| Bladder cancer | Diagnosing bladder cancer | Treatment for bladder cancer |
| Sexuality & bladder cancer | Living with a stoma |
This information has been reviewed by:
Associate Professor Jeremy Millar
Alfred Hospital, William Buckland Radiotherapy Centre
Doctors and other health professionals who treat bladder cancer
How bladder cancer is diagnosed
Liver and abdominal ultrasound scan
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 one day and disappear the next, but eventually it does come back. 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. 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 then 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.
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 (a ‘multidisciplinary team': see following list). Ideally, all your tests and treatment will be available at your hospital. This may not be possible in some non-metropolitan areas. Health professionals who care for people with bladder cancer include:
If your doctor suspects that you have bladder cancer, they will recommend some of the following tests.
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.
The doctor will examine your pelvis and other organs. A doctor may do a more extensive physical check later, in a hospital, while you are under anaesthetic.
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.
An intravenous pyelogram (IVP) shows up unusual changes in the kidneys, bladder and the rest of the urinary system. 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 pick up 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.
Some people, especially people who are allergic to iodine, may be allergic to the dye. If you think you may have such an allergy, tell your doctor and the staff performing the IVP.
In this test, sound waves are used to make up a picture of the inside of your abdomen and the liver. 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. This is painless and takes about 15 to 20 minutes.
The main test used to diagnose bladder cancer is called a cystoscopy. It can be done while you are under a general anaesthetic but in most cases is done under local anaesthetic.
Some jelly containing anaesthetic is inserted into the urethra. Using a small, flexible telescope called a cystoscope, the doctor looks 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 bladder has to be examined under a general anaesthetic. A sample of tissue is removed from the inside or lining of the bladder. This is called a biopsy. The samples are then 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. See the ‘Treatment’ section later in this booklet.
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.
The CT scan is a special type of x-ray that gives a three-dimensional (3-D) picture of the organs and other structures (including any tumours) in your body.
CT scans are usually done at a hospital or a radiology clinic. It takes about 30 to 40 minutes to complete this painless test. You may be asked not to eat or drink before the scan, except you may have a liquid dye, in a drink and/or in an injection. This dye makes your organs appear white on the scans that are taken, so anything unusual will show more clearly.
You will be asked to lie on a table while the CT scanner, which is large and round like a doughnut, moves around you. Most people are able to go home as soon as their scan is over. Some people, especially people who are allergic to iodine, 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 diagnose bladder cancer, as well as see whether the cancer has spread.
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 3 to 4 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 dis-appears 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.
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.
The tests described on previous pages 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).
Doctors combine this information to work out the stage of the cancer, from Stage 1 (I) to Stage 4 (IV). 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 I 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.
