My Doctors Suspect I Have Bladder Cancer. What Tests Will I Need?

Most patients who are being evaluated for bladder cancer are referred because of gross or microscopic blood in the urine. Others may have irritative voiding symptoms such as frequency, urgency, or pain. Finally, some may have a positive urine cytology test or a mass detected on a CT scan that was obtained for some other reason, such as back pain.

Several tests and procedures are used in the initial evaluation of bladder cancer. During your initial visit, your doctor will perform a rectal exam (and a pelvic exam for women) to determine whether the tumor is palpable or extending beyond the bladder. Other common tests include (1) urine cytology or other urine screening test , (2) X-rays of the kidneys and ureters , and (3) cystoscopy to examine the interior of the bladder directly . Your doctor will also perform a biopsy, often as part of the resection of the tumor in the operating room. The biopsy is sent to the pathologist, who looks at it under the microscope to diagnose accurately the type of cancer and the depth of penetration. Any further tests that you might need will depend on the results of the biopsy.

Regardless of the biopsy results, everyone should get an upper tract study . Upper tract studies are done to make sure that there is no cancer in your kidneys or ureters that cannot be seen during cystoscopy.

You may also need to have tests for your heart such as an electrocardiogram or an echocardiogram, especially if your doctor is planning  anesthesia for a biopsy or resection in the operating room. If these tests are abnormal, you may need further evaluation by a cardiologist. Also, some people, especially those older than 50 or those who smoke, may need a chest X-ray before having anesthesia.

Finally, for those patients in whom the cancer is suspected to be advanced, a CT scan of the abdomen and pelvis may be obtained. This scan will help to assess whether the cancer has invaded outside of the bladder as well as to determine whether any lymph nodes are enlarged.