Investigations for bladder cancer begin with those for the presenting symptoms, particularly blood in the urine.
The most reliable test for detecting bladder cancer is Cystoscopy. Cystoscopy is an important investigation when blood is detected in the urine, particularly if the blood is visible. The first cystoscopy is generally a Flexible Cystoscopy, done with a local anaesthetic gel instilled in the water pipe (urethra). It is minimally invasive procedure, and in most times it will rule out bladder cancer rather than find one. Some cases of bladder cancer are suspected based on radiological imaging (with ultrasound or CT scanning); these tests are not sufficiently accurate for routine detection of all bladder tumours, or excluding the possibility; for these reasons, cystoscopy is required.
The diagnosis of bladder cancer requires a biopsy of the tumour. This is almost always done under a full anaesthetic, and in many cases the tumour can be cleared at the same time, by an operation called transurethral resection of bladder. When a bladder cancer is first diagnosed, additional assessments are often required to determine the likely behaviour of the tumour and thereby also the need for further treatments. This will be discussed with you after the tumour has been processed and examined by a pathologist.
In some cases, a technique called Photodynamic Cystoscopy or Blue Light Cystoscopy may be recommended. This allows the bladder to be examined by fluorescence in order to identify tumours that may not be detectable on standard cystoscopy. It offers an advantage in some patients by more reliably detecting small tumours and areas of high grade abnormalities that have not yet grown into visible tumours. This can be very useful in selected patients, but it is not necessarily advantageous in all cases owing to “false positives”. This technique it requires that a catheter is placed into the bladder before the operation and a drug called hexaminolevulinate to be instilled for at least one hour.
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