Before you start treatment, your doctor first will get a clear understanding of the cause of your symptoms. To make their diagnosis, MSK experts learn about your medical history and overall health. They will give you a thorough exam and diagnostic tests, such as:

Cystoscopy and Transurethral Resection

A cystoscopy (sis-TOS-koh-pee) is a procedure that lets your doctor look at your urinary system. People who have a cystoscopy usually go home the same day.

How a cystoscopy is done

Many times, we do a quick office procedure using the cystoscope that takes less than 5 minutes. It gives us a complete view of the inside of your bladder and urethra.

Sometimes we do the cystoscopy as an outpatient surgery. This procedure takes a little longer, and you must have anesthesia (medicine to make you go to sleep). Your doctor will carefully examine your bladder’s lining. If necessary, they also will do a biopsy (take a sample of the tissue).

A transurethral (TRANZ-yoo-REE-thrul) resection of a bladder tumor (TURBT) is when we remove or biopsy a bladder tumor with the cystoscope. 

Urine Cytology

Another test is a urine cytology, which checks your urine sample for cancer cells.

Imaging of the Urinary Tract

Your doctor may order imaging tests to look at your urinary tract. You may need to have contrast during your scan. Contrast is a special dye used to make it easier for your doctor to see differences in your internal organs. Contrast is given into an intravenous (IV) in your hand or arm. The dye flows into your bladder to help find areas that have cancer.

• CT scan: A computed tomography (CT) scan helps your care team see if cancer cells are only in your bladder, or have spread. During a CT scan, sometimes called a CAT scan, a machine uses radiation to take detailed pictures of your body. It takes a series of pictures from different angles. A computer linked to the machine puts the pictures together to make 3D images.
• MRI: Magnetic resonance imaging (MRI) helps your care team see if cancer is in the bladder wall muscle, and how deep it is. This test also looks for signs of whether the tumor has spread outside the bladder. An MRI uses strong magnetic fields to make detailed 3D images of the inside of your body. We use the images to see the type, size, and location of tumors.
• PET scans: A positron emission tomography (PET) scan is a type of nuclear medicine test. PET scans take images that help your care team find cancer cells. 

Genetic Analysis of Bladder Tumors

For advanced bladder cancer that has spread, we use a test tool only offered at MSK called MSK-IMPACT^®. It’s for people with advanced cancer, and some early-stage cancers. This test looks at about 500 genes for genetic changes (mutations or variants) and other tumor traits.

MSK-IMPACT^® gives us very important information that tells us:

• The best treatment choices based on your tumor’s profile.
• Whether it’s likely a certain treatment will work well for you.
• If you’re a good match for one of our research studies, also known as clinical trials.

MSK doctors and researchers created MSK-IMPACT^®. It’s the first tumor-profiling test developed in a laboratory to get approved by the U.S. Food and Drug Administration(FDA).

If you need a more sensitive test after you have MSK-IMPACT^®, MSK also offers MSK-ACCESS^®. It’s a liquid biopsy test that looks for cancer cell genetic traces in your blood. This test analyzes 129 genes to see if your cancer has come back.