Since bladder cancer symptoms, such as blood in the urine, are more often due to other conditions, such as bladder stones, there may be a delay in diagnosis. Each individual case will be different, so not all diagnostic tests will necessarily be useful or available.
The following tests are generally used to rule out or diagnose bladder cancer. Many of these tests can also be used to assess the stage of the cancer.
- Health history and physical exam
- This will be used to record your risks and symptoms. Your doctor may ask questions about smoking, working with chemicals, radiation therapy, and chronic bladder irritation. They may also assess your family history of bladder cancers and other urinary tract cancers.
- The physical exam will allow your doctor to look for signs of bladder cancer. This may involve a pelvic exam or a digital rectal exam.
- Urinalysis and other urine tests
- A urinalysis is used to detect substances in a urine sample, such as blood, bacteria, and cells. Often, this will be the first test done when an abnormality is suspected in the urinary tract. Blood in the urine indicates bleeding in the urinary tract, which would be caused by cancer. Nitrites in the urine typically indicate the presence of a UTI.
- A urine culture will examine a urine sample for bacteria and other infectious agents. This can rule out an infection as the cause of bladder symptoms.
- Urine cytology studies the cells in a urine sample, which can detect abnormal cells such as bladder cancer cells.
- Cystoscopy
- A cystoscopy involves the insertion of a thin tube with a lens on the end to look at the urethra and bladder. It can detect tumours and abnormal areas. It is typically done when there is presence of blood or abnormal cells in the urine, and it can also take biopsy samples.
- A fluorescence cystoscopy may be done alongside a regular cystoscopy. This involves the use of a dye and special light which will make cancer cells easier to see, as they will glow under the light.
- Biopsy
- During a biopsy, tissue or cell samples will be cultivated to be tested in a lab. A pathologist’s report can confirm or deny the presence of cancer cells in the sample. Biopsy samples can be retrieved during a cystoscopy.
- A transurethral resection of bladder tumour (TURBT) is the most common type of biopsy in bladder cancer diagnosis. This surgery removes the tumour as well as some muscle from the nearby bladder wall. This can show how far the cancer has invaded the bladder wall, and can be a treatment for early stages of bladder cancer.
- Complete blood count (CBC)
- A CBC will measure the number and quality of white and red blood cells. This can check for anemia from long-term urinary tract bleeding, as well as infection. A CBC will typically be done before any cancer treatment starts.
Other possible tests include: blood chemistry tests, CT scan, MRI, and ultrasound.
Read more about diagnostic tests from the Canadian Cancer Society.