Diagnosis of Bladder Cancer

One of the warning signs for bladder cancer is blood in the urine, also known as haematuria. If blood is seen in the urine, this is known as visible haematuria. Unless there is another cause known, people should be referred for tests immediately under a policy of being seen by a urologist within two weeks of referral (“the 2 week rule”).

When traces of blood are not visible, however are picked up on testing this is known as non-visible haematuria and similarly warrants prompt further testing in people over the age of 40 yrs.

The types of disorders causing blood in the urine include:

• cancers (of the bladder, prostate, kidney)
• urinary tract stones (kidney and urinary bladder)
• infections,
• non-cancerous swelling of the prostate gland in men

Additionally, problems with kidney function can allow blood to pass into the urine. For the majority of people, however, no serious problem is identified.

The majority of people who have blood in their urine do not have bladder cancer. About a quarter (25%) of people with visible blood in their urine will have a disease process identified. This means that three quarters (75%) will not but there may be other causes for the blood. For non-visible haematuria the figure is much lower, less than one in twenty (5%).  It is therefore vital that you seek advice from your doctor to find the cause and have it treated appropriately.

The Haematuria Clinic

Many hospitals offer haematuria clinics for people referred by their GP with these symptoms. At these clinics investigations can be completed and people can be reassured or informed of their diagnosis and treatment straight away.

What happens at the Haematuria clinic?

A doctor or nurse will ask the patient questions about their urinary symptoms, general health, previous medical history, medications, family history, occupation and smoking history. These questions help build up a picture of what might be causing the bleeding. A physical examination will be performed and this will include a rectal examination for men and a vaginal examination for women.

A mid-stream urine sample will be taken and sent to the lab to look for evidence of urinary infection. Additionally, urine may be sent for cytology, which involves checking for cancerous cells under the microscope. Urine cytology does not pick up every cancer, and not every abnormal cytology sample indicates cancer is present. Other tests are needed to confirm the diagnosis.

A scan of the urinary tract will be performed. For most people this will be an ultrasound scan. Some patients may subsequently be referred for a CT scan depending on the results of other tests.

A telescopic examination of the urinary bladder is almost always required. This is called a flexible cystoscopy and involves passing a fine fibreoptic telescope via the waterpipe (urethra) into the urinary bladder, with local anaesthetic gel applied to make the procedure more comfortable. Many people are anxious about having this test performed, but it only takes a couple of minutes to perform. Most people are surprised at how easy this examination is to undergo. There is a small risk of urinary infection but this occurs in less than 1% of people and can be treated as required with antibiotics.

If a bladder tumour is seen on ultrasound scan or flexible cystoscopy this will be explained to the patient and any family members accompanying them. A specialist nurse is usually available to offer support and information. Arrangements will be made to admit the patient within a few weeks for a procedure under general anaesthetic to biopsy or remove the tumour.

If other disorders are suspected such as stones, swelling of the prostate or kidney impairment then treatment will be commenced or arranged with the appropriate specialist.