Bladder cancer diagnosis

A number of procedures will be done to diagnose bladder cancer. Most bladder cancers have a low chance of spreading – particularly if found early – so some of these tests may not be necessary. However, it is also possible that some cancer cells may have spread outside the bladder, so they are not always detected in tests.

  • General tests - Simple procedures that are not used to diagnose cancer, but can suggest if cancer is present. This includes a physical examination, blood tests and urine tests.
  • Tests to find the position of the cancer in the bladder -  A cystoscopy and biopsy, ultrasound and some types of CT scan.
  • Tests to find any cancer that may have spread –  Includes CT scans, MRI scans, radioisotope bone scans and x-rays.

Most tests are done on an outpatient basis, so you will probably be able to go home when they are finished.

Physical examination

Your doctor may feel for anything unusual by inserting a gloved finger into the rectum and, in women, the vagina. This may help to determine the size of the bladder tumour and if it has spread.

This test may be embarrassing and uncomfortable, but it only takes a few minutes. Some people have a physical examination under anaesthesia, during their first cystoscopy.

Blood test

A blood sample will be taken to check the different types of blood cells and show how well your organs are working.

Urine test (urinalysis)

You will be asked to give a urine sample, which is sent to a laboratory and checked for blood, bacterial infection (not cancer) or cancerous cells.

Cystoscopy and biopsy

Cystoscopy is the main procedure used to diagnose bladder cancer. It is a surgical procedure that is usually done as day surgery.

  • A cystoscopy may be done under local or general anaesthetic. If the doctor needs to take a tissue sample (biopsy), it is usually done under general anaesthesia.
  • A slender tube called a cystoscope is inserted through your urethra into the bladder. It has a lens and a light that allows the doctor to view the bladder on a monitor.
  • Small pieces of tissue can be removed from suspicious areas or growths.  If cancer is found during the cystoscopy,  it may be removed during the procedure.
  • Tissue will be examined under a microscope to check for cancer cells.
  • This takes 10-20 minutes.

For a few days afterwards you may have some soreness, pain or blood in your urine. If the tumour is large, you may have a tube left in your bladder to drain urine into a bag for 1-2 days. This is called a urinary catheter.

Ultrasound

An ultrasound scan uses soundwaves to create a picture of your organs. It is used to show if cancer is present and how large it is. An ultrasound can’t always find small tumours, so your doctor may do further tests.

  • You will uncover your abdomen and lie on an examination table.
  • A gel will be spread on your skin and a device called a transducer will be moved across your abdomen.  The transducer creates soundwaves that echo when they meet something dense, such as an organ or tumour.
  • The soundwaves are sent to a computer, which creates pictures of your body.
  • It is a painless scan.
  • Takes about  15-20 minutes.

MRI scan

An MRI (magnetic resonance imaging) scan uses magnetic waves to create detailed cross-section pictures of organs in your abdomen.

  • You may be injected with a dye that highlights the organs in your body.
  • Tell your doctor if you are allergic to iodine, fish or dyes before this injection, and tell your doctor if you have a pacemaker — you may not be able to have the MRI due to the effect of the magnet.
  • You will lie on an examination table inside a large metal tube that is open at both ends.
  • It is noisy and narrow, so some people feel claustrophobic (afraid of being confined in a small space). If you are distressed, speak to the person performing the scan. You may be given medication to help you relax or you might be able to take someone into the room with you for support.
  • Takes  30-90 minutes.

CT IVP or three-phase renal CT scan

A CT (computerised tomography) scan is a type of x-ray that takes several pictures of the inside of your body. The pictures are put together to build up a three-dimensional picture of your body. The scan may be called a three-phase renal CT or a CT IVP (intravenous pyelogram).

CT scans are usually done at a hospital or a radiology clinic. You will be asked not to eat for a few hours before the scan.

  •  Before the procedure, a dye will be injected into your vein. This may make you feel flushed, and you may have abdominal discomfort. Symptoms should ease quickly but tell your doctor if you feel unwell.
  • Tell your doctor if you are allergic to iodine, fish or dyes before this injection.
  • The dye travels through your bloodstream to the kidneys, ureters and bladder.
  • You will lie on an examination table and pass through the CT scanner, which is large and round like a doughnut.
  • You will usually be scanned three times: once before the dye is injected, once immediately afterwards, and then again a bit later.
  • The whole procedure takes about 30-45 minutes.

Radioisotope bone scan

A radioisotope scan may be done to see if any cancer cells have spread into the bones.

  • A tiny amount of a radioactive dye is injected into a vein, usually in your arm.
  • The radioactive substance collects in areas of abnormal bone growth.
  • After a few hours, a scanner measures the radioactivity levels and records them on x-ray film.
  • The radioisotope scan may take several hours in total.
  • You might have to sit alone after you are given the dye, so you may want to bring a book or something else to occupy your time.

Although only a small amount of radioactive material is used, it may take a few hours for it to leave your body. You will need to drink plenty of fluids, and the medical staff will talk to you about safety precautions, such as avoiding contact with pregnant women and young children for the rest of the day. Talk to your doctor if you are concerned.

X-rays

A chest x-ray may be taken to check your lungs for signs of cancer. This is sometimes done with the CT scanner.

This information was last reviewed in May 2012

This information has been reviewed by: Dr Paul Gassner, VMO Uro-oncological Surgeon at Bankstown, Liverpool and Shoalhaven Hospitals, NSW; David Connah, Cancer Council Connect Consumer Volunteer; Virginia Ip, Urology Care Coordinator, Sydney Cancer Centre, Royal Prince Alfred Hospital, NSW; Samantha Kelaher, Cancer Council Helpline Consultant, Cancer Council NSW; and Gary Schoer, Cancer Council Connect Consumer Volunteer.

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