Cystoscopy:
This is the most common and reliable test used to detect bladder cancer. During this test, a thin tube with a camera attached at one end (cytoscope) is inserted into the bladder through the urethra to examine the inside walls of the bladder. The doctor can also remove a sample of tissue for laboratory examination. This test can be performed under local anesthesia (where an anesthetic jelly is inserted into the urethra) or general anesthesia (situation where the patient needs to stay in the hospital).The most common side effect of cystoscopy is a soreness or mild pain when the patient urinates for the first time. The main disadvantage of this test is that it can miss flat lesions (Carcinoma in situ) or small papillary tumors. It is recommended that this test to be performed in combination with other tests (such as imaging and urine tests) for a correct diagnosis.

Imaging tests

• Computed Tomography (CT): This imaging test is similar with an x-ray test, and creates a detailed cross-sectional image of the body. This test can identify abnormal mass tissues.
  A CT scan is usually performed in two steps for a better diagnosis outcome:
  1). First, the targeted area is scanned without a contrast agent.
  2). Second, the targeted area is scanned after a contrast agent was administrated.
  This imaging test offers essential information regarding the tumor size, shape, and exact location, and also can outline if the cancer spread to other organs.

• Magnetic Resonance Imaging (MRI): An MRI is an advanced technique that uses radio waves and strong magnets to reveal a complete image of a targeted area of the body. The energy from the radio waves is absorbed by the tissues and then released into a pattern that allows the cancer to be detected and diagnosed.

• Chest X-ray: An x-ray test uses high energy electromagnetic radiation to penetrate the body and creates its image on a film. The chest x-ray is performed only in women with advanced stages of bladder cancer in order to establish whether or not the cancer has spread to the lungs.

• Bone Scan: This test is used to detect if the cancer has affected the bones. Before performing this test, the patient receives, through an injection, a radioactive agent that travels throughout the body and collects in areas where cancerous cells have been collected.

• Intravenous Pyelogram (IVP): This imaging test is an x-ray of the urinary tract. The patient, prior to the x-ray, receives a dye agent which is removed from the bloodstream by the kidneys and is passed into the ureters and bladder. The dye agent allows the doctor to locate the cancer in the bladder.

• Fluorescence In Situ Hybridization (FISH): This is a cytogenetic technique (the study of the structure of chromosome material) used to detect and localize the presence of certain chromosomal abnormalities often found in transitional cell cancer. This test is efficient in detecting recurrent cancer before the tumor becomes visually present. This test is used in clinic trials patients.

• Ultrasound Scan: Ultrasound imaging is a medical technique that uses high-frequency sound waves to create an interior image of the body on a special computer screen. This image is formed from the echoes of the sound waves on the surface of the organs. Abnormal tissue masses and organs reflect sound waves differently. This test involves a device called transducer, that is placed on the abdomen, and a computer that translates this sound into an image. Ultrasound imaging is a safe, noninvasive and brief test that can detect tumors. This test can check for blockages in the ureters caused by possible tumors.

Biopsy:
Biopsy is a medical procedure where a tissue sample is removed from the tumor or abnormal looking surface of an organ for a microscopic examination. In bladder cancer patients, the biopsy is removed during cystoscopy. In some cases, the entire tumor might be removed during biopsy. This procedure allows the pathologist to establish the nature of the cells and determine whether they are cancerous or not, and the cancer type.