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Bladder cancer tests

Most people begin by seeing their GP. Your GP will ask about your general health and examine you. You may have to give a urine sample, which will be sent away for testing. Your GP may want to examine you internally, to check other nearby organs. To do this they will put a gloved finger into your rectum (back passage) or vagina to see if everything feels normal.

At the hospital

The specialist will ask about your medical history and symptoms. They will examine you. And you may need to give another urine sample. Your doctor will then arrange for you to have an examination of the inside of the bladder called a cystoscopy.

Cystoscopy

This is the most important test for diagnosing bladder cancer. The doctor puts a thin tube with a light on the end inside your bladder. The tube has fibre optic cables inside it. This lets the doctor see inside your bladder. You can have this with a local anaesthetic.

If your doctor sees anything abnormal, they will want to take tissue samples. For this you will need another cystoscopy, this time under general anaesthetic. While you are under a general anaesthetic, the doctor will examine your bladder, take tissue samples (biopsies) and snip off any small growths. You can usually go home the same day.

Other tests

You may have 

  • An ultrasound of the urinary tract
  • An X-ray of the whole urinary system called an intravenous urogram
  • A CT scan of the urinary system called a CT urogram

 

CR PDF Icon You can view and print the quick guides for all the pages in the Diagnosing bladder cancer section.

 

 

Seeing your GP

Most people begin by seeing their GP if they have any symptoms of illness. Your GP will ask you about your general health and examine you. You may have to give a urine sample to be sent away for testing to see whether your symptoms could be due to a urine infection. If you have a bladder cancer the urine may contain some cancer cells.

Your GP may want to examine you internally, because the bladder is very close to the bowel, the prostate (in men) and the womb (in women). Your doctor will put a gloved finger into your rectum (back passage) or vagina to see if everything feels normal. If your doctor thinks that your symptoms could be due to a cancer they will refer you to a hospital. There you will see a doctor who specialises in illnesses of the urinary tract (a urologist).

 

At the hospital

Some hospitals have specialised clinics for people who have blood in their urine (haematuria). Other hospitals have urology departments, which diagnose and treat people with any urinary tract problems. The specialist you see will begin by asking you about your medical history and symptoms. They will then examine you by feeling the area around your tummy (abdomen) and bladder. 

You may be asked to have another internal examination. And you may need to give another urine sample. Your doctor will then arrange for you to have one or more of the following tests. Most people first have a cystoscopy. In some hospitals or clinics you may first have an intravenous urogram (IVU), an ultrasound of the urinary tract or a CT scan of your urinary tract.

 

Looking inside your bladder (cystoscopy)

This is the most important test for diagnosing cancer of the bladder. It means putting a thin tube with a light inside your bladder. The tube has fibre optic cables inside it. These allow your doctor to see inside your bladder. You can have this test done under local or general anaesthetic. During cystoscopy under local anaesthetic, your doctor will only examine the bladder. If you need tissue samples taken, you will need a cystoscopy under general anaesthetic.

 

Cystoscopy under local anaesthetic

You may have this test at your first appointment because it can be done quite quickly. The doctor will squeeze some anaesthetic jelly into your urethra and wait a few moments for it to work. In men, this means squeezing the jelly down the penis. This can be uncomfortable but should not be painful.

Once the anaesthetic has worked, your doctor will put the cystocopy tube (cystoscope) into your bladder and move it around to examine the whole of the inside lining. This only takes a few minutes. If anything looks abnormal inside your bladder, your doctor will want to take tissue samples (biopsies). So you will need another appointment to have a cystoscopy under general anaesthetic.

Cystoscopy for a man

Diagram showing a cystoscopy for a man © CancerHelp UK

Cystoscopy for a woman

Diagram showing a cystoscopy for a woman © CancerHelp UK

You can go home straight after this test. Your doctor or nurse will probably give you antibiotics to take for a few days to prevent infection. You may feel some discomfort or mild pain when you pass urine for the first time afterwards. But apart from that, there are usually no after effects.

