Diagnosis of Bladder Cancer

Executive Summary

Different tests are being conducted for the diagnosis of bladder cancer. Additional reviews are done to check bladder cancer metastasis to other body parts. The biopsy is the most common diagnostic test for identifying the affected body area. The diagnostic approach to bladder cancer depends upon the type of cancer, signs and symptoms, age and overall health, and results of previous medical tests. The diagnosis depends on suspicious cancer type, signs and symptoms, age and general condition of the last medical tests results. Urine test, Cystoscopy, Transurethral resection of bladder tumor, Imaging tests such as computed tomography (CT) scan, magnetic resonance imaging (MRI), Positron emission tomography (PET) scan, ultrasound are the standard diagnostic approach for determining the occurrence of bladder cancer and its level of extent into the body.

Diagnostic Approach of Bladder Cancer

Many tests are performed to find or Diagnose Bladder Cancer. Also, tests are done to learn if cancer has spread to parts other than where it started. 

A biopsy is a sure way to know if you have cancer in a particular part or organ of the body for most types of cancer. 

The different tests can be used for a person depending upon the following factors – 

  • Your signs and symptoms
  • The age and general health status
  • The type of cancer suspected
  • The result of earlier medical tests

The earlier you find Bladder cancer, the better are the chances of successful treatment and cure.

The given tests may be used for Diagnosis of Bladder Cancer ​1​

Urine Test

The urine cytology test is ordered if any blood is found in the urine ​2​. It uses a random urine sample from normal urination to know if the urine contains tumor cells. A supplementary test involving cleansing the bladder and collecting the liquid through the cystoscope inserted into the urethra may be performed if a patient is undergoing a cystoscopy. The general way is to look at the cells through a urinary cytology microscope. Other urine tests use molecular analysis.


It is the necessary diagnostic procedure for bladder cancer. It allows seeing inside the body with a thin, flexible tube called a cystoscope ​3​. This procedure determines the need for Biopsy or surgery. 

Also Read: Diagnostic Approaches

Biopsy/ Transurethral Resection of Bladder Tumor

If something abnormal is found in cystoscopy, the doctor will go for a biopsy. A biopsy removes a small part of tissue for examination under a microscope, and this surgical process is known as Transurethral resection of bladder tumor or TURBT. During TURBT, the doctor removes the tumor and sample of bladder muscle around the tumor. Another procedure is typically done before TURBT is EUA (Exam under anesthesia). The urologist evaluates the bladder to see if any masses are felt in this procedure. Any tissue sample removed during the TURBT is then analyzed by a pathologist.

The imaging tests can be used to determine if the bladder cancer has spread and helped with staging ​4​.

Computed tomography (CT or CAT) scan

A CT scan takes pictures of the inside of the body using x-rays taken from different angles. A computer combines photos into a detailed, 3-dimensional image that shows abnormalities or tumors. A CT scan is used to measure the size of the tumor and recognize enlarged lymph nodes, which may indicate the spread of cancer. A contrast medium dye is given before the scan to deliver better detail on the image. This dye can be injected intravenously into the patient or given as a liquid to swallow. Before this test, patients should tell the staff if they are allergic to iodine or other contrast media.

Magnetic resonance imaging (MRI)

An MRI uses magnetic fields, not x-rays, to produce detailed body images. MRI can measure the tumor’s size and identify expanded lymph nodes, indicating that cancer has increased. A special dye called a contrast medium is given before the scan to create a better picture. This dye is different from the one provided for a CT scan (see above) and can be injected into a patient’s vein. 

Positron emission tomography (PET) or PET-CT scan

A PET scan creates images of organs and tissues present inside the body. A small amount of a radioactive substance is injected into the patient’s body which is taken up by cells using the most energy. The cancer cells which use energy actively take up the radioactive substance, and the scanner then spot this substance to produce images of the inside of the body. In specific situations, a PET scan may help find bladder cancer that has spread better than a CT scan or MRI alone.


An ultrasound uses sound waves to create an image of the internal organs. It is used to find out if the ureters or kidneys are blocked. No contrast medium is required in this test.

For patients who have symptoms or have had bladder cancer in the past, newer tests that look for tumour markers in urine may include:

  • UroVysion™ (looks for chromosome alterations)
  • BTA tests (looks for bladder tumor-associated antigen—BTA—which is also known as CFHrp)
  • ImmunoCyt™ (looks for mucin and carcinoembryonic antigen substances that are frequently found on cancer cells)
  • NMP22 BladderChek® (looks for NMP22—nuclear matrix protein 22—which is often elevated in bladder cancer patients)


  1. 1.
    Oeyen E, Hoekx L, De Wachter S, Baldewijns M, Ameye F, Mertens I. Bladder Cancer Diagnosis and Follow-Up: The Current Status and Possible Role of Extracellular Vesicles. IJMS. Published online February 14, 2019:821. doi:10.3390/ijms20040821
  2. 2.
    Konety BR. Molecular markers in bladder cancer: A critical appraisal. Urologic Oncology: Seminars and Original Investigations. Published online July 2006:326-337. doi:10.1016/j.urolonc.2005.11.023
  3. 3.
    Burke DM, Shackley DC, O’Reilly PH. The community-based morbidity of flexible cystoscopy. BJU International. Published online February 28, 2002:347-349. doi:10.1046/j.1464-4096.2001.01899.x
  4. 4.
    Sharma S, Ksheersagar P, Sharma P. Diagnosis and treatment of bladder cancer. Am Fam Physician. 2009;80(7):717-723. https://www.ncbi.nlm.nih.gov/pubmed/19817342