurethral Resection of Bladder Tumor

A transurethral resection of bladder tumor (TURBT) is a procedure used to remove a tumor caused by bladder cancer. Similar to a cystoscopy, a TURBT uses a long, thin tube inserted into the urethra and the bladder. In a TURBT, the tube is called a resectoscope and has a wire loop on the end to remove a tissue sample. The tissue sample is sent to a pathology laboratory to learn more information about the cancer and help find out the stage.

The TURBT is usually done with general anesthesia (medicine to put you to sleep) or local anesthesia (medicine that numbs a part of the body). Some people can recover from a TURBT at home, but you may have to spend a few days in the hospital.

In addition to being a diagnostic tool, TURBT is also the first treatment for people with some types of early-stage bladder cancer. If the urologist can remove all of the cancer cells using a TURBT, no additional surgery may be needed. However, if the cancer has started to invade the muscle layer of the bladder, more surgery may be needed.

6. Bladder Tissue Testing

The bladder tissue removed during cystoscopy or TURBT is sent to a pathology laboratory for more testing. A pathologist (a doctor who studies body tissues) will examine the tissue sample to give more information about the stage and type of bladder cancer that can help guide your treatment options.

Invasiveness of Bladder Cancer

Invasiveness refers to how deep the cancer has spread into the wall of the bladder. A pathologist can tell how deeply the cancer has grown into the bladder by looking at the tissue sample under a microscope.

Non-muscle-invasive bladder cancer is a type of early-stage bladder cancer that hasn’t started to grow into the layer of muscle around the bladder. This type of bladder cancer is usually easier to treat.

Muscle-invasive bladder cancer is when the cancer has begun to spread through the muscle layer or deeper. This type of bladder cancer is often more difficult to treat and more likely to spread.

Bladder Cancer Grade

The cancer grade refers to how abnormal cancer cells look under a microscope compared to normal cells. Low-grade cancers look similar to normal bladder cells. High-grade cancers look more abnormal, require more aggressive treatments, and are more likely to spread to other parts of the body.

Biomarker Testing

Cancer cells can also be tested for biomarkers. For example, your cancer care team may recommend a test to check for a genetic change in the fibroblast growth factor receptor (FGFR) gene. The FGFR gene provides instructions for making a protein that helps cancer cells grow. If you have a change in the FGFR gene, you may respond well to a group of targeted drugs called FGFR inhibitors. You may also be tested for PD-L1, a protein targeted by some immunotherapies to boost your immune system.

7. Imaging Tests

Imaging tests create pictures of the inside of your body to help find cancer. There are several types of imaging tests that may be used to find cancer in your urinary tract or other parts of your body. They can also be used to help guide the biopsy of a tumor by showing its exact location and size.

Common types of imaging tests for bladder cancer may include:

• Ultrasound — Uses sound waves to create an image of the inside of your body
• Computed tomography (CT) scan — Uses X-rays to create cross-sectional images of the inside of your body
• Magnetic resonance imaging (MRI) scan — Uses a magnetic field and radio waves to create an image of your body
• Intravenous pyelogram — Uses X-rays to take pictures of the urinary tract after a special dye is injected into your veins to identify bladder tumors
• Retrograde pyelogram — Uses X-rays to take pictures of the urinary tract after a special dye is injected into the bladder from a urinary catheter

Other imaging tests can help look for cancer that has spread to distant parts of the body, such as a chest X-ray, positron emission tomography (PET) scan, and bone scan.

8. Genetic Testing

If you have a family history of bladder cancer or colon cancer, or if you’ve been diagnosed with bladder cancer before age 45, your health care provider may recommend genetic testing. Most cases of bladder cancer are associated with genetic mutations (changes) that happen during your lifetime. However, genetic testing can help find cancer-causing gene mutations passed down from your parents. This may include related conditions, such as Lynch syndrome, an inherited condition that raises the risk of some cancers, like colon and bladder cancer.

Genetic testing can give you more information about your risk of other types of cancer.

Talk With Others Who Understand

MyBladderCancerTeam is the social network for people with bladder cancer and their loved ones. On MyBladderCancerTeam, members come together to ask questions, give advice, and share their stories with others who understand life with bladder cancer.

Have you or a loved one been diagnosed with bladder cancer? What testing did you receive to confirm a diagnosis? Share your experience in the comments below, or start a conversation by posting on your Activities page.