Cystoscopy

A cystoscope is a thin, flexible tube with a camera and light on the end. Your doctor (urologist) passes this device through your urethra and into your bladder to examine the inside of the bladder and check for any abnormalities.  This is usually started in the clinic.   If an abnormality is seen, your doctor will do another cystoscopy using a rigid tube but under general anesthesia in the operating room to obtain a biopsy sample of any abnormal tissue and send it to a lab to be analyzed. A biopsy is the only way to know for sure if you have bladder cancer.

Urine cytology

Your doctor may take a sample of urine during a cystoscopy and send it to a lab to be analyzed for any signs of cancer cells. This test can help find only certain types of bladder cancer, so a negative test result doesn't necessarily mean you are free and clear of cancer.

Urine culture

Your doctor takes a sample of your urine and sends it to a lab to be analyzed for germs and signs of infection. Your doctor uses this test to rule out an infection, which may be the cause of your symptoms.

Urine tumor markers

Tumor markers are substances found in higher than normal amounts in a person's urine when they have bladder cancer. Your doctor will take a sample of your urine and have it analyzed for substances that might have increased levels if you have bladder cancer.

• Please see Understanding Tumor Markers for more information

Intravenous pyelogram (IVP)

An IVP is a series of X-rays taken after your doctor injects a special dye into your veins. The dye travels through the kidneys, ureters and bladder, and makes these organs show up clearly on the X-rays, helping your doctor spot urinary tract tumors.

Retrograde pyelogram

This test is very similar to an IVP, except your doctor injects the dye into your ureters through a catheter passed through a cystoscope that is in your bladder. Doctors usually only use this test for people who are allergic to X-ray dyes and can't have an IVP. The purpose of this test and the IVP is to be sure you don't have additional cancers in the ureters or renal pelvis.

Computed tomography (CT) scan

A CT scan can show the exact location, size, and shape of a tumor in your urinary tract, and can also show cancer in the lymph nodes and abdomen. For a CT scan, you lie flat on a table while a machine rotates around your body and takes pictures, producing detailed cross-sectional images of your body. A CT scan of the urinary tract is known as a CT urogram.

CT guided biopsy – if a CT scan shows multiple abnormalities in the bladder as well as another organ (e.g. lung, liver or bone). Then, your team might request a CT guided biopsy of the abnormality in these organs outside of the bladder. The CT scan is used to guide the doctors where the needle goes to obtain the biopsy. This is usually an outpatient procedure (i.e. does not require a hospital stay).

Magnetic resonance imaging (MRI) scan

In an MRI scan, radio waves and a powerful magnet are used to produce clear, detailed images of the body. The patient lies flat on a table in the MRI machine and radio waves are absorbed and released by the body. A computer then translates these waves into detailed images showing “slices” of the body. An MRI can show the urinary tract and lymph nodes in clear, detailed images. Doctors often use MRIs to determine if your cancer has spread outside of the bladder into nearby lymph nodes.

Positron Emission Tomography (PET) Scan

For a PET scan, the doctor injects a radioactive substance into the patient's bloodstream. This substance collects in malignant (cancerous) cells in the patient's body. The doctor then uses a PET scanner to detect these areas of radioactivity and to find the exact location of cancer in the patient's body.

Ultrasound

Ultrasounds bounce sound waves off of your internal organs in order to create echoes that form a picture. Your doctor will wave an ultrasound device over your abdomen, and use it to determine the size of your bladder cancer and whether it has spread outside of the bladder to nearby lymph nodes or structures.

Chest X-Ray

Your doctor may perform a chest X-ray to see if your bladder cancer has spread to your lungs.

Bone Scan

A bone scan uses a radioactive substance to identify cancerous tissues in the bones. It can show all of the bones of the body and find small areas of cancer spread not seen on plain x-rays. Your doctor may order a bone scan if he thinks the bladder cancer has spread to your bones.