To find the cause of symptoms, the doctor asks about the patient's medical history and does a physical exam. The physical will include a rectal or vaginal exam that allows the doctor to check for tumors that can be felt. In addition, urine samples are sent to the laboratory for testing to check for blood and cancer cells.

The doctor may use an instrument to look directly into the bladder, a procedure called cystoscopy. This procedure may be done with local or general anesthesia. The doctor inserts a thin, lighted tube (called a cystoscope) into the bladder through the urethra to examine the lining of the bladder. The doctor can remove samples of tissues through this tube. The sample is then examined under a microscope by a pathologist. The removal of tissue to look for cancer cells is called a biopsy. In many cases, performing a biopsy is the only sure way to tell whether cancer is present. If the entire cancer is removed during the biopsy, bladder cancer can be diagnosed and treated in a single procedure.

A patient who needs a biopsy may want to ask the doctor some of the following questions:

• Why do I need to have a biopsy?
• How long will it take? Will I be awake? Will it hurt?
• What side effects can I expect?
• How soon will I know the results?
• If I do have cancer, who will talk with me about treatment? When?

Once bladder cancer is diagnosed, the doctor will want to learn the grade of the cancer and the stage, or extent, of the disease. Grade is important because it tells how closely the cancer resembles normal tissue and suggests how fast the cancer is likely to grow. Low-grade cancers more closely resemble normal tissue and are likely to grow and spread more slowly than high-grade cancers.

Staging is a careful attempt to find out whether the cancer has spread and, if so, what parts of the body are affected. The stage of bladder cancer may be determined at the time of diagnosis, or it may be necessary to perform additional tests. Such tests may include imaging tests--CT scan, MRI, sonogram, IVP, bone scan, or chest x-ray.