Diagnosing Bladder Cancer

See your doctor right away if you develop any of the signs or symptoms of bladder cancer, including bloody, painful or frequent urination. Your doctor will ask you about your medical history and perform a thorough physical exam. This may include an internal examination during which your doctor gently inserts a gloved, lubricated finger into your rectum or vagina. To help diagnose bladder cancer, you may also have one or more of the following tests:

Urine test (urine cytology). Doctors are evaluating several new methods to determine if bladder cancer can be accurately diagnosed using noninvasive methods, including tests that check a sample of your urine for cancer markers. One such marker is the enzyme telomerase, which is active in malignant cells but inactive in normal cells. The FDA has also approved two tumor marker tests that help diagnose recurrent bladder cancer. Both of these tests involve checking a urine sample for proteins associated with bladder tumors.
Intravenous pyelogram (IVP). This X-ray allows your doctor to see an image of your kidneys and lower urinary tract, including your bladder. You'll receive an injection of a contrast dye through a vein in your arm. Your bloodstream delivers the dye to your kidneys, ureters and bladder. The contrast agent makes it easier for your doctor to see any abnormalities or tumors on a series of X-rays.
Cystoscopy. In this procedure, your doctor inserts a narrow tube (cystoscope) through your urethra. The cystoscope has a lens and fiber-optic lighting system, allowing your doctor to see your urethra and bladder. Your doctor can also use the cystoscope to remove a small sample of tissue (biopsy) for analysis in the laboratory.

Staging tests
If you're found to have bladder cancer, you're likely to have tests to help determine whether the cancer has spread (metastasized) — a process known as staging. The stage of cancer helps your doctor determine the best course of treatment and the outlook for your recovery. Staging tests may include one or more of the following:

Computerized tomography (CT).This is essentially a highly detailed X-ray that allows your doctor to see your bladder in two-dimensional "slices." Split-second computer processing creates these images while a series of thin X-ray beams pass through your body. In most cases, you will have a contrast dye injected into a vein before the test. The dye makes it easier for your doctor to see your organs and to determine if anything abnormal is present that might suggest cancer. Your greatest risk with this procedure is a possible allergic reaction to the dye.
Magnetic resonance imaging (MRI). Instead of X-rays, this test uses a powerful magnetic field and radio waves to create images of your urinary tract. During the test, you're enclosed in a cylindrical tube that can seem quite confining to some people. The machine also makes a loud thumping noise you might find disturbing. In most cases you'll be given earplugs to help block out the noise. If you're claustrophobic, ask your doctor whether an open scan or some mild sedation may be an option for you.
Bone scan. This imaging test is used to determine whether cancer has spread to your bones. During the procedure, a small amount of a radioactive substance that collects in bone is injected into a vein in your arm. A special scanner then takes pictures of all your bones.
Chest X-ray. This test may help detect cancer that has spread to the lungs.