How bladder cancer is diagnosed
Usually, you begin by seeing your GP who will ask for a sample of your urine. This is tested in the GP surgery to find out if there’s any blood present (haematuria), and is sent to a laboratory to be checked for any infection.
If there’s no obvious explanation for having blood in the urine (such as an infection), your GP should arrange an urgent referral if:
you can see blood in your urine whatever your age
you have urinary symptoms and a urine test finds blood in your urine (although it can’t be seen) at any age
a urine test finds blood in your urine and you’re over 40.
You may be referred to hospital to see a doctor who specialises in diagnosing and treating urinary, bladder and kidney problems (a urologist). Some people are referred directly to a haematuria clinic where tests needed to find the cause can often be carried out on the same day.
The urologist or a urology nurse specialist will ask about your urinary symptoms and your general health.
The doctor may examine you by feeling your abdomen (tummy) and bladder. They will then usually arrange some tests for you. At a haematuria clinic, you will have tests carried out on the day you attend.
Having tests to diagnose bladder cancer can take a while and some may need to be repeated. This can be frustrating, but it’s important your doctor has all the information they need to make the diagnosis. You’ll usually have some of the following tests.
Samples of your blood may be taken to check your general health, the number of blood cells in your blood (blood count) and how well your kidneys are working.
A urine sample will be taken to see if there are any cancer cells in it. Sometimes, a test to check for other markers in the urine (molecular testing) may be done. This is not a standard test and is still in the early stages of being used.
This is the main test used to diagnose bladder cancer. A doctor or specialist nurse uses a cystoscope (a thin tube with a camera and light on the end) to examine the inside of your bladder.
A cystoscopy to check for bladder abnormalities is usually done under local anaesthetic using a flexible cystoscope. You may be asked to drink lots of fluids before the cystoscopy and to provide a sample of urine, which will be checked for infection.
The doctor or nurse will squeeze a jelly containing anaesthetic into the opening of your urethra (see diagram on page 7) to make the procedure less uncomfortable. The anaesthetic starts to work after a few minutes. Some people may have a sedative to help them relax.
The doctor gently passes the cystoscope through your urethra and into the bladder and examines the whole lining of the bladder and urethra. The whole test takes a few minutes and you can usually go home after it’s finished.
You may have some burning or mild pain when you pass urine for the first couple of days or notice blood in your urine. This should clear up after a day or two. You’ll be asked to drink lots of fluids to help flush out your bladder.
If these symptoms don’t go away or you have a high temperature, it’s important to see your doctor to make sure you don’t have an infection.
After the cystoscopy, the doctor will be able to tell you if they have seen a bladder tumour. They will then arrange for you to come into hospital to have a procedure under general anaesthetic. This will involve having another cystoscopy, but the doctor will pass instruments through the cystoscope to take a small piece of tissue taken (biopsy), or to remove the tumour.
If you need to have a biopsy or a tumour removed from the bladder lining, you’ll usually have a cystoscopy in hospital under a general anaesthetic.
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During a standard cystoscopy, the doctor uses white light to see inside the bladder. A new technique called photodynamic diagnosis (PDD) involves having a light-sensitive drug put into the bladder before the cystoscopy. This is absorbed by cancer cells. During the cystoscopy, the doctor uses a blue light, which makes areas of cancer glow (fluoresce). This helps to pick up small bladder tumours and carcinoma in situ (CIS).
Research is going on to find out if using PDD is a better technique than a standard cystoscopy for diagnosing bladder cancer.
This test can also show up anything unusual in your urinary system. It uses sound waves to build up a picture of the inside of the body. You’ll be asked to drink plenty of fluids before the test so that your bladder is full and can be seen clearly.
Once you’re lying comfortably on your back, a special gel is spread over your tummy (abdomen). A small device like a microphone is passed over the area. It gives out sound waves and picks them up as they bounce back as echoes from the organs inside your body. The echoes are made into a picture by a computer. The scan is painless and takes about 15-20 minutes. Once it’s over, you can empty your bladder.
CT (computerised tomography) urogram
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A CT scan takes a series of x-rays, which builds up a three-dimensional picture of the inside of the body. A CT urogram is a CT scan of the bladder, ureters and kidneys.
The scan is painless and takes 10-30 minutes. It uses a small amount of radiation, which is very unlikely to harm you and won’t harm anyone you come into contact with. You’ll be asked not to eat for at least four hours before the scan.
You may be given a drink or an injection of a dye, which allows your bladder, ureters and kidneys to be seen more clearly. This may make you feel hot all over for a few minutes.
It’s important to let your doctor know if you’re allergic to iodine or have asthma, because you could have a more serious reaction to the injection.
You’ll probably be able to go home as soon as the scan is over.
Intravenous urogram (IVU)
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Some people may have an IVU. This test shows if there’s anything unusual in your urinary system. It’s done in the hospital x-ray department and takes about an hour. A dye is injected into a vein, usually in the arm, and travels through the bloodstream to your kidneys. The doctor watches on a screen to see how the dye passes through the urinary system. This helps them see any problems. The dye will make you feel hot and flushed for a few minutes, but this feeling goes away after a short time. If you have allergies or asthma, tell the doctor and the person doing the test before you have the injection.
This investigation can be combined with a CT scan and is known as a CT urogram. You will probably be able to go home as soon as the scan is over.
MRI (magnetic resonance imaging) scan
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This test uses magnetism to build up a detailed picture of areas of your body. It’s used to find out how deeply the cancer has grown into the bladder and if it has spread outside the bladder. The scanner is a powerful magnet, so you may be asked to complete and sign a checklist to make sure it’s safe for you. The checklist asks about any metal implants you may have (for example, a pacemaker, surgical clips or bone pins). You should also tell your doctor if you’ve ever worked with metal or in the metal industry, as very tiny fragments of metal can sometimes lodge in the body. If you do have any metal in your body, it’s unlikely that you’ll be able to have an MRI scan. In this situation, another type of scan can be used.
Before the scan, you’ll be asked to remove any metal belongings including jewellery. Some people are given an injection of dye into a vein in the arm, which doesn’t usually cause discomfort. This is called a contrast medium and can help the images from the scan to show up more clearly. During the test you’ll lie very still on a couch inside a long cylinder (tube) for about 30 minutes. It’s painless but can be slightly uncomfortable, and some people feel a bit claustrophobic. It’s also noisy, but you’ll be given earplugs or headphones. You can hear and speak to the person operating the scanner.
A bone scan can show any abnormal areas of bone. It may be done to find out if the cancer has spread to the bones.
A very small amount of a mildly radioactive liquid will be injected into a vein, usually in your arm. The level of radioactivity used is very small and doesn’t cause any harm. Abnormal bone absorbs more of the radioactive substance than normal bone. This shows up on a scan as highlighted areas (known as hot spots).
You will have to wait for up to three hours after having the injection before you have a scan. This is to allow time for the bone to absorb the radioactive substance. It’s a good idea to take a book or a magazine to help pass the time. After a few hours, you’ll have a scan of the whole body.
A bone scan can show conditions other than cancer, such as arthritis. In this case, you may need to have further tests, such as an x-ray of the abnormal area.
Waiting for test results
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Waiting for test results can be a difficult time. It may take from a few days to a couple of weeks for the results of your tests to be ready.
You may find it helpful to talk with your partner, family or a close friend. Your specialist nurse can also provide support. You can also talk things over with one of our cancer support specialists.