Diagnosing bladder cancer

Tuesday 31 May, 2011
Reviewed by: Dr Farshad Foroudi, Radiation Oncologist, Peter MacCallum; Dr Mario Guerrieri, Radiation Oncologist, Radiation Oncology Victoria; Mr Shomik Sengupta, Urologist, Freemason's Medical Centre

On this page: Symptoms | Health professionals who treat bladder cancer | How bladder cancer is diagnosed | Urine test | Physical examination | Blood tests | Ultrasound scan | Cystoscopy and biopsy | Computerised tomography scan | Bone (radioisotope) scan | Chest x-ray | Intravenous pyelogram (IVP) | ‘Staging’ the disease

Diagnosis

The most common symptom of bladder cancer is blood in the urine (haematuria). This usually occurs suddenly and is generally not painful. The blood may be present on and off, and even if the bleeding has stopped, it is important to be checked for bladder cancer. Sometimes blood clots can form, and these may cause problems emptying the bladder.

The amount of blood in the urine is not related to the extent of the cancer. Sometimes there is only a small amount of blood, perhaps not even visible to the naked eye. Bladder cancer is often found ‘by accident' during routine tests.

Some people have a burning feeling when they pass urine, and need to pass urine often. These are symptoms of any bladder irritation and usually mean an infection rather than cancer. However, if it persists and is not cleared up by antibiotics, further tests may be needed.

If you see any blood in your urine, have it checked by your doctor as soon as possible. Remember that this symptom also occurs with kidney or bladder stones, and non-cancerous enlargement of the prostate in men.

Doctors and other health professionals you may see

Your doctor will examine you and refer you for tests to see if you have cancer. This can be a worrying and tiring time, especially if you need to have several tests.

If the tests show you have or may have cancer, your doctor will refer you to a specialist, who will examine you and may ask you to have more tests. If you have cancer, one or more specialists will advise you about treatment options.

You should expect to be cared for by a team of health professionals from the relevant major fields listed below. Ideally, your tests and treatments should be available at your hospital; however, this may not be possible.

Health professionals who care for people with bladder cancer include:

  • urologists, who are surgeons who specialise in diseases of the urinary tract and are responsible for tests including biopsies and other surgical procedures
  • medical oncologists, who are responsible for chemotherapy
  • radiation oncologists, who are responsible for radiotherapy
  • nurses and general practitioners, who will help you through all stages of your cancer
  • stomal therapy nurses, who help people care for a stoma
  • dieticians, who will advise you about the best foods to eat while you are recovering
  • social workers, physiotherapists, psychologists and occupational therapists, who will advise you on support services and help you get back to normal activities.

How bladder cancer is diagnosed

If your doctor suspects that you have bladder cancer, they will recommend some of the following tests.

Urine test

Your doctor will ask you for a urine sample. This will be sent to a laboratory to be checked under a microscope for any unusual cells.

Physical examination

The doctor will examine your abdomen, pelvis and other organs; this will usually include internal examinations. A doctor may do a more extensive physical check later, in hospital, while you are under anaesthetic.

Blood tests

The doctor will take a blood sample to check your general health and your blood count (the relative numbers of different cells in your blood) and to see how well your kidneys are working.

Ultrasound scan

In this test, sound waves are used to make up a picture of the organs on the inside of your abdomen and pelvis, particularly the kidneys and bladder.

Before your test you will be asked to drink plenty of fluids so that your bladder is full and a clear picture can be seen. Once you are lying on your back, a jelly is spread over your abdomen. A small device, like a microphone, is passed over the area. The echoes are converted into a picture by a computer, which may be recorded and printed. A radiologist (x-ray doctor) will provide a report on the scan for your doctor.

This is painless and usually takes about 15 to 20 minutes.

Cystoscopy and biopsy

Cystoscopy is the main test used to diagnose bladder cancer. It can be done while you are under a general anaesthetic but sometimes is done under local anaesthetic.

Some jelly containing anaesthetic is inserted into the urethra. The doctor uses a small, flexible telescope called a cystoscope to look at the lining of the bladder and urethra. The cystoscope is gently passed through the urethra and into the bladder.

