Diagnosis & Staging

At Memorial Sloan Kettering, our doctors evaluate hundreds of cases of bladder cancer annually and have developed extensive expertise in diagnosing the disease. Our pathologists are highly practiced at analyzing cell and tissue samples to accurately identify cancer subtypes and assess stages.

Because of the extensive number of referrals made to Memorial Sloan Kettering, our physicians are also familiar with diagnosing and treating rarer bladder cancers, such as squamous cell carcinoma and small cell carcinoma.

We perform a comprehensive physical examination and order a urine sample test to look for cancer cells under a microscope. Through an examination of the inside of the bladder — in which a thin, lighted instrument called a cystoscope is inserted into the bladder through the urethra — we can take a small amount of tissue and examine it. This outpatient procedure is done under general anesthesia, which likely enables patients to go home the same day.

We may also perform imaging tests to confirm the diagnosis and stage the cancer. These tests may include:

  • Computed Tomography (CT), in which special x-ray equipment obtains cross-sectional pictures of the body. A CT scan can determine whether the cancer cells are confined to the bladder or have spread to other parts of the body, such as the lymph nodes, lungs, bones, or liver.
  • Magnetic resonance imaging (MRI), which produces pictures of the inside of the body and can help in determining whether the cancer has invaded the muscle in the bladder wall and how deeply.
  • Positron emission tomography (PET), in which a small amount of radioactive fluid is injected into a vein and a scanner makes detailed, computerized pictures of areas inside the body. PET scans capture images at the molecular level and enable your doctor to distinguish between living and dead tissue, to determine whether it is normal or cancerous.

For most people, CT and MRI provide enough information to stage and evaluate bladder cancer. Our doctors are continually investigating improvements, however, and a recent study suggested that combining CT with PET may provide additional diagnostic information compared with CT and MRI alone (1).

If diagnostic tests indicate the presence of bladder cancer, your doctor will use this information to determine the type and stage of the tumor (how advanced it is) and choose the best treatment approach.

Bladder cancer stages are based on whether the tumor is still confined to the lining of the bladder or has penetrated the muscles of the bladder, or whether cancer cells have traveled beyond the organ to other parts of the body.

Five stages of bladder cancer

  • Stage 0 — Noninvasive (known as in situ)
    Cancer cells are found only on the surface of the inner lining of the bladder.
  • Stage I — Superficial, Non-Muscle-Invasive
    Cancer is confined to the inner lining of the bladder, with no evidence that it has spread to another part of the pelvis or to other organs.
  • Stage II — Muscle-Invasive
    Cancer has spread into the muscle wall of the bladder.
  • Stage III — Muscle-Invasive
    Cancer has spread into the muscle wall of the bladder as well as the fatty layer surrounding the bladder, and to reproductive organs such as the prostate, uterus, or vagina.
  • Stage IV — Metastatic
    Cancer has spread beyond the bladder to the wall of the abdomen or pelvis, and possibly to lymph nodes or other parts of the body.