Tests to check for bladder cancer include physical exams, urine tests, and imaging. A doctor may also need a biopsy or cystoscopy to confirm a diagnosis. If you’re at high risk, at-home tests might help you screen for bladder cancer.
The bladder is a hollow organ in your lower pelvis. Its job is to store urine until you’re ready to release it. When cells in your bladder multiply and grow out of control, bladder cancer may result.
If you have bladder cancer symptoms, a healthcare professional may recommend several diagnostic tests. These tests may rule out bladder cancer. If you have bladder cancer, diagnostic testing can identify your type and stage.
For some cancers, doctors recommend screening annually or every several years. They may suggest you get screened for cancer even if you’re at average risk or have no symptoms. You may be familiar with screenings such as mammograms for breast cancer and colonoscopy for colon cancer.
Unlike these cancers, there’s no standard or routine screening test for bladder cancer. But if you’re above average risk of this condition or have had bladder cancer in the past, a doctor will recommend routine screenings, even if you don’t have any symptoms.
Bladder cancer symptoms include:
- blood in your urine (hematuria)
- pain or difficulty with urination
- urination urgency and increased frequency
Blood in your urine is the most common bladder cancer symptom. If you have hematuria or any other bladder cancer symptoms, a clinician will look for additional signs of this condition.
If the disease has advanced, a physical exam may identify the following symptoms:
- pelvic pain
- swelling in your legs
- flank or low back pain
- bone tenderness
A clinician may also do a bimanual (two-handed) exam to look for a mass (tumor) in your abdomen, pelvis, or rectum.
In people assigned female at birth, a clinician may perform a pelvic exam to look for masses in the vaginal wall. For those assigned male at birth, they may perform a rectal exam and check the lower abdomen for masses in the prostate.
If you previously had bladder cancer, a healthcare professional will recommend routine screening that includes urine tests. If your cancer has come back, a screening test may identify it early, when treatment can work best.
Doctors can also use urine tests to diagnose bladder cancer. However, these don’t provide enough information on their own to allow for a diagnosis. In some cases, a urine test can miss cancer or produce a false positive.
Urine tests require you to supply a urine sample by peeing into a sterile cup. If you feel dehydrated, you may need to drink fluids before you give a sample. This noninvasive test requires no preparation other than washing your hands. You’ll usually go to a healthcare clinic to provide the sample.
Urinalysis (hematuria test)
Urinalysis tests for bladder cancer can identify red blood cells in your urine. A urinalysis can also find white blood cells and other substances, such as bacteria. Doctors also use urinalysis to help diagnose other conditions, such as diabetes or urinary tract infections (UTIs).
Blood in your urine is the most common symptom of bladder cancer. In some instances, blood may visibly change the color of your urine to pink, brown, or red. When you can see the blood in your urine, doctors refer to it as gross hematuria (“gross” meaning “large”).
Blood in the urine isn’t always visible to the eye. Sometimes, it can only be visible under a microscope. This is called microscopic hematuria.
For this test, you’ll supply a urine sample that a doctor will send to a laboratory for analysis. As a first step, a clinician may also use an in-office dipstick to check for blood in your urine. Dipstick tests sometimes result in false positives, so doctors depend on lab tests that use a microscope to back them up.
Various conditions can cause blood in your urine. A urinalysis can detect blood but won’t provide enough information to definitively diagnose bladder cancer.
A urine cytology test looks for cancerous and precancerous (abnormal) cells in your urine. Your sample will be sent to a lab and viewed under a microscope. Lab technicians will analyze the sample for the presence of tumor cells.
Urine culture test
Urine culture tests identify fungi, yeasts, and bacteria that cause infection. They don’t identify bladder cancer. A clinician may recommend this test to rule out other diagnoses, such as a UTI.
Urine tumor marker test
Urine marker tests look for substances in your urine that might indicate bladder cancer. There are several types. The
- UroVysion looks for chromosomal changes in your bladder cells that might indicate cancer.
- Bladder tumor-associated antigen (BTA) tests check for BTA (also known as CFHrp), a substance that cancer cells produce.
- ImmunoCyt tests for mucin and carcinoembryonic antigen, two substances found on cancer cells.
- NMP22 BladderChek looks for NMP22, a protein found in people with bladder cancer.
At-home screening options for bladder cancer
There are tests you can take at home to check for bladder cancer. However, experts don’t recommend you use this as the only diagnostic tool. They also don’t recommend it for people who don’t have a history of bladder cancer.
If you’re under surveillance for bladder cancer recurrence, a healthcare professional may recommend using at-home urine tests that measure biomarker genes. After you take a urine sample at home, you mail it back to a laboratory for analysis.
At-home tests provide convenience and may limit your need for invasive testing. Some health insurance providers, including Medicare, may cover some of these tests.
Cystoscopy is a minimally invasive procedure that lets a doctor see inside your bladder and urethra. Unlike scans, which may miss certain spots, cystoscopes provide a complete view of the bladder. Some doctors may use cystoscopy as a screening tool.