If anything unusual is seen, the doctor will examine your bladder while you are under a general anaesthetic. A sample of tissue will be removed from the inside or lining of the bladder. This is called a biopsy. The sample will then be looked at under a microscope to see if there are any cancer cells. If an obvious cancer is found during this test it can be removed at the same time. 

Further tests

If the tests show that you have bladder cancer, the urologist may want you to have more tests, to see if the cancer has spread. Many bladder cancers have a low chance of spreading, so people with these bladder cancers may not need further tests. These tests also help the doctor to decide on the best type of treatment for you.

Computerised tomography (CT) scan

A CT scan is a type of x-ray that takes pictures of your organs and other structures, including tumours. These are put together to build up a three-dimensional picture of your body.

This painless test is usually done at a hospital or a radiology clinic and takes 30 to 40 minutes to complete. You may be asked not to eat or drink before the scan. You may have a liquid dye (contrast) before the scan, in a drink and/or in an injection. This dye makes your organs appear white on the scans, so anything unusual will show more clearly.

You will be asked to lie on a table that slowly moves through the CT scanner, which is large and round like a doughnut. Most people can go home as soon as the scan is over.

Some people, especially people who are allergic to iodine or shellfish, may be allergic to the dye. If you think you may have such an allergy, tell your doctor and the staff performing the CT scan.

CT scans are sometimes also used to investigate symptoms such as blood in the urine, and may show a bladder cancer.

Bone (radioisotope) scan

A radioisotope scan may be done for some cancers, to see if any cancer cells have spread beyond the bladder and into other places such as the bones. For this test, a tiny amount of a radioactive dye is injected into a vein, usually in the arm. It is normal to wait for the dye to move through the body for a while before the images are taken. For a bone scan, this can take three to four hours.

You will be scanned by a machine that measures tiny amounts of radioactivity. The doctor can tell if the cancer has spread, because a larger amount of radioactivity is found in areas of bone affected by cancer cells. This causes a dark spot to appear on the bone scan.

The amount of radiation used is small and the radiation disappears from your body within a few hours. You will be advised to avoid contact with pregnant women and young children for the rest of the day, and drink plenty of fluids.

This procedure is not recommended for pregnant or breastfeeding women.

Chest x-ray

A chest x-ray uses low doses of radiation to check for abnormal areas in the chest. It takes only a few minutes and is painless and safe. This is taken to check that your lungs and heart are healthy.

Intravenous pyelogram (IVP)

You may have an intravenous pyelogram (IVP), which shows up unusual changes in the kidneys, bladder and the rest of the urinary system, although this test is not commonly done.

A dye is injected into a vein, usually in the arm, and goes through the blood to the kidneys. The doctor can watch the dye move around the body on an x-ray screen and see anything unusual.

The dye will probably make you feel hot and flushed for a few minutes, but this will pass. You may feel some discomfort in your abdomen, but this won't last long. You should be able to go home as soon as the test is over. It takes about an hour.

‘Staging’ the disease

The tests described above show whether you have cancer. They will show where the primary cancer is and whether the cancer cells have spread to other parts of your body (this is known as metastasis). This helps your doctors ‘stage’ the disease so they can work out the best treatment for you.

The staging system used for bladder cancer is known as the ‘TNM system’ (T=tumour, N=nodes, M=metastases).

  • T followed by a number between 1 and 4 describes how far the cancer has spread into the bladder wall and nearby tissue. A higher number after the T (for example, T3 or T4) means it has spread further.
  • N plus a number from 0 to 3 describes whether the cancer has spread to lymph nodes near the bladder and, if so, the amount of cancer in the nodes. Higher numbers are used for nodes that are more affected by the cancer.
  • M followed by 1 shows that the cancer has spread to other organs or to lymph nodes that are not near the bladder. M0 means there is no sign of the cancer having spread in this way.

Doctors combine this information to work out the stage of the cancer, from Stage 1 to Stage 4. For example, a cancer assessed as T1, N0, M0 (tumour contained within the bladder, lymph nodes not affected and no metastasis) would be called a Stage 1 cancer.

Ask your doctor to explain the stage of your cancer in a way you can understand. This will help you to choose the best treatment for your situation.

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