Checking for bladder cancer usually involves a number of tests. The diagnostic tests for bladder cancer you get will depend on your specific situation and may include:
- general tests to check your overall health and body function
- tests to find bladder cancer
- further tests to see if the cancer has spread (metastasised).
Some tests may be repeated during or after treatment to check how well the treatment is working.
Waiting for the test results can be a stressful time. It may help to talk to a friend or family member, a health professional, or call Cancer Council 13 11 20.
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To investigate abnormal symptoms, your doctor may perform an internal examination and arrange certain blood and urine tests.
As the bladder is close to the rectum and vagina, your doctor may do an internal examination by inserting a gloved finger into the rectum or vagina to feel for anything unusual. Although some people find this test embarrassing or uncomfortable, it is painless and only takes a few seconds.
Blood and urine tests
Blood samples may be taken to check your general health. You will be asked to give a urine sample, which will be checked for blood and bacteria – this test is called a urinalysis. You may also be asked to give three separate urine samples, which will be sent to a laboratory to look for cancer cells (cytology).
Bladder cancer tests
To determine the position of the cancer in the bladder, you will need various tests. These may include an ultrasound, a CT or MRI scan, a flexible cystoscopy, and a rigid cystoscopy and biopsy.
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.
Your medical team will usually ask you to have a full bladder for the ultrasound. After the first scan, you will then be asked to empty your bladder and the scan will be repeated.
During an ultrasound scan, 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 solid, such as an organ or tumour. A computer turns the soundwaves into a picture.
Ultrasound scans are painless, and they usually take 15–20 minutes.
A CT (computerised tomography) scan uses x-ray beams to take many pictures of the inside of your body and then compiles them into one detailed, cross-sectional picture. If the scan is checking for bladder cancer, it may be called a CT-IVP (intravenous pyelogram) or a triple-phase abdomino-pelvic CT.
CT scans are usually done at a hospital or a radiology clinic. Your doctor will give you instructions about eating and drinking before the scan.
As part of the procedure, a dye, sometimes called the contrast, will be injected into one of your veins. The dye usually contains iodine. If you have had an allergic reaction to iodine or dyes during a previous scan, tell your medical team beforehand. You should also let them know if you are diabetic, have kidney disease or are pregnant.
The dye travels through your bloodstream to the kidneys, ureters and bladder, and shows up any abnormal areas. You will then lie on an examination table and pass through the CT scanner, which is large and round like a doughnut.
The scan is usually done three times: once before the dye is injected, once immediately afterwards, and then again a bit later. The dye may make you feel flushed and cause some discomfort in your abdomen. Symptoms should ease quickly, but tell the doctor if you feel unwell.
The whole procedure takes 30–45 minutes.
Less commonly, an MRI (magnetic resonance imaging) scan may be used to check for bladder cancer. This scan uses magnetic waves to create detailed cross-sectional pictures of organs in your abdomen. You should let your medical team know if you have a pacemaker, as the magnetic waves can interfere with some pacemakers.
For an MRI, you may be injected with a dye that highlights the organs in your body. You will then lie on an examination table inside a large metal tube that is open at both ends.
The noisy, narrow machine makes some people feel anxious or claustrophobic. If you think you may become distressed, mention it beforehand to your medical team. You may be given a mild sedative to help you relax or you might be able to bring someone into the room with you for support. You will usually be offered headphones or earplugs.
The MRI scan may take between 30 and 90 minutes.
Cystoscopy is a common procedure for diagnosing bladder cancer. A slender hollow tube with a light and a camera, called a cystoscope, is used to examine the inner lining of the bladder. The cystoscope may be flexible or rigid.
In many cases, your first cystoscopy will use a flexible cystoscope and will be done under local anaesthetic. For this procedure, anaesthetic jelly is passed down the urethra to numb the area. The cystoscope is inserted through your urethra and into the bladder to examine the whole of the inside lining.
If the test finds abnormal tissue, you will usually be asked to come back for a rigid cystoscopy under general anaesthetic so that a tissue sample (biopsy) can be taken (see Rigid cystoscopy and biopsy, below).
A flexible cystoscopy usually takes 10–20 minutes. For a few days afterwards, you may experience some soreness, pain, or blood in your urine.
Rigid cystoscopy and biopsy
If earlier tests suggest that there are suspicious areas of tissue or tumours in your bladder, you will probably have a cystoscopy performed in hospital under a general anaesthetic. This type of cystoscopy uses a rigid cystoscope.
A biopsy is when tissue samples or small tumours are removed during the cystoscopy and sent to a pathologist to check for cancer cells.
In the first few hours after the cystoscopy, you may have some difficulty controlling your bladder (incontinence), but this will usually settle. Continue to drink enough fluids and make sure you are near a toilet. You may have some soreness, pain, or blood in your urine for a few days.
If larger tumours need to be removed during a cystoscopy, the operation is called a transurethral resection of bladder tumour (TURBT).
A CT or MRI can sometimes show how far the bladder cancer has spread, but you might also need further tests such as an FDG-PET scan, a radioisotope bone scan or x-rays. In some cases, cancer cells that have spread outside the bladder are not detected in further tests.
FDG-PET (fluorodeoxyglucose positron emission tomography) is a specialised imaging test that can find disease in lymph nodes and at other sites that may not be picked up on a CT scan.
Before an FDG-PET scan, you will be injected with a specially modified sugar molecule (fluorodeoxyglucose or FDG). You will be sedated or asked to sit quietly for 30–90 minutes while the solution moves through your body. Cancer cells will absorb more of the FDG, so they will be highlighted when your body is scanned.
It will take several hours to prepare for the scan and to have it. You may want to take a book to read or bring a friend for company and support.
Radioisotope bone scan
A radioisotope scan may be done to see if any cancer cells have spread to the bones. This will usually only be done if the tumour is advanced or you have bone pain. It may also be called a whole body bone scan (WBBS) or simply a bone scan.
A tiny amount of radioactive dye is injected into a vein, usually in your arm. The dye collects in areas of abnormal bone growth. You will need to wait for several hours before having the scan. This gives the bones time to absorb the dye. The scanner will measure the radioactivity levels and record them on x-ray film.
You may want to bring a book or another activity to pass the time while you are waiting.
Although only a little radioactive material is used, it may take a few hours to leave your body. You will need to drink plenty of fluids. The medical staff will discuss any precautions, such as avoiding contact with pregnant women and young children for the rest of the day. Speak to your doctor if you are concerned.
You may need x-rays if a particular area looks abnormal in other tests or is causing symptoms. A chest x-ray may be taken to check the health of your lungs and for any signs the cancer has spread. This is sometimes done with the CT scanner.