How bladder cancer is diagnosed

Usually, you begin by seeing your GP, who will examine you and ask you to give a urine sample. The examination may include an internal examination of the back passage (rectum) in men, and an internal examination of the rectum and vagina in women. As the rectum and vagina are so close to the bladder, this allows the doctor to feel for any lumps or thickening in the bladder.

The urine sample will be sent to a laboratory to be checked under a microscope for any cancer cells. Your GP may also arrange for further tests or x-rays. They will refer you to hospital for these tests, and for specialist advice and treatment from a urologist, if this is needed. Urologists are doctors who specialise in treating illnesses of the urinary system.

At the hospital

The urologist will ask you about your medical history and current symptoms. They will examine you by feeling your abdomen and bladder. You may have another internal examination and may give another urine sample.

Cystoscopy and biopsy

The most important test is a cystoscopy. It can be done while you are under a local or general anaesthetic.

In most cases it is done first under local anaesthetic. An anaesthetic jelly is squeezed into the urethra and you will wait a few minutes for it to work. A small, flexible, fibre-optic tube with a light at the end (cystoscope) is then passed into the urethra. This allows the doctor to look at the whole lining of the bladder and urethra. The whole test takes a few minutes and you can usually go home straight afterwards. You may have some soreness or mild pain when you pass urine for the first time. However, there are not usually any other effects.

If any abnormal area that could be a bladder cancer is seen, you will be invited back to the hospital for a cystoscopy on another day. This is normally done as a day-case under a general anaesthetic. Your specialist will give you instructions on how to prepare for the test. You may have a blood test and chest x-ray to make sure you are fit enough to have the anaesthetic. Under the anaesthetic, the doctor can thoroughly examine the inside of the bladder and can take samples (tissue biopsies) of any abnormal areas. Any small, mushroom-like growths can be snipped off, as they could be cancer. You can usually go home the same day. The tissue samples are sent to a pathologist who examines them under a microscope in a laboratory.

If the biopsy shows that you have cancer of the bladder, you will be asked to go back to the hospital to have the cancer removed.