Bladder cancer is most often initially diagnosed by examining cells in the urine under a microscope and confirmed by inspecting the bladder with a cystoscope, a slender tube fitted with a lens and a light that can be inserted into the urinary tract. Red blood cells are often an indicator of bladder cancer, although they can be found with benign conditions. Cystoscopy does not require a skin incision and can be easily performed in the clinic. If cancer is suspected, biopsies in the operating room will be needed to be taken during a cystoscopic examination to confirm the presence of cancer. Once cancer is confirmed, a computed-tomography (CT) scan, chest x-ray, and blood work may also be needed to determine if the cancer if confined to the bladder or whether it has spread to other parts of the body, such as the lymph nodes, lungs, bones, or liver.
About 75% of all bladder tumors are diagnosed while they are still confirmed to the lining of the bladder. This is known as superficial or non-invasive bladder cancer. The five-year survival rate for this type of bladder cancer is over 90%. Although superficial bladder cancer tends to recur frequently, most of the tumors that return are also superficial. There are more aggressive and worrisome subtypes of noninvasive bladder cancer and, up to 20% of superficial tumors may become invasive and grow into the muscle layer of the bladder. These tumors are more likely to spread to other parts of the body and require more invasive treatment.