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Diagnosing Bladder Cancer

Today, there is no recommended routine screening for the general public for bladder cancer. However, you may be referred to a urologist if your primary care doctor believes you have a problem. A urologist handles problems of the urinary and male reproductive systems.

The urologist will ask about your possible exposure to risk factors, such as smoking and chemicals. He or she will also discuss your health habits, family medical history and any past treatments. Those who had certain birth defects of the bladder, had bladder cancer before or were exposed to certain chemicals would be considered very high risk. This may result in more wide-ranging tests. The earlier bladder cancer it is found, the chance of it being successfully treated is higher.

After a thorough physical exam, one or more tests also may be prescribed:

Imaging Tests

If there is blood in your urine, a CT scan of your kidneys, ureters and bladder may be ordered. A contrast dye is injected into a vein to help create a better image for diagnosis. A CT scan is like a highly detailed x-ray, but taken from many angles. A computer then builds them into a single picture.

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Urine Cytology

Your urine will be tested under a microscope (urine cytology) to look for cancer cells. There are several tests that can also look for tumor markers. These are commonly linked with cancer cells.


A soft, thin, flexible tube with a fiber optic lens is inserted through your urethra into your bladder. Sterile salt water is also injected through the scope to fill your bladder for better viewing. This is often done in the doctor’s office using local anesthesia on the area for comfort. Any tumors found in the urethra or bladder are unlikely to be removed during this procedure. You will likely need to return for surgery to remove them. This is known as TURBT surgery.

Grading and Staging Bladder Cancer

If cancer is found, it will then be staged. These are measurement systems based on the size (grade) and location (stage) of the tumor. There are two main systems used by many doctors. They tell all treating doctors the severity and location of the cancer. TURBT (transurethral resection of bladder tumor) will be used to get a tissue sample. This minimally invasive procedure is done through the urethra during cystoscopy. It can remove entire tumors that are clearly seen and take tissues samples (biopsy) from the bladder. A pathologist will look at how different the cells look from healthy cells, on a scale of 1 to 3. Generally, the higher the grade or stage given to a patient, the worse the prognosis. They also will look how far the tumor has grown through the bladder wall and whether it has grown into nearby tissue.

Bladder Cancer Grading Systems

TNM System

  • Stage
  • Tumor Location
  • Ta & Tis:
  • Low-grade tumor appears on the bladder lining
  • T1:
  • Tumor goes into the bladder lining
  • T2 (a & b):
  • Tumor goes into the muscle layer
  • T3 (a & b):
  • Tumor has spread outside the bladder and also may be in the ureter, vagina or prostate
  • T4 (a & b):
  • Tumor has spread (metastasized) to nearby lymph nodes or parts of the body farther away

1973 WHO (World Health Organization) System

Used to grade the aggressiveness of the urothelian neoplasm (bladder tumors).

  • Grade
  • Appearance
  • Urothelian Papillomas
  • Benign lesions
  • Grade 1:
  • Well differentiated (less aggressive)
  • Grade 2:
  • Moderately differentiated
  • Grade 3:
  • Poorly differentiated (more aggressive)

More tests may be needed to determine the stage of the bladder cancer. These can include a CT scan, MRI (magnetic resonance imaging) scan, bone scan or chest x-ray.