A number of tests may be performed to investigate symptoms of bladder cancer and confirm a diagnosis. Some of the more common tests include:
- a physical examination of the body which may include an internal exam of the vagina or rectum to check for lumps
- urine testing looking for blood or infection in the bladder, and examination of urine under a microscope 
- imaging of the bladder and nearby organs, which may include ultrasound, X-ray, computerised tomography (CT) scans or magnetic resonance imaging (MRI) – this may include getting a dye injected into a vein to help the imaging detect possible cancers 
- examination of the inside of the bladder using a camera on a thin tube inserted into the urethra (cystoscope)
- removal of a small sample of tissue from the bladder wall (biopsy) for examination under a microscope.
Staging of bladder cancer
If you are diagnosed with bladder cancer, you might have more tests to determine the stage of the disease and whether the cancer has spread in the bladder or to other organs or lymph nodes. Knowing the stage of the disease helps your medical team plan the best treatment for you.
The stages of bladder cancer can be complex. To determine the cancer’s stage, doctors will check:
- how far the cancer has grown into the lining of the bladder wall
- whether the cancer has spread to nearby tissues and organs
- whether the cancer has spread to nearby lymph nodes or distant organs.
Stages of bladder cancer
- The staging system used for bladder cancer is based on three factors:
- tumour growth (T),
- spread to lymph nodes (N) and
- whether it has spread to other organs called metastases (M).
The numbers or letters after T, N and M provide details of these factors, with higher numbers meaning that the cancer may be more advanced.
Stages of bladder cancer can be summarised as below:
Stage 0: The cancer is non-invasive and has grown into the hollow of the bladder and inside lining of the bladder. There is no spread to lymph nodes or distant sites.
Stage I: The cancer has grown into the layer of connective tissue under the lining of the bladder, but not reached the muscle layer of the bladder wall. There is no spread to lymph nodes or distant sites.
Stage II: The cancer has grown into the muscle layer of the bladder wall, but not passed completely through this layer. There is no spread to lymph nodes or distant sites.
Stage III: The cancer has grown through the muscle layer of the bladder wall . It may have spread to the prostate, seminal vesicles, uterus or vagina but not spread to the pelvic or abdominal wall. The cancer may have spread to nearby lymph nodes. There is no spread to distant sites
Stage IV: The cancer has grown through the bladder wall into the pelvic or abdominal wall; or spread to distant lymph nodes or distant sites such as bones, liver or lungs.
The staging of the cancer is important to understand the prognosis and treatment options that your doctor may discuss with you.