If you are referred to a UCLH specialist, there are several tests you may have to check for bladder cancer. Most patients are referred because of blood in urine or abnormal, persistent symptoms such as recurrent urinary tract infection. Blood in urine is known as haematuria and can be visible or non-visible which is usually picked up following a dipstick test.
It is important to know that most people with haematuria will not have bladder cancer, but we want to make sure that this is the case.
You may be asked to provide a urine sample so it can be checked for any infection or abnormal cells. The test for abnormal cells is called urine cytology.
Urinary cytology is not 100 per cent accurate, so is used selectively. It can sometimes detect abnormal cells even though there is no cancer present (a false-positive result), or it can fail to detect abnormal cells when cancer is present (a false-negative result). Urinary cytology is therefore used to help diagnose bladder cancer, rather than to provide a definitive diagnosis.
At UCLH we are conducting a study which is funded by the Medical Research Council (MRC) to develop a urinary test for bladder cancer which will be more effective that cytology and you may be invited to take part.
Cystoscopy uses an instrument known as a cystoscope (a thin tube with a camera and light at the end) to examine the inside of your bladder. The procedure usually takes about five minutes.
During a flexible cystoscopy, a local anaesthetic gel is applied to your urethra (the tube through which you urinate) in order to minimise any pain you might feel. The gel also acts as a lubricant to help the cystoscope pass into the urethra more easily and has antiseptic properties.
It will be necessary to check your kidneys as a cause of haematuria and we will perform a scan, either an ultrasound scan or a CT scan to assess the kidneys. The decision to perform an ultrasound scan or CT scan will depend on your symptoms.
- Kidney ultrasound – non-invasive scan of the kidneys, urethras and bladder using ultrasound waves.
- Computerised tomography (CT) scan – a series of x-rays are taken to create a detailed picture of the inside of the body; you may be given an injection of contrast dye beforehand which helps to provide better quality images and highlight abnormal areas
If abnormalities are found in your bladder during a cystoscopy, it is likely you will be asked to return for a further cystoscopy under general anaesthetic so the abnormal bladder tissue can be sampled or removed for further testing. This is referred to as a cystoscopy and biopsy when a bladder inspection and sample of tissue is required, or TURBT (trans-urethral resection of a bladder tumour) if a growth (tumour) in the bladder needs to be removed. The abnormal tissue is then sent for laboratory testing to see if bladder cancer is present.
Once all of the tests have been completed it should be possible to tell you the grade of the cancer and what stage it is.
Grading is a measurement of how likely the cancer might be to return or to spread to other parts of the body in the future (the potential risk). Bladder cancer is graded using a numbering system ranging from grade 1 (low-risk) to grade 3 (high-risk). Higher grade bladder cancers have more potential to return or spread in the future than lower grade cancers.
Staging is a measurement of how far the cancer has spread (the extent of the cancer). The most widely used staging system for all cancers is called as the TNM classification system. This identifies:
- T (tumour) - how much the cancer has grown and spread.
- N (nodes) - whether the cancer has spread into nearby lymph nodes.
- M (metastasis) - whether the cancer has developed in another part of the body such as the lungs or bones (also called secondary cancer).
Your urology team will be able to provide more information about the TNM classification of your cancer.
Generally speaking, lower stage bladder cancers are usually confined to the inside wall of the bladder (non-muscle invasive) and have a better chance of successful response to treatment.