If your doctor suspects you have bladder cancer, they will examine you and arrange tests. The tests you have may include:
- general tests to check your overall health and body function
- tests to find cancer
- further tests to see if the cancer has spread (metastasised).
Some tests may be repeated during and after treatment to see how the treatment is working. If you feel anxious waiting for test results, it may help to talk to a friend or family member, or you can call 13 11 20 to speak to our trusted cancer nurses.
As the bladder is close to the rectum and vagina, your doctor may do an internal examination by sliding a gloved finger into the rectum or vagina to feel for anything unusual. Some people find this test embarrassing or uncomfortable, but it takes only a few seconds. Sometimes you won’t need an internal examination until after bladder cancer has been diagnosed.
Your doctor may take blood samples to check your overall health. You will also be asked for a urine sample, which will be checked for blood and bacteria (urinalysis). If you have blood in your urine, you may need to collect urine samples over three days. These samples will be checked for cancer cells (urine cytology).
Tests to find cancer in the bladder
The main test to look for bladder cancer is a cystoscopy. 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.
Before having scans, tell the doctor if you have any allergies or have had a reaction to contrast (dye) during previous scans. You should also let them know if you have diabetes or kidney disease or are pregnant or breastfeeding.
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.
In many cases, the next test 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.
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).
A CT (computerised tomography) scan uses x-rays and a computer to create a detailed picture of the inside of the body.
A scan of the urinary system may be called a CT urogram, CT IVP (intravenous pyelogram) or a triple-phase abdomen and pelvis CT – these are different names for the same test. Some people have a CT scan of other areas of the body to see if the cancer has spread.
As part of the procedure, a dye (the contrast) is injected into one of your veins. The dye travels through your bloodstream to the kidneys, ureters and bladder, and helps show up abnormal areas more clearly. 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 hot all over and cause some discomfort in the abdomen.
Symptoms should ease quickly, but tell the person doing the scan if you feel unwell. During the scan, you will need to lie still on a table that moves in and out of the scanner, which is large and round like a doughnut. The whole procedure takes 30–45 minutes.
Less commonly, your doctors may recommend an MRI (magnetic resonance imaging) scan to check for bladder cancer. This scan uses a powerful magnet and radio waves to create detailed cross-sectional pictures of organs in your abdomen. The MRI scan takes between 30 and 90 minutes.
Before the scan, let your medical team know if you have a pacemaker or any other metallic objects in your body. Also ask what the MRI will cost, as Medicare usually does not cover this scan for bladder cancer.
Before the MRI, you may be injected with a dye to help make the pictures clearer. You will then lie on an examination table inside a large metal tube that is open at both ends. The person doing the scan (radiographer) will place you in a position that will allow you to stay still and limit movement during the MRI. You will hear loud repetitive sounds during the scan.
The test is painless, but the noisy, narrow machine makes some people feel anxious or claustrophobic. If you think you could 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.
A CT or MRI scan can sometimes show if and how far the bladder cancer has spread, but you might also need other imaging tests such as a radioisotope bone scan, x-rays or a PET–CT scan.
Radioisotope bone scan
You may have a radioisotope scan 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.
Before you have the scan, a tiny amount of radioactive dye is injected into a vein, usually in your arm. You will need to wait for a few hours while the dye moves through your bloodstream to your bones. The dye collects in areas of abnormal bone growth.
Your body will be scanned with a machine that detects radioactivity. A larger amount of radioactivity will show up in any areas of bone affected by cancer cells. The scan is painless.
Afterwards, you need to drink plenty of fluids to help remove the radioactive substance from your body through your urine. It usually passes out of the body in a few hours. You should avoid being around young children and pregnant women for the rest of the day. Your treatment team will discuss these precautions with you.
You may need x-rays if a particular area looks abnormal in other tests or is causing symptoms. A chest x-ray can check the health of your lungs and look for signs the cancer has spread. Sometimes, people will have a CT scan instead of an x-ray.
A PET (positron emission tomography) scan combined with a CT scan is a specialised imaging test. It can sometimes be used to find bladder cancer that has spread to lymph nodes or other areas of the body that may not be picked up on a CT scan.
Clinic staff will tell you how to prepare for a PET–CT scan, particularly if you have diabetes. Before the scan, you will be injected with a glucose solution containing a small amount of radioactive material. Cancer cells show up brighter on the scan because they take up more glucose solution than normal cells do. You will be asked to sit quietly for 30–90 minutes as the glucose moves through your body, then you will be scanned.
It will take several hours to prepare for and have the PET–CT scan. Ask what the scan will cost, as Medicare does not currently cover the cost of a PET–CT scan for bladder cancer.
Staging bladder cancer
The tests above help show whether you have bladder cancer, how far the cancer has grown into the layers of the bladder, and whether there are any signs of cancer outside the bladder. This is called staging. Your doctor may describe the cancer as:
- Non-muscle-invasive bladder cancer (NMIBC) – the cancer cells are found only in the inner lining of the bladder (urothelium) or the next layer of tissue (lamina propria) and haven’t grown into the deeper layers of the bladder wall.
- Muscle-invasive bladder cancer (MIBC) – the cancer has spread beyond the urothelium and lamina propria into the layer of muscle (muscularis propria), or sometimes through the bladder wall into the surrounding fatty tissue. These cancers can also sometimes spread to lymph nodes close to the bladder.
- Advanced bladder cancer – the cancer has spread (metastasised) outside of the bladder into distant lymph nodes or other organs of the body.
The most common staging system for bladder cancer is the TNM (tumour-nodes-metastasis) system. In this system, letters and numbers are used to describe the cancer, with higher numbers indicating larger size or spread.
Some doctors put the TNM scores together to produce an overall stage, from stage 1 (earliest stage) to stage 4 (most advanced).
Grade and risk category
The biopsy results will show the grade of the cancer. This is a score that describes how quickly a cancer might grow. Knowing the grade helps your urologist predict how likely the cancer is to come back (recur) and if you will need further treatment after surgery.
- Low grade – the cancer cells look similar to normal bladder cells and are usually slow-growing. They are less likely to invade and spread.
- High grade – the cancer cells look very abnormal and grow quickly. They are more likely to spread both into the bladder muscle and outside the bladder.
In non-muscle-invasive cancers, the grade may be low or high, while almost all muscle-invasive cancers are high grade.
Based on the stage, grade and other features, a non-muscle-invasive bladder cancer will also be classified as having a lower or higher risk of returning after treatment or spreading into the muscle layer. Knowing the risk category will help your doctors work out which treatments to recommend.
Prognosis means the expected outcome of a disease. You may wish to discuss your prognosis with your doctor, but it is not possible for anyone to predict the exact course of the disease. In general, the earlier bladder cancer is diagnosed, the better the outcome.
To work out your prognosis, your doctor will consider:
- your test results
- the type of bladder cancer
- the stage, grade and risk category
- how well you respond to treatment
- other factors such as your age, fitness and medical history.
Understanding Bladder Cancer
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Expert content reviewers:
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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The information on this webpage was adapted from Understanding Bladder Cancer - A guide for people with cancer, their families and friends (2022 edition). This webpage was last updated in February 2022.