The main test to look for bladder cancer is a cystoscopy. This procedure lets your doctor look closely at the bladder lining (urothelium). Other tests can give your doctors more information about the cancer. These may include an ultrasound before the cystoscopy, a tissue sample (biopsy) taken during a cystoscopy, and a CT or MRI scan.
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Ultrasound
An ultrasound uses soundwaves to create a picture of the bladder. This scan is used to show if cancer is present and how large it is, but an ultrasound can’t always find small tumours.
Your medical team will usually ask you to drink lots of water before the ultrasound so you have a full bladder. This makes the bladder easier to see on the scan. After the first scan, you will go to the toilet and empty your bladder, then the scan will be repeated.
During an ultrasound, you will lie on a bench and uncover your abdomen (belly). A cool gel will be spread on your skin, and a small handheld device called a transducer will be moved across your abdominal area. 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. An ultrasound scan is painless and usually takes 15–20 minutes.
Flexible cytoscopy
In many cases, the next test after an ultrasound will be a cystoscopy. This will be done with a flexible cystoscope – a thin, bendy tube with a light and a camera on one end. This procedure is done under local anaesthetic, with a gel squeezed through a thin tube into the urethra to numb the area. The cystoscope is put in through your urethra and into the bladder. The camera projects images onto a monitor so the doctor can see inside the bladder.
A flexible cystoscopy usually takes only a few minutes. For a few days afterwards, you may see some blood in your urine and feel mild discomfort when urinating.
Rigid cystoscopy and biopsy
If the ultrasound and flexible cystoscopy suggest there are areas in the bladder that look like cancer, you will probably have a cystoscopy with a rigid cystoscope (a thin tube that does not bend). This is done in hospital under general anaesthetic, usually as a day procedure.
The doctor may insert some instruments through the rigid cystoscope and remove tissue samples or small tumours from the lining of the bladder. This is known as a biopsy. A specialist doctor called a pathologist will examine the tissue under a microscope for signs of cancer. Biopsy results are usually available in 5–7 days. If you feel anxious waiting for the results, call Cancer Council 13 11 20 for support.
A rigid cystoscopy takes about 30 minutes. After the procedure, you may have some urinary symptoms, such as going to the toilet frequently, needing to rush to the toilet, or even having trouble controlling your bladder (incontinence). These symptoms will usually settle in a few hours. Keep drinking fluids and stay near a toilet.
For a few days afterwards, you may also have some discomfort or notice some blood in your urine. Avoid lifting heavy objects until any bleeding has settled.
After a rigid cystoscopy, you may need a urinary catheter for a few hours or up to 1–2 days. If larger tumours need to be removed during a cystoscopy, the operation is called a transurethral resection of bladder tumour (TURBT).
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Prof Dickon Hayne, Professor of Urology, UWA Medical School, The University of Western Australia, Chair of the Bladder, Urothelial and Penile Cancer Subcommittee, ANZUP Cancer Trials Group, and Head of Urology, South Metropolitan Health Service, WA; A/Prof Tom Shakespeare, Director, Radiation Oncology, Coffs Harbour, Port Macquarie and Lismore Public Hospitals, NSW; Helen Anderson, Genitourinary Cancer Nurse Navigator (CNS), Gold Coast University Hospital, QLD; BEAT Bladder Cancer Australia; Mark Jenkin, Consumer; Dr Ganessan Kichenadasse, Lead, SA Cancer Clinical Network, Commission of Excellence and Innovation in Health, and Medical Oncologist, Flinders Centre for Innovation in Cancer, SA; A/Prof James Lynam, Medical Oncology Staff Specialist, Calvary Mater Newcastle, NSW; Jack McDonald, Consumer; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; Tara Redemski, Senior Physiotherapist – Cancer and Blood Disorders, Gold Coast University Hospital, QLD; Prof Shomik Sengupta, Consultant Urologist, Eastern Health and Professor of Surgery, Eastern Health Clinical School, Monash University, VIC.
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