Why Did We Fail In The Past
Although noninvasive tests are labelled to diagnose bladder cancer, it remains unclear how they can effectively be integrated into clinical decision-making, particularly when making an initial diagnosis because the presenting signs and symptoms may be caused by a number of different diseases and conditions. This situation is different from that in prostate cancer screening where the diagnosis is usually being sought in asymptomatic individuals who may themselves request a screening test.
It seems obvious that new tests for the initial diagnosis of bladder cancer should be investigated in patients with symptoms and/or signs associated with this disease. This will pertain largely to patients who have gross hematuria, those who may have irritative voiding symptoms without urinary tract infection, and those found on routine urinalysis to have microscopic hematuria. However, an investigation of the literature shows that this approach is often neglected. In contrast, the vast majority of studies are case-control trials comparing artificially composed study cohorts, in which the prevalence of the disease frequently exceeds 50%. High disease prevalence is usually not seen in urological practice and such an evaluation is likely to result in an optimistic assessment of the positive predictive value .
Urine testing has several advantages, including:
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Urine Lab Tests To Rule Out Bladder Cancer
If the healthcare provider thinks that bladder cancer may be the cause of the symptoms, the patient may be asked to provide a urine sample for analysis in the laboratory. Several types of urine lab tests may be used to help make a diagnosis of bladder cancer, including:
- Urinalysis testing
- Urine tests for tumor markers
Urine Tests For Tumor Markers
A relatively new type of diagnostic technology for bladder cancer are urine tests for substances called tumor markers.3 It is possible for these tests to detect substances in the urine that may be linked to the presence of bladder cancer cells, but like urine cytology test, they are not perfectly reliable. These new tests include:
- Tests that can detect bladder tumor-associated antigen
- A test that can detect the genetic changes that are common in bladder cancer cells
- A test that can detect substances often found on cancer cells, called mucin and carcinoembryonic antigen
- A test that can detect a protein that is often elevated in patients with bladder cancer
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Criteria For Assessment Of Reporting Marker Status And Level Of Evidence
In this assessment the different markers and trials were classified according to the level of evidence for diagnostic procedures , the accuracy of data reporting according to the STARD criteria , and the status of the marker with regard to clinical implementation . Finally, a consensus on four key questions was obtained prospectively: can molecular markers support screening of patients at risk of having or developing bladder cancer?’, can molecular markers be used in reflex testing for bladder cancer?’, can molecular markers support follow-up of patients with superficial low risk bladder cancer?’, and can molecular markers support follow-up of patients with superficial high risk bladder cancer?’. All statements and recommendations were discussed within the group. Recommendations were provided and categorized according to the criteria of the Agency for Health Care Policy and Research and required consensus of the group.
Bladder Tumor Antigen Stat And Trak
The BTA STAT & TRAK tests use monoclonal antibodies to detect complement factor H-related protein and complement factor H in voided urine specimens. These factors are found in bladder cancer cell lines and inhibit the complement cascade to prevent cell lysis.BTA STAT is a point of care qualitative assay with an average sensitivity and specificity of 68.7% and 73.7% , respectively.BTA TRAK is a quantitative enzyme-linked immunosorbent assay with similar sensitivity and specificity of 62% and 73.6% , respectively. Studies have shown wide ranges of sensitivity and specificity with BTA testing. Additionally, the specificity of both of these tests can be significantly decreased, as false positives have been noted to occur in the setting of hematuria, urolithiasis, inflammation, recent instrumentation, other genitourinary malignancies, and intravesical BCG therapy.
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Rate Of Abnormal Tests By Month
There was an increasing rate of abnormal tests for all tests towards diagnosis except high AST .
Rate of abnormal blood tests in the year prediagnosis, with dotted line signifying increase in rate from baseline for that particular test .a
aInflection line for high WCC and high platelets both occur at 6 months pre-diagnosis. ALT = alanine transaminase. AST = aspartate aminotransferase. CRP = C-reactive protein. ESR = erythrocyte sedimentation rate. Hb = haemoglobin. LFT = liver function test. Plt = platelets. WCC = white cell count.
Evidence of inflection points for eight of the ten blood tests examined was found: low haemoglobin, high WCC, high platelet count, high CRP and ESR, high ALT and AST, and high creatinine . The earliest rate of increase was for high ESR and AST at 8 months prediagnosis, and the rate of increase was the closest to diagnosis for high ALT .
