Initial testing
If you notice blood in your urine, your GP will ask you to provide a urine sample. This will be sent to a laboratory to be tested for any abnormal cells that could be due to the presence of bladder cancer. This test is known as urinary cytography.
Urinary cytography is not 100% accurate. It can sometimes detect abnormal cells when there no cancer is present (a false-positive result) or alternatively it can fail to detect abnormal cells when cancer is present (a false-negative result). Therefore, urinary cytography is an aid to diagnosis but it is not a definitive diagnosis in itself.
Your urine will also be tested for the presence of bacteria in case your symptoms are due to an infection.
Your GP will also examine your rectum (back passage) and, if you are a woman, your vagina. This is because in some cases of bladder cancer it is possible to feel a noticeable lump that presses against the rectum and vagina.
If the results of these initial testing are inconclusive, or a diagnosis of bladder cancer is suspected, it is likely that you will be referred to an urologist for further testing. A urologist is an expert in treating conditions that affect the urinary system.
Confirming the diagnosis
Intravenous urogram (IVU)
An intravenous urogram (IVU) is a test that is used to determine whether there are any abnormalities in your urinary system (your bladder, kidneys and uterus). An IVU can sometimes help to confirm a diagnosis of bladder cancer, or uncover an alternative cause of your symptoms, such as bladder stones.
Before the IVU takes place, you will be injected with a special dye that shows up on X-ray. The radiologist (a specialist in using medical imaging technology, such as X-rays) will study how the dye moves through your urinary system in order to see if there are any problems.
You may experience a metallic taste in your mouth and flushed, itchy skin when the dye is injected. This is normal and the symptoms will pass in a few minutes.
Cystoscopy
A cystoscopy is a procedure that uses a special instrument, called a cystoscope, to examine the inside of your bladder. The procedure usually takes between 5-10 minutes to perform.
A cystoscope is a thin, flexible telescope (viewing tube) that is passed into your body and allows the urologist to look inside your bladder.
During a cystoscopy, jelly containing a local anaesthetic is squirted into the opening of your urethra (the tube through which you urinate). As well as working as a painkiller, the jelly helps the cystoscope to pass into the urethra more easily.
The urologist will study the lining of your bladder and urethra in order to identify any abnormal areas that could be the result of bladder cancer.
Biopsy
If any abnormalities are found in your bladder during a cystoscopy, it is likely that you will be asked to come back so that a sample of bladder tissue can be removed for further testing. This is known as a biopsy.
A sample of bladder tissue will be taken using a more rigid type of cystoscope as it is necessary to pass small surgical instruments up through the cystoscope in order to remove the sample. As this procedure can be uncomfortable, you will be given a general anesthetic.
Further testing
If the results of your biopsy show that there are cancerous cells in your bladder lining, you may be referred for a series of further tests in order to determine whether the cancer has spread beyond the lining of your bladder and, if so, how far it has spread.
These tests can include:
- chest X-rays
- computer topography (CT) scan
- a magnetic resonance imaging (MRI) scan
- a bone scan
A bone scan involves a small amount of radioactive material being injected into your veins. Abnormal areas of bone will absorb the material at a faster rate than normal bone. Therefore, any abnormal areas of bone that may be affected by cancer will show up as "hot-spots" on the scan.
