Getting a diagnosis
In order to reach a diagnosis of bladder cancer – or eliminate it – your medical team will do lots of tests. This page explains what's involved and why they are important.
If you are reading this you, or someone you care about, is probably being investigated to find the cause of urinary problems. Signs and symptoms might include blood in your wee or pain when weeing, or needing to go more frequently. You may have been told that a possible cause of your symptoms is cancer, but there are other possibilities, such as a urinary tract infection (UTI), urinary stones, cystitis or prostate problems.
Please remember that cancer is only one possibility. However hard it may be, try not to jump to conclusions. Wait for your diagnosis.
Whatever the outcome, it is important to remember that you are not alone. There are many people who can give you the support and information you need to get you through.
Remember that every person is different – physically and mentally – so what is right for one person may not be right for another. Investigate, ask questions, talk to people and listen to their viewpoints, then make the best decision for you.
Initial tests for bladder cancer
Many of the symptoms of bladder cancer are the same as those experienced by people with a urinary tract infection (UTI). It is important to use several tests to rule out more straightforward conditions before diagnosing someone with bladder cancer. That is why there are a number of procedures used in the testing and assessment process. A full medical assessment is made as well as a full blood screen to assess kidney function.
The most common procedures used to test for bladder cancer are:
- urine test (at the same time as a medical assessment and blood screen)
- ultrasound scan of your kidneys, ureter and bladder
- flexible cystoscopy
- CT or MRI scan
Urine checks on a sample of your wee are sometimes carried out by your GP at an early stage to help them decide if you need further investigations. There are various types of urine tests that your GP may perform.
The first is a dip test for non-visible blood in the urine. This is usually carried out in the surgery and will help the doctor to decide on further actions. If the urine shows a possible infection, the sample will be sent for analysis. If the analysis confirms an infection, the doctor will prescribe an antibiotic.
The second is a mid-stream specimen of urine (MSU). This sample is usually sent to the hospital laboratory for testing and will help establish whether there is an infection in the urine.
Thirdly, there is a test called urinary cytology, in which a urine sample is sent to a different laboratory for analysis. This test aims to establish if you have any cancer cells in your wee. The test is not 100% accurate (it can miss cancers or think that cancers are present when they are not) so not all doctors use this test. If they do and the test is positive or inconclusive, you are likely to be referred to a urologist for further tests.
Some patients may be offered an ultrasound scan. An ultrasound scan is a good way of seeing into the internal organs of your body, and the radiologist who carries out the scan will be able to see if there are any signs of something abnormal in your bladder or kidneys.
This is the same scan that pregnant women have to check on their babies. It uses sound waves to create an image of your insides. It is a painless and quick outpatient procedure. The practitioner will spread some lubricating gel on your skin, which will feel cold.
They will then gently move a scanner head over your abdomen to display the pictures of your insides on the screen. You will feel some pressure and it may feel a little uncomfortable on a full bladder but it is over quickly
It may be possible, after these initial investigations, to determine whether or not you have bladder cancer. However, some cases are difficult to detect, in which case, even if there is an obvious growth in your bladder, further tests will be needed.
You may be referred to have a cystoscopy or a CT or MRI scan.
If a diagnosis has not been possible using urine tests or scans, you will be booked for a cystoscopy, which is the most important test for diagnosing bladder cancer.
A cystoscopy allows the urologist to look inside your bladder, and the images are shown on a large screen (although not all hospitals have this facility). You may be asked whether you would like to see the screen yourself. Many people find this positive but others would rather not look inside their own bladder, so don’t be afraid to tell them that if that’s how you feel.
Types of cystoscopy
There are two types of cystoscopy: a flexible cystoscopy (or flexi), and a rigid cystoscopy.
For an initial bladder inspection, it is most likely that the doctor or a urology clinical nurse specialist (CNS) will perform a flexible cystoscopy under a local anaesthetic using a thin, flexible instrument called a cystoscope.
For more information on cystoscopy including tips from patients about the procedure, download or order a copy of our Tests and Investigations booklet (see link at the bottom of this page).
A rigid cystoscope is generally used for treatments such as taking a tissue sample for examination in the pathology laboratory, or for removing cancer growths themselves from the lining of the bladder. This is a procedure known as a Transurethral Resection of Bladder Tumour (TURBT). It is almost always carried out under an anaesthetic, either a general or a regional (such as an epidural or spinal injection that numbs you from the waist down).
