The main test to look for bladder cancer is a cystoscopy. This procedure lets your doctor look closely at the bladder lining (urothelium). Other tests can also give your doctors information about the cancer. These may include an ultrasound before the cystoscopy, a tissue sample (biopsy) taken during a cystoscopy, and a CT or MRI scan.
Learn more about:
Ultrasound
An ultrasound uses soundwaves to create a picture of the bladder. This scan is used to show if cancer is present and how large it is, but an ultrasound can’t always find small tumours.
Your medical team will usually ask you to drink lots of water before the ultrasound so you have a full bladder. This makes the bladder easier to see on the scan. After the first scan, you will go to the toilet and empty your bladder, then the scan will be repeated.
During an ultrasound, you will lie on a bench and uncover your abdomen (belly). A cool gel will be spread on your skin, and a small handheld device called a transducer will be moved across your abdominal area. 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. Having an ultrasound is painless and usually takes 15–20 minutes. Not all people will have an ultrasound. Sometimes, a CT scan is the first scan you will have.
Learn more about ultrasounds.
Cystoscopy
The next test is often a cystoscopy. This is done using a cystoscope (a thin tube with a light and camera on the end), which will be either flexible or rigid (a tube that does not bend). A flexible cystoscopy allows the doctor to see if there is a tumour, while a rigid cystoscopy or transurethral resection of bladder tumour (TURBT) is needed to remove a tumour. If the initial scans suggest there may be a tumour, you will usually have a rigid cystoscopy.
Flexible cystoscopy
This procedure is done under a local or general anaesthetic, with a gel squeezed into the urethra to numb the area.
The cystoscope is put through your urethra and into the bladder. The camera projects images onto a monitor so the doctor can see inside the bladder. A flexible cystoscopy usually takes only a few minutes. For several days after the procedure, you may see some blood in your urine and feel mild discomfort when urinating.
Rigid cystoscopy and biopsy
This is done in hospital under general anaesthetic, usually as a day procedure. It takes about 30 minutes.
The cystoscope is put through your urethra into the bladder. If a small tumour is found, the doctor will put some instruments into the cystoscope and remove a sample of tissue. This will be tested for signs of cancer (a biopsy). The biopsy results are usually available in 5–7 days. If a larger tumour is found, you may have a procedure called a transurethral resection of bladder tumour (TURBT).
After the cystoscopy, you may have some urinary symptoms, such as going to the toilet frequently and/or urgently, or even having trouble controlling your bladder (incontinence). These symptoms will usually settle in a few hours. Keep drinking fluids and stay near a toilet.
Before having scans, tell the doctor if you have any allergies or have had a reaction to contrast (dye) during previous scans. You should also let them know if you have diabetes or kidney disease or are pregnant or breastfeeding.
Learn more about biopsies.
→ READ MORE: CT scan for bladder cancer
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Dr Prassannah Satasivam, Urologist and Robotic Surgeon, Epworth Hospitals and Cabrini Hospitals, VIC; Donna Clifford, Urology Nurse Practitioner, Royal Adelaide Hospital, SA; Marc Diocera, Genitourinary Nurse Consultant, Peter MacCallum Cancer Centre, VIC; Dr Renee Finnigan, Radiation Oncologist, Gold Coast University Hospital, QLD; Lisa Hann, 13 11 20 Consultant, Cancer Council SA; Dr Andrew Hirschhorn, Director of Allied Health and MQ Health Academy, MQ Health, Macquarie University, NSW; Anne Marie Lyons, Stomal Therapy Nurse, Concord Hospital and NSW Stoma Limited, NSW; John McDonald, Consumer; Prof Manish Patel, Urological Cancer and Robotic Surgeon, Westmead Hospital, Macquarie University Hospital, and The University of Sydney, NSW; Dr Jason Paterdis, Urological Surgeon, Brisbane Urology Clinic, QLD; Graeme Sissing, Consumer; Prof Martin Stockler, Medical Oncologist, The University of Sydney, Concord Cancer Centre, and Chris O’Brien Lifehouse RPA, NSW.
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