How Do Doctors Find Bladder Cancer?

Bladder cancer affects numerous individuals and families annually, and it’s important to test for bladder cancer early if possible. Early detection is crucial for prompt treatment initiation, as with other cancers. If bladder cancer is suspected, exams and tests will be needed to confirm the diagnosis. If cancer is found, more tests will be done to help find out the extent (stage) of the cancer. Similar to other forms of cancer, the earlier bladder cancer is detected, the faster the treatment process can begin. Explore information on testing for bladder cancer below and consult a healthcare professional for any inquiries or apprehensions.

How Do Doctors Test for and Diagnose Bladder Cancer?

There are several tests that doctors may use to diagnose bladder cancer. They include:

Urinary Screening

One of the most common symptoms of bladder cancer is blood in the urine. There are numerous reasons why you might have blood in your urine, so your doctor test your urine.  

Specifically, the doctor may run a urine cytology scan. This scan is done to see if there are any abnormal cells present in your urine. While it’s not common, sometimes if the doctor spots something unusual, he or she may use a microscope or perform a molecular analysis to see if there are any tumor cells in the urine.


A cystoscopy is a crucial test for diagnosing bladder cancer. This diagnostic procedure involves the insertion of a long, thin camera through the urethra into the bladder to identify any growths or abnormalities. If the doctor detects anything suspicious during the cystoscopy, they may opt to conduct a biopsy to confirm the diagnosis. While a cystoscopy can detect abnormalities, confirming the diagnosis often requires obtaining a tissue sample for further analysis.A cystoscopy is one of the most important diagnostic procedures for bladder cancer. Watch our video on cystoscopy.


A biopsy involves removing a small piece of the growth for further examination and testing. If a tumor or other abnormality is identified, the urologist will likely schedule you for a cystoscopy under anesthesia with bladder biopsy. During the biopsy procedure, the doctor will remove a piece of the tumor and send it to the lab for analysis by a pathologist. The doctor may want to take multiple biopsies to make sure he or she gets an accurate picture of the entire growth. Watch our video about biopsies.

After this, the doctor may decide to perform a transurethral resection of the bladder tumor, or TURBT. During this procedure, the doctor will try to remove as much of the tumor as possible through the urethra. The doctor may use tools attached to a resectoscope to remove the tumor tissue.. Then, the tumor will be sent to the pathologist for further testing.

Your doctor may also run additional tests to look at other parts of your urinary tract.

Radiological Test

The CT urogram is a radiological test to explore possible reasons for blood in the urine or other symptoms. This specialized scan uses intravenous (IV) contrast (a substance used to enhance the visibility of internal structures in X-ray based imaging). A CT urogram examines the upper urinary tract (kidneys and ureters) in detail.

This test for bladder cancer is good at finding tumors of the kidney, renal pelvis, and ureter, as well as other urologic abnormalities. It may identify kidney stones and hydronephrosis (swelling of the kidney that is often due to downstream blockage). In addition, the entire abdomen and pelvis is also imaged. This allows a radiologist to identify other abnormalities in these parts of the body.  In patients with cancer, it will help identify signs of spread to lymph nodes or other organs like the liver.

Your healthcare provider will request blood work to see if you have normal kidney function before you can receive the contrast required for a CT urogram. If the contrast cannot be given, your doctor may decide to perform a CT scan without contrast or other imaging study. A procedure called cystoscopy with retrograde pyelograms may be suggested. The urologist performs x-rays while injecting dye into the ureters. Like a CT urogram, it can help to identify abnormalities of the ureter and renal pelvis.

While some bladder tumors may be found on a CT urogram or other imaging test, others will not. A urologist will often recommend a cystoscopy to evaluate the lower urinary tract (bladder/urethra) for a source of blood in the urine or to workup other urologic symptoms.

What is a MR Urogram?

Another option for imaging is MRI of the abdomen and pelvis or MR Urogram.  This test is also effective at finding tumors in the kidney and ureters and evidence of spread of cancer.  It may be used to avoid radiation or in patients with contrast dye allergies or borderline kidney function.  It is not quite as good at finding kidney stones and similar to CT urogram may miss tumors in the bladder such that patients still require cystoscopy.

What is Renal Ultrasound?

Renal ultrasound is the least invasive way to evaluate the kidneys.  It does not require radiation and avoids contrast.  It may be used in lower risk patients and those with contrast allergies or poor renal function. Unfortunately, it can miss small kidney stones and tumors.  Also, it will not detect tumors in the ureter unless they are causing a blockage leading to hydronephrosis.

Testing for Bladder Cancer is Necessary

Early testing for bladder cancer plays a pivotal role in the timely detection and treatment of this disease. By undergoing regular screenings and diagnostic procedures, individuals can increase their chances of detecting bladder cancer at an early stage when treatment options are most effective. Prioritizing testing for bladder cancer empowers individuals to take control of their health and potentially improve their prognosis. Therefore, it is crucial to raise awareness about the importance of testing and encourage individuals to proactively engage in screening efforts.

Frequently Asked Questions (FAQs) for Testing and Diagnosis for Bladder Cancer

Some of the most common questions people ask include:

What are the first symptoms of bladder cancer?

Some of the most common initial symptoms include blood in the urine, pain while urinating, urinating more frequently, and back pain.

Can bladder cancer be diagnosed using a CT scan alone?

A CT scan is useful in staging bladder cancer because it can identify unusual growth, but it is impossible to diagnose bladder cancer without placing a piece of the growth under a microscope.

Does a cystoscopy hurt?

A cystoscopy should not be painful. Typically, the patient is awake during the procedure, but local anesthesia might be given.

Our Get the Facts | Cystoscopy (PDF) is filled with advice from patients who have experienced it.