Generally, the first thing is to see your GP, as they will examine you and ask you for a urine sample to see if you have hematuria or an infection. If there is no obvious explanation for the hematuria, you will be sent to a specialist if:

- There are signs of blood in the urine

- You have urinary symptoms and the urine test shows hematuria (at any age)

- The urine test shows hematuria and you are over 40

Your urologist will ask you about your urinary symptoms and overall state of health. They may examine your abdomen and bladder by palpation and run some test.

• Blood test

Blood samples are taken to check on the overall health of the patient, the number of cells in the blood, and to see how the kidneys are functioning.

• Urine analysis

A urine analysis will be done to see if it contains cancer cells. Sometimes, a test may be performed to check for other markers in your urine (molecular tests); this, however, is not a standard test.

• Cystoscopy

This is the most commonly used test to diagnose bladder cancer. A thin tube with a camera and a small light on the end (cystoscope) is used, making it possible to examine the interior of your bladder.

Cystoscopy can detect abnormalities in the bladder. This is usually done under local anesthesia. You will be asked to drink lots of fluids before the test and you will have a urine test done to see if there are signs of infection.

A cystoscope is inserted through the urethra in the direction of the bladder, examining the lining of both structures. The test takes a few minutes.

You may experience a burning sensation or slight pain when urinating, or you may notice blood in your urine for the first few days after the test. This should pass in a couple of days; you will be asked to drink lots of fluids to help this along. If the symptoms do not go away, talk to your doctor.

If anything out of the ordinary is found, you may have a biopsy done at the same time as the cystoscopy; however, this procedure is usually done with the patient under general anesthesia.

• Photodynamic diagnosis

During standard cystoscopy, white light is used to see the inside of the bladder. With photodynamic diagnosis, a substance that is sensitive to light is administered into the bladder and is absorbed by the cancer cells. During cystoscopy, a blue light is used to signal the cancer cells with fluorescence. This helps detect small tumors and in situ bladder carcinomas.

• Ultrasound

This test can be used to detect any unusual finding along the urinary tract. It uses sound waves to create an image of the inside of body. The procedure is painless and only takes a few minutes. You will be asked to drink lots of fluids beforehand so that your bladder is full, allowing it to be seen clearly.

A gel is spread over your abdomen and then a small device that emits ultrasound waves is used to form an image on a computer. This takes about 15-20 minutes.

• CT (computed tomography)

A CT takes a series of x-rays, creating a 3-D image of the inside of the body. It takes from 5-15 minutes and is painless. A small amount of radiation is used, though it is very unlikely to cause you any harm. You will be asked to refrain from eating and drinking for at least an hour before the procedure.

You may be given a drink or an injection with a dye, which makes it possible to see certain areas more clearly. This may make you feel hot for a few minutes. It is important that you inform your health professionals if you are allergic to iodine or have asthma, as you may have a reaction to the injection.

• PET/CT

This is a combination of computed tomography and positron emission tomography (PET). PET uses low doses of radiation to measure cell activity in different parts of the body. This test offers more detailed information on the part of the body being scanned.

You will not be able to eat for six hours before the test. A slightly radioactive substance is injected into a vein (normally the arm). This is followed by a wait of at least an hour before the examination, which takes between 30 and 90 minutes.

• Intravenous urography

This test shows any abnormalities there may be in the urinary system. It is performed in the radiology department and takes about an hour.

A dye or contrast medium is injected into a vein—usually through an arm—and then travels throughout the blood stream to the kidneys. This is then examined on a computer screen, making it possible to check for abnormalities.

This procedure is often performed in conjunction with a CT can, and when this happens the procedure is called a CT urography.

• MRI (magnetic resonance imaging)

This test uses magnetism to build a detailed image of one of the areas of your body. The scanner is a powerful magnet, which is why you will be asked to fill out and sign a checklist and provide your consent. As part of this consent form, you will be asked if you have any implants such as a pacemaker or surgical clips. You should also tell your doctor if you have ever worked with metals or in the metal industry.

Before the scan, you will be asked to remove all metal belongings, including jewelery. Sometimes, a contrast dye is given by injection in a vein of the arm to help the images come through more clearly.

You will have to remain very still during the test, which lasts about 30 minutes. The process is painless but can be somewhat uncomfortable, and some people experience a bit of claustrophobia. It is also quite loud, though you will be given earplugs or headphones.

• Bone scan

A bone scan can show any abnormality of the bone. This may be done to see if the cancer has spread into the bones.

A small quantity of (usually radioactive) liquid is injected into a vein, normally in the arm. The level of radioactivity used is very low and does not cause any harm. The abnormal bone mass absorbs the radioactive substance more than normal bone, and this shows up on the scanner; these are known as hot spots.

A bone scan may show conditions other than cancer, such as arthritis. In this case, you may have to have further tests done such as an x-ray of the abnormal area.