Bladder cancer tests

To investigate abnormal symptoms, your doctor may perform an internal examination and arrange certain blood and urine tests.

Internal examination

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 also be asked to give a urine sample, which will be checked for blood and bacteria – this test is called a urinalysis. If you have blood in your urine, you may be asked to give three separate urine samples over three days, which will be sent to a laboratory to look for cancer cells – this test is called a urine cytology.

To determine the position and extent 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.

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 additional tests.

Your medical team will usually ask you to have a full bladder for the ultrasound. After the first scan, you will 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 cool 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.

Cystoscopy

A cystoscopy is a common procedure for diagnosing bladder cancer. A thin tube with a light and a camera on the end (cystoscope) is used to examine the inner lining of the bladder. The cystoscope may be flexible or rigid.

Flexible cystoscopy

In many cases, your first cystoscopy will be done under local anaesthetic using a flexible cystoscope. 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.

This procedure usually takes 10–20 minutes. For a few days afterwards, you may see blood in your urine and feel mild discomfort when passing 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 with a rigid cystoscope. It will be performed in hospital under a general anaesthetic.

With this type of cystoscope, a biopsy can be taken. This 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 rigid cystoscopy, you may have some difficulty controlling your bladder (incontinence), but this will usually settle. Continue to drink fluids and make sure you are near a toilet. You may also have some discomfort, need to pass urine urgently or have blood in your urine for a few days. Avoid lifting anything heavy until the bleeding has settled.

If larger tumours need to be removed during a cystoscopy, the operation is called a transurethral resection of bladder tumour (TURBT).

CT scan

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 urothelial carcinoma, 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 a vein to make the pictures clearer. 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 that moves in and out of the 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.

MRI scan

Less commonly, an MRI (magnetic resonance imaging) scan may be used to check for bladder cancer. This scan uses a powerful magnet to build up cross-sectional pictures of organs in your abdomen. Before the scan, let your medical team know if you have a pacemaker, as the magnetic waves can interfere with some types of 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. You will hear loud repetitive sounds. The radiographer will place you in a position that will enable you to stay still so that movement is limited during the MRI.

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 earplugs or headphones to listen to music.

The MRI scan takes between 30 and 90 minutes.

A CT or MRI scan can sometimes show how far the bladder cancer has spread, but you might also need further imaging tests such as a radioisotope bone scan, x-rays or an FDG-PET scan.

 Radioisotope bone scan

A radioisotope scan may be done to see whether the cancer has spread to the bones. 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 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.

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.

X-rays

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.

FDG-PET  scan

This scan can be used to find cancer that has spread to lymph nodes or other sites that may not be picked up on a CT scan. Medicare does not currently cover the cost of an FDG-PET (fluorodeoxyglucose-positron emission tomography) scan for bladder cancer. If this test is recommended, check with your doctor what you will have to pay. PET scans are usually found only in major hospitals, so you may need to travel to have one.

Before an FDG-PET scan, a small amount of radioactive solution is injected into a vein. This specially modified sugar molecule is called fluorodeoxyglucose or FDG. You will be sedated or asked to sit quietly for 30–90 minutes while the solution moves through your body. Your body is then scanned. Areas of cancer usually absorb more of the FDG, so they will be highlighted on the scan. It will take several hours to prepare for and have the scan.