If you have symptoms of bladder cancer, such as blood in your urine, you should see your GP.
Your GP may ask about your symptoms, family history and whether you've been exposed to any possible causes of bladder cancer, such as smoking.
In some cases, your GP may request a urine sample, so it can be tested in a laboratory for traces of blood, bacteria or abnormal cells.
Your GP may also carry out a physical examination of your rectum and vagina, as bladder cancer sometimes causes a noticeable lump that presses against them.
If your doctor suspects bladder cancer, you'll be referred to a hospital for further tests.
In 2015, the National Institute for Health and Care Excellence (NICE) published guidelines to help GPs recognise the signs and symptoms of bladder cancer and refer people for the right tests faster. Find out who should be referred for further tests for suspected bladder cancer.
At the hospital
Some hospitals have specialist clinics for people with blood in their urine (haematuria), while others have specialist urology departments for people with urinary tract problems.
If you're referred to a hospital specialist and they think you might have bladder cancer, you should first be offered a cystoscopy.
This procedure allows the specialist to examine the inside of your bladder by passing a cystoscope through your urethra (the tube through which you urinate). A cystoscope is a thin tube with a camera and light at the end.
Before having a cystoscopy, a local anaesthetic gel is applied to your urethra (the tube through which you urinate) so you don't feel any pain. The gel also helps the cystoscope to pass into the urethra more easily.
The procedure usually takes about five minutes.
You may be offered a CT scan or an MRI scan if the specialist feels they need a more detailed picture of your bladder.
An intravenous (IV) urogram may also be used to look at your whole urinary system before or after treatment for bladder cancer.
During this procedure, dye is injected into your bloodstream and X-rays are used to study it as it passes through your urinary system.
Transurethral resection of a bladder tumour (TURBT)
If abnormalities are found in your bladder during a cystoscopy, you should be offered an operation known as TURBT. This is so any abnormal areas of tissue can be removed and tested for cancer (a biopsy).
TURBT is carried out under general anaesthetic.
Sometimes, a sample of the muscle wall of your bladder is also taken to check whether the cancer has spread, but this may be a separate operation within six weeks of the first biopsy.
You should also be offered a dose of chemotherapy after the operation. This may help to prevent the bladder cancer returning, if the removed cells are found to be cancerous.
See treating bladder cancer for more information about the TURBT procedure.
Staging and grading
Once these tests have been completed, it should be possible to tell you the grade of the cancer and what stage it is.
Staging is a measurement of how far the cancer has spread. Lower-stage cancers are smaller and have a better chance of successful treatment.
Grading is a measurement of how likely a cancer is to spread. The grade of a cancer is usually described using a number system ranging from G1 to G3. High-grade cancers are more likely to spread than low-grade cancers.
The most widely used staging system for bladder cancer is known as the TNM system, where:
- T stands for how far into the bladder the tumour has grown
- N stands for whether the cancer has spread into nearby lymph nodes
- M stands for whether the cancer has spread into another part of the body (metastasis), such as the lungs
The T staging system is as follows:
- TIS or CIS (carcinoma in situ) – a very early high-grade cancer confined to the innermost layer of the bladder lining
- Ta – the cancer is just in the innermost layer of the bladder lining
- T1 – the cancerous cells have started to grow into the connective tissue beyond the bladder lining
Bladder cancer up to the T1 stage is usually called early bladder cancer or non-muscle-invasive bladder cancer.
If the tumour grows larger than this, it's usually called muscle-invasive bladder cancer and is categorised as:
- T2 – the cancer has grown through the connective tissue, into the bladder muscle
- T3 – the cancer has grown through the layer of muscles, into the surrounding layer of fat
If the tumour grows larger than the T3 stage, it's considered to be advanced bladder cancer and is categorised as:
- T4 – the cancer has spread outside the bladder, into surrounding organs
The N staging system is as follows:
- N0 – there are no cancerous cells in any of your lymph nodes
- N1 – there are cancerous cells in just one of your lymph nodes in your pelvis
- N2 – there are cancerous cells in two or more lymph nodes in your pelvis
- N3 – there are cancerous cells in one or more of your lymph nodes (known as common iliac nodes) deep in your groin
There are only two options in the M system:
- M0 – where the cancer hasn't spread to another part of the body
- M1 – where the cancer has spread to another part of the body, such as the bones, lungs or liver
The TNM system can be difficult to understand, so don't be afraid to ask your care team questions about your test results and what they mean for your treatment and outlook.
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