Often, bladder cancer is asymptomatic until there is advanced disease. Therefore, in such cases, screening must be performed to detect the tumor. The most widely used screening tests are medical interview, physical examination, urinalysis, urine cytology, and cystoscopy. These tests are also used to diagnose bladder cancers symptomatic patients as well.

The doctor will review the patient's medical condition, work history, habits and lifestyle so that he can develop and assess the risk for bladder cancer. A complete physical examination is performed including rectal or vaginal exam. The physician may insert a gloved finger into the vagina, rectum or both to feel for any lumps that might indicate a tumor or another cause of bleeding.

Urinalysis :
It is a collection of tests for finding abnormalities in the urine such as blood, protein, sugar (glucose), and solids. Any abnormal findings should be investigated with more definitive tests.

Urine cytology (Urine tests) :
Abnormal cells or tumors in the bladder wall slough off cells that are suspended in the urine and excreted from the body during urination. In this test, a sample of the urine is examined under a powerful microscope to look for abnormal cells that might suggest cancer. A urine culture may be done to rule out an infection. The presence of certain antibodies and other markers may indicate cancer.

Cystoscopy :
It is the method of examining bladder and urethra using cystoscope, which is a thin, narrow tube with a light and a camera on the end. Cystoscope is inserted into the bladder through the urethra to examine any abnormalities such as tumors. The camera transmits pictures to a video monitor, allowing direct viewing of the inside of the bladder wall. With the cystoscope, sample tissues can be removed and it is examined under a microscope to detect cancer.

If bladder cancer is suspected, further tests are performed. These includes :

Pyelography :
It is a series of x-rays of the kidneys, ureters, and bladder. The doctor will inject a special dye into a vein (intravenous pyelography or IVP) or into the urethra (retrograde pyelography) and x-ray film of the urinary tract is taken. The dye highlights the organs of the urinary tract and makes seeing certain abnormalities easier.

CT (Computerized tomography) Scan :
Similar to an x-ray film, CT gives a 3-dimensional view of the bladder, urinary tract (especially the kidneys), and pelvis to look for masses and other abnormalities. In most cases, before the test, a contrast dye is injected into a vein to highlights the organs. The greatest risk with this procedure is a possible allergic reaction to the dye.

Biopsy :
Biopsy is the removal of tissue to look for cancer cell. It is the only sure way to tell whether cancer is present. Tiny samples of the bladder wall are removed, usually during cystoscopy. The samples are examined under a microscope. Small tumors are sometimes completely removed during the biopsy process.

If bladder cancer is identified, certain other tests may be performed to find whether it has invaded the bladder wall or spread to other parts of the body. It is called staging and the tests may include CT scan, ultrasound scan, magnetic resonance imaging (MRI), sonogram, bone scan or chest x-ray.

Ultrasound Scan :
This scan can show the size and how far the tumor has spread to other organs. In this painless test, a handheld device run over the surface of the skin uses sound waves to examine the contours of the bladder and other structures in the pelvis.

Chest x-ray film :
A simple x-ray film of the chest is taken to check whether the bladder cancer has spread to the lungs.

Magnetic resonance imaging (MRI) :
Instead of X-rays, MRI uses a powerful magnetic field and radio waves to create the image of urinary tract.

Bone scan :
This imaging test is used to determine whether cancer has spread to your bones. In this method a tiny amount of a radioactive substance is injected into the veins. A special scanner then takes pictures of all your bones.