How bladder cancer is diagnosed

Your GP may also carry out an internal examination of your back passage (rectum) and, for women, your vagina. The rectum and vagina are very close to the bladder, so this allows your doctor to feel for any obvious changes.

Your GP will send your urine sample to a laboratory to be checked under a microscope for abnormal cells and for infection. They may also refer you to hospital for further tests or x-rays, and for expert advice and treatment from a urologist (a specialist doctor who treats bladder and kidney problems).

People who have visible blood in their urine (visible haematuria) and no signs of urinary infection are usually referred to the hospital urgently so that they are seen by a specialist within two weeks. Sometimes they go to a ‘one-stop’ haematuria clinic where all the tests needed to make a diagnosis can often be carried out on the same day.

At the hospital

You will see a specialist nurse or urologist, who will ask you about your symptoms and general health. They will then examine you by feeling your tummy (abdomen) and bladder, and you may have another internal examination. They’ll probably ask you to give another urine sample.

They will then arrange some of the following tests for you:

Blood tests

Samples of your blood may be taken to check your general health, the number of cells in your blood (blood count) and to see how well your kidneys and liver are working.

Cystoscopy

This is where a specialist nurse or doctor uses a cystoscope (a thin tube with a camera and light on the end) to look at the inside of your bladder. The doctor views the images on a TV monitor. Fine instruments can be passed down the cystoscope to carry out procedures.

A cystoscopy is usually done under a local anaesthetic. A jelly that contains anaesthetic is squeezed into the opening of your urethra (the tip of the penis or just above the vagina). The anaesthetic will start to work after a few minutes. The doctor will then gently pass the cystoscope into your urethra to show the lining of the urethra and bladder.

The whole test takes only a few minutes and you can usually go home after it is done. You may have some soreness or mild pain when you pass urine for the first time after the test. And, there may be some blood in your urine for the first couple of days. There are not usually any other after-effects.

If any abnormal areas that could be bladder cancer are seen during the cystoscopy, small pieces of tissue may be removed (biopsied) from these areas during the test. Alternatively, you may be asked to come back to the hospital for a second cystoscopy when biopsies can be taken under a general anaesthetic. The tissue samples are sent to be examined by a pathologist (an expert who identifies diseases by looking at cells under a microscope).

Photodynamic diagnosis

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 taken up by cancer cells. The doctor then shines a blue light on the area and any cancer cells glow (fluoresce). Trials studying PDD are trying to find out if it's a better technique than standard cystoscopy.

Ultrasound scan

This test uses sound waves to build up a picture of the inside of the body. It can show abnormalities in your urinary system (the bladder, ureters and kidneys). You’ll be asked to drink plenty of fluids before your test so that your bladder is full and can be seen clearly.

Once you’re lying comfortably on your back, a gel is spread over the skin of your 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) scan

A CT scan takes a series of x-rays that build up a three-dimensional picture of the inside of your body. Usually you will have x-ray pictures taken of the chest, abdomen and pelvis, and these pictures are fed into a computer to give a detailed picture. This picture will help your doctor look for any signs that the cancer has spread. The scan is painless and takes 10-30 minutes. You’ll be asked not to eat or drink anything for at least four hours before the scan. CT scans use a small amount of radiation, which is very unlikely to harm you and won’t harm anyone you come into contact with.

You may be given a drink or an injection of dye (contrast) before it. This helps the doctor see particular areas more clearly. Most people feel hot and flushed for a few minutes after having the injection. If you’re allergic to iodine or have asthma, you could have a more serious reaction to the injection, so it’s important to let your doctor know beforehand. You’ll probably be able to go home as soon as the scan is over.

Intravenous urogram (IVU)

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

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.

Bone scan

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

It will probably take 1-2 weeks for the results of your tests to be ready. Your results will show the stage of the cancer and help your specialist to decide on the most appropriate treatment for you.

Waiting for your results can be a difficult time. It may help you to talk things over with a relative or close friend. You may want to ring us and speak with one of our cancer support| specialists.