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How is bladder cancer diagnosed?

If your doctor suspects you have bladder cancer, they will examine you and arrange tests. The tests you have will depend on your specific situation and may include:

  • general tests to check your overall health and body function;
  • tests to find cancer; and
  • further tests to see if the cancer has spread (metastasised).

Some tests may be repeated later to see how the treatment is working. If you feel anxious waiting for test results, it may help to talk to a friend, family member or health professional, or call Cancer Council 13 11 20.

General tests

Internal examination 
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.

Blood and urine tests
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 – this test is called a 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 – this is called a urine cytology.

Tests to find cancer in the bladder

The main test to look for bladder cancer is a cystoscopy. This is an examination of the inner lining of the bladder with a cystoscope, a tube with a light and a camera on the end. Other tests can give your doctors more information about the bladder cancer. These may include an ultrasound before the cystoscopy, a biopsy taken during a cystoscopy, and a CT or MRI scan.

An ultrasound uses soundwaves to create a picture of your organs. This scan is used to show if cancer is present and how large it is, but it can’t always find small tumours.

Your medical team will usually ask you to have a full bladder for the ultrasound. After the first scan, you will empty your bladder and the scan will be repeated.

During an ultrasound, you will uncover your abdomen and lie on a bench. A cool gel will be spread on your skin, and a device called a transducer will be moved across your abdomen. 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. Ultrasound scans are painless and usually take 15–20 minutes.

In many cases, the next test will be a cystoscopy using a flexible cystoscope. This is done under local anaesthetic, with a gel squeezed through a thin tube into the urethra to numb the area. The cystoscope is inserted through your urethra and into 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.

If an ultrasound and flexible cystoscopy suggest that there are suspicious areas in your bladder, you will probably have a cystoscopy with a rigid cystoscope. This will be done in hospital under a general anaesthetic, usually as a day procedure. You may also have a biopsy during the rigid cystoscopy. This is when tissue samples or small tumours are removed and sent to a pathologist to check for cancer.

After the rigid cystoscopy, 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 make sure you are near a toilet. You may also have some discomfort or notice some blood in your urine for a few days. Avoid lifting heavy objects until any bleeding has  settled.

In some cases, you may need a urinary catheter for several hours after a rigid cystoscopy. 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-ray beams to take many pictures of the inside of your body and then compiles them into one detailed, cross-sectional picture. 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. A CT scan of other parts of your body may be used to see whether the cancer has spread.

CT scans are usually done at a hospital or a radiology clinic. Your doctor will give you instructions about eating and drinking before the scan. As part of the procedure, a dye (the contrast) will be injected into a vein to make the pictures clearer. The dye travels through your bloodstream to the kidneys, ureters and bladder, and helps show up abnormal areas. You will then lie on an examination table that moves in and out of the scanner, which is large and round like a doughnut.

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 flushed and cause some discomfort in the abdomen. Symptoms should ease quickly, but tell the doctor if you feel unwell. 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 a computer to build up cross-sectional pictures of organs in your abdomen.

Before the scan, let your medical team know if you have a pacemaker, as the magnetic waves can interfere with some pacemakers. Also ask what the MRI will cost, as Medicare usually does not cover this scan for bladder cancer.

For an MRI, you may be injected with a dye that highlights the organs in your body. You will then lie on an examination table inside a large metal tube that is open at both ends. You will hear loud repetitive sounds. The radiographer will place you in a position that will allow you to stay still so that movement is limited during the MRI.

The noisy and narrow MRI machine makes some people feel anxious or claustrophobic. If you think you may 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. The MRI scan takes between 30 and 90 minutes.

A CT or MRI scan can sometimes show if and how far the bladder cancer has spread, but you might also need further imaging tests.

Radioisotope bone scan

A radioisotope scan may be done 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.

A tiny amount of radioactive dye is injected into a vein, usually in your arm. The dye collects in areas of abnormal bone growth. You will need to wait several hours before having the scan. This gives the bones time to absorb the dye. The scanner will measure the radioactivity levels and record them on x-ray film.

X-rays

You may need x-rays if a particular area looks abnormal in other tests or is causing symptoms. A chest x-ray may be taken to check the health of your lungs and look for signs the cancer has spread. This is sometimes done with the CT scanner.

FDG-PET scan

A PET (positron emission tomography) scan detects radiation from a low-level radioactive solution that is injected into the body. In an FDG-PET, the solution used is called fluorodeoxyglucose (FDG).

An FDG-PET scan can be used to find cancer that has spread to lymph nodes or other sites that may not be picked up on a CT scan. Medicare does not currently cover the cost of an FDG-PET scan for bladder cancer, so check with your doctor what you will have to pay. PET scans are usually available only in major hospitals, so you may need to travel to have one.

Before an FDG-PET scan, a small amount of FDG is injected into a vein. You will be asked to sit quietly for 30–90 minutes while the solution moves through your body. Your body is then scanned. Areas of cancer usually absorb more of the FDG, so they will be highlighted on the scan. It will take several hours to prepare for and have the scan.

This information is reviewed by

This information was last reviewed in February 2020 by the following expert content reviewers: Prof Dickon Hayne, UWA Medical School, The University of Western Australia, and Head, Urology, South Metropolitan Health Service, WA; BEAT Bladder Cancer Australia; Dr Anne Capp, Senior Staff Specialist, Radiation Oncology, Calvary Mater Newcastle, NSW; Marc Diocera, Genitourinary Nurse Consultant, Peter MacCallum Cancer Centre, VIC; Dr Peter Heathcote, Senior Urologist, Princess Alexandra Hospital, and Adjunct Professor, Australian Prostate Cancer Research Centre, QLD; Melissa Le Mesurier, Consumer; Dr James Lynam, Medical Oncologist Staff Specialist, Calvary Mater Newcastle and The University of Newcastle, NSW; John McDonald, Consumer; Michael Twycross, Consumer; Rosemary Watson, 13 11 20 Consultant, Cancer Council Victoria.