 

Cystoscopy under general anaesthetic

For a cystoscopy under general anaesthetic, you will need to go into hospital. You will probably not have to go in until the day of the test. You shouldn't eat or drink anything for at least 6 hours before a general anaesthetic. Your specialist will give you exact instructions.

You may have a blood test and a chest X-ray before your anaesthetic. This is just to check your general health and is routine. When it is time for your cystoscopy, you will put on a hospital gown and lie on a trolley to go down to the operating theatre, where you will have your anaesthetic.

While you are under anaesthetic, your specialist will thoroughly examine the inside of your bladder and urethra. They will take samples of tissue (biopsies) of any areas that look abnormal. Your specialist will snip off any little mushroom like growths that you have inside the bladder because these may be cancer. The specialist may also take some biopsies from areas of the bladder lining that look normal. This helps to be sure of the diagnosis.

As part of the cystoscopy your doctor may put a light sensitising dye into the bladder an hour before the procedure. During the cystoscopy they shine a blue light on the bladder lining to show up any abnormal cells. They call this blue light cystoscopy or photodynamic diagnosis (PDD) of bladder cancer. It can help to show up any areas of cancer more clearly. 

You can usually go home the same day after a cystoscopy. This will depend on

  • How many biopsies your doctor took
  • How the anaesthetic affected you
  • The time of day you have the anaesthetic because if it is very late in the day, it may be better for you to stay overnight
  • If there are large tumours that need treatment you will need to stay longer and you may need a catheter (a tube in the bladder) for a few days after the operation
 

Ultrasound scan

An ultrasound scan test uses a microphone to bounce sound waves off body structures and build up a picture. Liver ultrasound scans are used to check for cancer spread to the liver. 

Ultrasound scans can check for blockages in the tubes that move urine between the kidney and bladder (the ureters). Doppler ultrasound, which uses colour pictures, can show the blood flow into the kidneys and urine flow into the bladder. There is information about having an ultrasound scan in the section on cancer tests.

 

Intravenous urogram (IVU)

An intravenous urogram (IVU) is also sometimes called an intravenous pyelogram (IVP). It is a general X-ray examination to look at the whole of your urinary system. You may have this test to see what is causing your symptoms. If you are having the test after you've had a cancer diagnosis, this is to make sure the rest of your urinary tract is healthy. There is information about having an IVU in the section about cancer tests.

 

CT scan of the urinary tract

In some hospitals you may have a special computerised tomography (CT) scan called a CT urogram. This scan is to make sure that any blood in your urine is coming from the bladder and nowhere else in your urinary tract. The scanner creates computerised, three dimensional pictures that allow your doctor to see the whole urinary tract clearly. 

There is information about having a CT scan in the section on cancer tests. Before the test you may have a drug called furosemide to make you produce more urine and give better pictures of the kidneys. 

 

Urine tests

There are some urine tests in development to help diagnose bladder cancer, such as the NMP22 test and the MCM5 test. There is more about this in the bladder cancer research section.

Some hospitals take blood tests to measure levels of a hormone called human chorionic gonadotrophin (HCG). The level of HCG can be raised in some people whose bladder cancer has spread.

 

Getting the results

Your doctor will ask you to go back to the hospital when your test results have come through. But this may take from a few days to a couple of weeks. This is a very anxious time for most people. While you are waiting for results it may help to talk to a close friend, a relative or your specialist nurse about how you feel. You may want to contact a cancer support group to talk to someone who has been through the same experiences. 

Our bladder cancer organisations page gives details of people who can help and support you. You can also find details of counselling organisations in our counselling section. Our bladder cancer reading list has information about books and leaflets on bladder cancer and its treatment. If you want to find people to share experiences with on line, you could use CancerChat, our online forum. 

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Updated: 21 October 2013