Diagnosing bladder cancer can be a long and frustrating process. This is because many of the symptoms present in early stage bladder cancer (i.e., blood in urine, pain, and frequent urination) are also common to other conditions (i.e., UTIs or bladder stones). In order to make a proper bladder cancer diagnosis, your physician or a specialist will need to conduct a physical exam (including taking a thorough patient health history) and several tests in order to rule out or diagnose bladder cancer, to find out what stage of bladder cancer the patient is in, and to plan a proper bladder cancer treatment plan.

The diagnosis of bladder cancer may vary by a specialist, however, the following exams and tests are conducted commonly, and in the order in which they are listed:

Physical exam and health history
An examination of your symptoms will often start with a personal health history, in which your physician asks about your family history of bladder cancer – if you’re a smoker if you’ve had chemotherapy or radiation to your pelvis, frequency of bladder infections, and if you’ve been exposed to certain chemicals. A physical exam will look for symptoms of bladder cancer, including enlarged lymph nodes (in the neck, abdomen, and groin) and swelling in the liver.

Bimanual pelvic exam
A bimanual pelvic exam allows your physician to examine the bladder for lumps or areas of thickness. He or she does this by inserting a gloved and lubricated finger into the rectum (for male patients) and into the vagina (for female patients), and pressing on the lower abdomen with the opposite hand.

Cystoscopy
A cystoscopy exam involves the use of a cystoscope lens (or a lens contained in a narrow tube). This is inserted through the urethra to provide a view of your inner urethra and bladder, to check for the presence of abnormal cell growth and cancer.

Cell biopsy
A cell biopsy procedure is also referred to as a transurethral resection of bladder tumor (or TURBT), which collects a cell sample from the bladder for lab testing.

Intravenous or excretory urogram
Also known as an IVP, this imaging exam is conducted by injecting a contrast medium into a vein, which then concentrates in the urine and moves through the urinary system (bladder, kidneys, urethra, and ureters), as a series of x-rays are captured to examine for issues.

CT urogram
A CT urogram (or computerized tomography) is more commonly prescribed by doctors than an IVP to rule out or diagnose issues within the urinary system (kidneys, urethra, ureters, and bladder). This imaging test also makes use of a contrast dye to get a detailed look as it flows through the urinary tract.

Retrograde pyelogram
This x-ray is similar to an IVP, however, contrast dye is injected directly into the ureter via a tube and cystoscopy to check if an obstruction is present and, if there is one, where it is. This test is often used as an alternative if the patient is allergic to the injected contrast medium, or if their kidney function is jeopardized.

Urine cytology
A urine cytology takes and analyzes a sample of urine for the presence of abnormal cells or cancer cells.