Diagnosis of Bladder Cancer

• Physical exam: This might include an internal exam in the rectum or vagina to feel around the bladder to determine if any masses are present.
• Urine tests: Urine is tested for blood and to look for abnormal bladder cells that may be present (cytology).
• Cystoscopy – A cystoscope, a long tube with a lens at the end, is directed into the bladder through the urethra. The cystoscope is used to visualize the inside of the bladder and can be used to collect a biopsy.
• Fluorescence cystoscopy: This enhanced form of cystoscopy, also known as blue light cystoscopy uses a light-activated drug. The drug is taken up by cancer cells and glows when a blue light is shone upon it, allowing for easier detection of cancerous areas
• Biomarker testing/personalized medicine: 
• Biopsy: In this procedure, bladder tissue is removed from the body and viewed with a microscope by a pathologist. The pathologist will be able to determine if the cells are cancerous, and the grade (severity) of any bladder cancer cells that may be present.

If cancer is detected or suspected, additional tests are performed to determine the type and stage of disease. These include:

• Computerized tomography (CT) scans: A scan of the abdomen allows physicians to visualize the bladder and surrounding organs in a non-invasive manner.

After a diagnosis of bladder cancer, the physician must determine the stage (aggressiveness) of the tumor in order to treat it appropriately. This is performed by a surgery called transurethral resection of bladder tumor (TURBT) using a cystoscope under anesthesia. Here the tumor is resected and the depth of invasion into the bladder is assessed.

Staging of Bladder Cancer

The following stages are used to describe the location and extent of bladder cancer:

• Stage 0: Non-invasive papillary carcinoma limited to the superficial lining of the bladder including carcinoma in situ (cis) (urothelium)
• Stage 1 - The tumor has grown into the urothelial lining (lamina propria) but not into the muscle layer
• Stage 2 - The tumor has grown into the muscle layer (muscularis propria)
• Stage 3 - The tumor has grown outside the bladder muscle into the fatty tissue that surrounds the bladder
• Stage 4 - The tumor invades into surrounding structures including the prostate, uterus, vagina, pelvic wall, or abdominal wall