Being diagnosed with invasive and advanced bladder cancer

Your GP will ask you about your symptoms and will test your urine for signs of blood (haematuria). If there is no obvious reason for blood in your urine, such as an infection, they will arrange for you to see a specialist. At the hospital or haematuria clinic, a urologist or urology nurse specialist will examine you. They will explain the tests that you need.

You will usually have blood and urine tests and a flexible cystoscopy. A thin tube with a camera at the end is used to see inside your bladder. This is the main test to diagnose blad-der cancer. It is usually done under local anaesthetic and takes a few minutes.

You may also have scans such as an ultrasound, CT, MRI or PET-CT scan. You may also need to have a bone scan. You should be able to have these as an outpatient and go home afterwards.

Having tests and waiting for the results can be a difficult time. You may want to talk to someone close to you or one of our cancer support specialists.

How it is diagnosed

Most people are diagnosed after going to see their GP when they notice symptoms. Your GP will talk to you about your symptoms and ask you for a sample of your urine. They can do a quick test to find out if there is any blood in your urine (haematuria). The sample is then sent to a laboratory to check for infection.

If you have blood in your urine, your GP will make sure there is no obvious reason for this, such as an infection.

Your GP should arrange for you to see a specialist if:

  • you can see blood in your urine which can’t be explained
  • you can still see blood in your urine after having treatment for a urine infection
  • a urine test finds blood in your urine and you have urinary symptoms but don’t have a urine infection.

Most people are referred to a haematuria clinic for tests and to see a specialist. You can usually have most of the tests done on the same day.

Some people are referred to hospital to see a specialist. You may see a doctor who specialises in diagnosing and treating urinary, bladder and kidney problems (a urologist). Or you may see a nurse called a urology nurse specialist.


At the hospital

The urologist or urology nurse specialist will ask you about your symptoms and your general health. They will examine you by feeling your tummy (abdomen) and bladder. Then they will talk to you about the tests you need.

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:

Blood tests

You will have samples of your blood taken. These are used to check your general health and number of blood cells in your blood (blood count). They can also show how well your kidneys are working.

Urine tests

A sample of your urine can be tested to look for cancer cells.

Some people may have a test which looks for substances in the urine that are present in bladder cancer. This is called molecular testing and is only occasionally done.

Flexible cystoscopy

This is the main test used to diagnose bladder cancer. A cystoscope is a thin tube with a camera and light on the end. A doctor or specialist nurse uses it to look at the inside of your bladder.

A cystoscopy to check for bladder changes 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. This is to make the procedure less uncomfortable. The anaesthetic starts to work after a few minutes.

The doctor gently passes the cystoscope through your urethra and into the bladder. They look at the whole lining of the bladder and urethra. The 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 a couple of days after the test. You may also notice blood in your urine. This should clear up after a day or two. Your doctor will ask you to drink lots of fluids to help flush out your bladder.

If these symptoms don’t go away or you have a high temperature, tell your doctor straight away. They can check to make sure you don’t have an infection.

After the cystoscopy, the doctor will usually be able to tell you if they have seen a bladder tumour. If they have, they will arrange for you to come into hospital to have a rigid cystoscopy. This is done under general anaesthetic.

Rigid cystoscopy

During this test, the doctor will pass instruments through the cystoscope to remove the tumour. Or they may take a small piece of tissue (biopsy). This is done under general anaesthetic.

Blue light cystoscopy

During a cystoscopy, the doctor uses light to see inside the bladder. Sometimes the doctor uses a technique called blue light cystoscopy or photodynamic diagnosis (PDD). This is usually done under general anaesthetic as part of a rigid cystoscopy.

A light-sensitive drug is put into the bladder through the catheter. It is absorbed by cancer cells. During the cystoscopy, a blue light is used to show the inside of the bladder. The blue light makes areas of cancer glow pink. It can pick up small bladder tumours and carcinoma in situ (CIS).

Narrow-band imaging (NBI)

Some people may have a newer type of cystoscopy called narrow-band imaging (NBI). Your doctor or specialist nurse can give you more information.

Ultrasound scan

This scan can 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 gel is spread over your tummy (abdomen). A small device that gives out sound waves is passed over the area. It picks the sound waves up again when 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, which build up a three-dimensional picture of the inside of the body. The scan takes 10–30 minutes and is painless. It uses a small amount of radiation, which is very unlikely to harm you and will not harm anyone you come into contact with. You will be asked not to eat or drink for at least four hours before the scan.

CT scan
CT scan

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You may be given a drink or injection of a dye, which allows particular areas 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 are 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.

MRI scan

This test uses magnetism to build up a detailed picture of areas of your body. 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, such as a pacemaker, surgical clips, bone pins, etc. 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 likely that you won't 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.

PET-CT scan

This is a combination of a CT scan, which takes a series of x-rays to build up a three-dimensional picture, and a positron emission tomography (PET) scan. A PET scan uses low-dose radiation to measure the activity of cells in different parts of the body.

PET-CT scans give more detailed information about the part of the body being scanned. You may have to travel to a specialist centre to have one. You can't eat for six hours before the scan, although you may be able to drink. A mildly radioactive substance is injected into a vein, usually in your arm. The radiation dose used is very small. The scan is done after at least an hour’s wait. It usually takes 30–90 minutes. You should be able to go home after the scan.

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 small amount of a mildly radioactive liquid is injected into a vein, usually in your arm. The level of radioactivity used doesn’t cause any harm. Abnormal bone absorbs more of the radioactive substance than normal bone. These areas show up as highlighted on the scan. They are known as hot spots.

After having the injection, you will have to wait for up to three hours before you have a scan of your whole body. This gives time for the bone to absorb the radioactive substance. You may want to read a book or magazine to help pass the time.

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.

The procedure is nothing to worry about. It’s slightly uncomfortable for a few seconds as the camera goes in, but then it’s painless.

Richard


Waiting for test results

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 or one of the organisations listed on our database, can also provide support. You can also talk things over with one of our cancer support specialists on 0808 808 00 00.

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