More information on what happens during a TURBT and tips from other people who have had this done, is available in our What is a TURBT booklet (link at the bottom of this page).
2. CT and MRI scans
Scans are becoming more common as diagnostic tools for bladder cancer.
Increasingly, patients who present with blood in their wee are given a computerised axial tomography (CAT or CT) scan. These scans are a special type of x-ray that provide a detailed picture of the inside of your body, focusing on the bladder, ureter and kidneys. Most patients will have a CT urogram, which involves using a contrast dye, either ingested or given as an injection, to give a clear impression of what is going on. The contrast medium may make you feel rather hot but should not otherwise be a problem.
However, if your kidney function is impaired, the scan will be given without the contrast because it can be toxic to the kidneys; this is known as a KUB scan. You should also let your doctor know if you are allergic to iodine or seafood as these may also mean a CT urogram is not appropriate.
A magnetic resonance imagination – or MRI – scan uses magnetic energy to build up a picture of the inside of your body. It is a painless procedure that is done as an outpatient appointment. You will change into a gown and you must be sure not to be wearing any metal. Make sure the doctor is aware if you have any implants.
During the scan, you lie in a tunnel in the scanner, so if you are feeling anxious about that, talk to the doctor in advance. The tunnel may seem quite small so people with claustrophobia find it uncomfortable. As the scanner is very noisy, you may be given earplugs or earphones – and you may even be offered a choice of music.
Contra-indications for CT and MRI scans
Both of these scans are painless and safe but there are some restrictions on who they are suitable for. For example, they are not always possible for people who have certain types of implants fitted, such as a pacemaker.
For all scans, you will need to let the hospital know if you have any allergies or kidney problems, or if you’re taking diabetes medication, as special arrangements may need to be made. You should also let the hospital know if you are pregnant.
The best advice is if you are worried about anything, just ask. Don't suffer in silence.
When will I know if I have bladder cancer?
The tests you have been through should be enough for your medical team to assess whether or not you have bladder cancer and they will give you the results of the investigations.
Sometimes, the problem will be obvious straight away and you will be given a diagnosis before you go home. Alternatively, it could be that you have to wait a few weeks for all the experts to review the results of your tests before they can let you know.
If it is NOT cancer
If it is not cancer, you will be referred to the appropriate consultant or medical team to deal with your specific problem. If the tests you have had have ruled out cancer but not established the cause of your symptoms, then your doctor will decide what additional tests you will need.
If you DO have bladder cancer
If you are diagnosed with cancer, there is nothing that can prepare you for that news and most people find they experience a whirlwind of emotions. Along with rising panic, you may be feeling overwhelmed, frightened and probably angry.
As a newly diagnosed bladder cancer patient, you are embarking on a journey. Right now, as you begin this journey, the most important thing you should know is: you are not alone.
There are thousands of others living with this disease, and there are people and resources to help you find the information you need to help you make the best choices, and the support you need to get you through.
Whether you have to wait just half an hour or two weeks for results, it will seem like forever. Hang on in there – this is all part of you getting the best treatment.
What could come next?
If you do have bladder cancer, at this stage, the medical team will not yet have all the information they need to be able to decide which treatment is best for you.
In order to do this, they may take a sample of cells from your bladder – known as a biopsy – to examine in the pathology laboratory. This sample will be taken during a second cystoscopy, usually a rigid cystoscopy.
Full details are in our What is a TURBT booklet (see link at the end of the page).
After all the various tests have been completed, you will be offered another appointment with your urologist, at which they will explain their findings and what they propose to do in terms of treatment.
Support for you
Please remember that you can contact us at any time for support, whether you are a patient or care for someone who is.
Our helpline is open from 09.00–16.30, Monday to Friday. There's an answerphone if we're busy, but we will call you back as soon as we can. Call 01844 351 621 or email email@example.com
Talking to other people who have had the same tests, investigations and diagnosis can help. Our private online forum on Facebook is available 24/7, 365 days a year. (See our getting support page for details of how to join and other support available.)
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We’ve done everything we can to make all the information on this site as accurate as possible. Whilst we have had support from a small team of medical professionals advisors to review the general medical content of this site, please remember, that only YOUR medical team can give YOU specific advice about YOUR symptoms or illness. We encourage you to discuss any potential options with them.