Cystoscopy is usually an outpatient procedure. You’ll also be under local or general anesthesia. A healthcare professional will give you complete instructions about the type and scope of procedure you’re expected to have.
A clinician will insert the cystoscope (a thin tube with a lit end) into your urethra and thread it through to your bladder. They’ll insert water or a sterile saline solution into the cystoscope to expand the bladder wall. This makes it easier to view the bladder’s inner lining, where most bladder cancers start.
There are two types of cystoscopes. A flexible cystoscope can only help view the inside of your bladder and urethra. It’s very narrow and bendy. You can usually be awake for the procedure.
A rigid cystoscope is slightly wider and doesn’t bend. But a clinician is able to insert surgical instruments into a rigid cystoscope. They can use these tools to remove cysts, benign growths, small tumors, or tissue samples for biopsy.
Whether you’re assigned male or female at birth, either type is an option.
The male urethra forms a bridge between the bladder and the penis. Your body transports urine, semen, and sperm out of your body through your urethra.
In people assigned male at birth, the opening of the urethra (urethral meatus) is located at the tip of the penis. During a cystoscopy, a healthcare professional will place the scope into the urethra through this opening.
The female urethra transports urine out of the body. It’s located at the foot of your bladder and extends down through your pelvic floor. The opening of the urethra is located within the labia minora, in front of the vaginal opening.
If you’re assigned female at birth and need a cystoscopy, a healthcare professional will place the scope into your urethra through the urethral opening.
In some instances, a doctor may find suspicious or abnormal-looking tissue during a cystoscopy. If so, they may perform a biopsy to determine if these areas of tissue contain cancer cells.
A biopsy is a laboratory test that analyzes tissues taken from the body under a microscope. A biopsy can help a doctor make a definitive diagnosis of bladder cancer. Doctors can also use a biopsy to determine the tumor grade and the amount of spread, or invasiveness, within the bladder wall.
If a doctor uses a rigid cystoscope during a cystoscopy, they may remove a tiny piece of tissue for testing.
They may also choose to do a follow-up surgical procedure called transurethral resection of bladder tumor (TURBT). Doctor use TURBT to confirm a bladder cancer diagnosis and to check for tumor spread into the muscle layer of the bladder wall.
During a TURBT procedure, a doctor will remove any tumors they find for biopsy. They’ll also remove a portion of the bladder muscle surrounding the tumors and send it to a lab for analysis.
Since cancer cells spread before tumors form, a doctor may also remove tiny portions of tissue from throughout the bladder for testing. They may also use a saltwater wash during a TURBT procedure. They can check the collected water for cancer cells in the lab.
Since blood in urine is often visible, doctors catch many cases of bladder cancer early. But in some instances, cancerous cells may have a chance to spread outside your bladder. Doctors can use imaging tests after a diagnosis to check for enlarged lymph nodes and tumors in tissues and organs throughout the body.
Imaging can also provide information about the primary (original) tumor. Imaging tests for bladder cancer include:
Computed tomography (CT) urogram
CT scans use X-rays to obtain cross-sectional images of your body. CT urograms are scans that look at your ureters, bladder, kidneys, and nearby lymph nodes. A CT urogram provides information about a bladder cancer tumor’s size, shape, and position.
Magnetic resonance imaging (MRI) urogram
Unlike CT scans, MRIs use magnets and radio waves instead of X-rays to take pictures. MRI urograms take images of the upper urinary system. Doctors also use MRI scans to identify areas of localized spread outside your bladder.
Intravenous pyelogram (intravenous urogram)
An intravenous (IV) pyelogram uses X-rays to take pictures of your urinary system. For this test, a clinician will inject X-ray dye into a vein. The dye highlights urinary tract tumors, making them easier to see.
If you’re unable to get an injection into a vein, a doctor may recommend a retrograde pyelogram instead. These tests are less common. For this test, they’ll inject the X-ray dye through a catheter they place in your urethra.
Ultrasounds take pictures of your internal organs with sound waves. Doctors can use a bladder ultrasound to gauge the size of bladder cancer tumors and to check for spread in nearby organs, such as your kidneys.
If you have bone pain or tenderness, a doctor may perform a bone scan to check for bladder cancer spread into your bones. For this test, they’ll inject low-level radioactive material into one of your veins. They’ll then use a camera to create an image of your skeleton showing areas where the material indicates the presence of cancer cells.
A doctor may perform a chest X-ray to determine if cancer has spread to your lungs.
After testing, you may have to wait several days or longer to get your test results. You may even receive your test results electronically before your doctor has had a chance to review them.
Biopsies and other test results may be confusing to read. It’s important to discuss your results with a healthcare professional or the pathologist who prepared your report. They can answer your questions about test results and what they mean.
A healthcare professional can also work with you on next steps, such as additional testing and a treatment plan. Bladder cancer is treatable and often curable.
Healthline resources for after a bladder cancer diagnosis
After a diagnosis, you may have several questions. To help you with your next steps, Healthline recommends the following resources: