Your doctor will review your medical history, especially any history of kidney stones or urinary-tract infections, because these conditions also can cause blood in the urine. Your doctor also will ask about your history of cigarette smoking, your occupation and your diet.
If you don't smoke now, but did in the past, it is important to tell your doctor. Even though you have quit smoking, your risk of bladder cancer remains high for more than 10 years after your last cigarette.
After reviewing your symptoms and risk factors, your doctor will examine you, including a rectal examination and, in women, a pelvic examination. Your doctor also will order laboratory tests, including blood tests and urine tests to check for microscopic amounts of red blood cells and infection. In addition, a urine sample may be sent to a special lab to look for atypical cells and cancer cells.
The main test when looking for bladder cancer is cystoscopy, a procedure in which your doctor inserts a medical instrument through your urethra into your bladder so that he or she can look at the lining of your bladder. Your urethra is the opening through which you urinate. With cystoscopy, your doctor can see whether or not there are tumors growing in the bladder. During cystoscopy, your doctor either will take a biopsy of the tumor or remove it entirely, if that is possible. A biopsy involves cutting out a small piece of tissue so that it can be examined under a microscope to look for cancer cells. In many cases, two cystoscopies will be performed, the first to take a biopsy and determine whether cancer is present and the second to remove any cancer that was found during the first procedure.
In some cases, additional tests may be necessary to determine how far the cancer has spread. At the very least, your doctor should examine the ureters and the renal pelvises, which are the parts of the kidneys where urine collects before draining into the bladder. This can is done in one of three ways:
A special X-ray test called an intravenous pyelogram (IVP) - In an IVP, dye is injected into the blood and X-rays are taken of the kidneys and ureters as the dye filters through the kidneys and drains into the bladder. An IVP is done to look for other tumors in the upper urinary tract.
A special computed tomography (CT) scan called a CT urogram - A CT urogram creates computerized, three-dimensional images that allow a doctor to see the ureters clearly.
A retrograde pyelogram - This test I similar to an IVP, but it is done by a urologist during cystoscopy. Instead of the dye being injected into the bloodstream, the urologist injects dye directly into the ureters during cytoscopy.