How Do Doctors Find Bladder Cancer?

Bladder cancer is something that impacts many individuals and families every year. Similar to other forms of cancer, the earlier bladder cancer is detected, the faster the treatment process can begin. Learn more about bladder cancer diagnosis below and reach out to a healthcare professional with any questions or concerns.

Cystoscope used for diagnosing and monitoring bladder cancer

How Do Doctors Detect 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 one of the most important diagnostic procedures for bladder cancer. The doctor will use a long thin camera that is inserted through the urethra and into the bladder to see if there any growths present. If a doctor spots something unusual, he or she may decide to perform a biopsy to confirm the diagnosis. While a cystoscopy may spot something unusual, it is difficult to confirm the diagnosis without getting a piece of the growth. 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:  What is a CT Urogram?

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 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.

Frequently Asked Questions (FAQs)

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.

Click here to read our Get the Facts | Cystoscopy (PDF), filled with advice from patients who have experienced it.