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Symptoms and diagnosis of bladder cancers

Bladder cancer is usually diagnosed after one of the following symptoms presents:

  • Blood in the urine visible to the naked eye (macroscopic haematuria)
  • Blood in the urine detected microscopically
  • Painful urination, called dysuria, in the absence of infection (a symptom of carcinoma in situ)

All three of these symptoms are common and have many benign causes, but warrant complete and appropriate investigation to rule out urinary tract malignancy.

Initially, analysis of a urine sample should be undertaken by voided urinary cytology or VUC, which involves collecting a urine specimen and examining it under the microscope for cancer cells.

Urine culture might also be undertaken to exclude urinary tract infection, especially if dysuria is present in the absence of blood in the urine.

In cases of painless macroscopic haematuria, bleeding from the urinary tract above the bladder must be excluded, usually by a CT scan . Specifically, it is important to rule out cancer of the kidneys. The lower urinary tract is then investigated using cystourethroscopy, a procedure which involves insertion of a small tube with a camera on the end into the bladder under local or general anaesthesia.

Urinary cytology is usually negative when superficial bladder cancers are diagnosed; it is important to have a cystourethroscopy regardless of your cytology results.

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