Who Can Use Cxbladder
We offer three different Cxbladder tests to serve a wide range of patients, including patients with hematuria, patients with suspected bladder cancer, and those monitoring bladder cancer for recurrence.
Cxbladder Triage is our test designed to help physicians rule out the presence of bladder cancer in low-risk patients with hematuria.
For patients with a greater risk of bladder cancer, doctors can use Cxbladder Detect, which can inform a bladder cancer diagnosis when combined with other tests in a urological evaluation.
Finally, doctors and cancer specialists can use Cxbladder Monitor to assess patients with a history of bladder cancer for disease recurrence. This cancer test can reduce the number of invasive procedures required, allowing Cxbladder Monitor to significantly improve quality of life for people in recovery.Learn More About Cxbladder
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Bladder Cancer Clinical Trials
What about Clinical Trials?
You may hear about clinical trials for your bladder cancer. Clinical trials are research studies that test if a new treatment or procedure is safe and effective.
Through clinical trials, doctors find new ways to improve treatments and the quality of life for people with disease. Trials are available for all stages of cancer. The results of a clinical trial can make a major difference to patients and their families. Please visit our clinical trials research webpage to learn more.
How Much Does A Bladder Ultrasound Cost
If you have medical insurance, your copayment for a bladder ultrasound can vary or may even be free. Without insurance, the average cost of an ultrasound in the United States is between about $250 and $400.
If you have Medicare, an ultrasound may be covered under your Part A coverage if you have the procedure during an inpatient hospital stay.
At an outpatient facility, an ultrasound is covered by Medicare Part B. Your share of the cost can be between about $17 and $30 depending on where the test is done.
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What Is A Mr Urogram
Another option for imaging is MRI of the abdomen and pelvis or MR Urogram. This test is also effective at finding tumors in the kidney and ureters and evidence of spread of cancer. It may be used to avoid radiation or in patients with contrast dye allergies or borderline kidney function. It is not quite as good at finding kidney stones and similar to CT urogram may miss tumors in the bladder such that patients still require cystoscopy.
What Do Your Lab Test Results Mean
Ever logged into MyChart to check on some lab test results, then just stared blankly at the screen once you saw them? Youre not alone.
Unless you work in the medical field, figuring out what all of those values mean and how to interpret them can sometimes be a challenge.
We sought insight from Adriana Maria Knopfelmacher-Couchonal, M.D., a specialist in Laboratory Medicine. Heres what she had to say.
How are lab tests used in cancer care?
Lab tests are performed for cancer screening and diagnosis, as well as for cancer staging, treatment planning and monitoring patients during treatment.
What types of lab tests are used in cancer diagnosis and treatment?
There are too many different kinds to list. But the complete blood count is probably the most common lab test performed. It measures three main things:
What are the reference ranges for?
Reference ranges are designed to give people an idea of what normal values are for those categories. Theyre created by averaging the results of large numbers of healthy individuals.
What other lab tests are used in cancer care?
Doctors look at six different values to gauge liver function:
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Can A Tumor Marker Be Used To Screen For Cancer
Ideally, markers could be used as a screening test for the general public. The goal of a screening test is to find cancer early, when it is the most treatable and before it has had a chance to grow and spread. So far, the only tumor marker to gain some approval as a screening tool is the Prostate Specific Antigen for prostate cancer, though this has concerns as well.
The main worry with tumor markers is that they are not specific enough they have too many false-positives. This means that the level is high when cancer is not present. This leads to costly tests that are not needed and causes the patient to be worried. The other concern is that the marker level is not high in early enough stages of the cancer, so the cancer cannot be found any earlier than when symptoms start to appear. Keep in mind that some substances used as tumor markers are normally made in the body, and a normal level is not always zero.
If You Do Have Bladder Cancer
If you are diagnosed with cancer, there is nothing that can prepare you for that news and most people find they experience a whirlwind of emotions. Along with rising panic, you may be feeling overwhelmed, frightened and probably angry.
As a newly diagnosed bladder cancer patient, you are embarking on a journey. Right now, as you begin this journey, the most important thing you should know is: you are not alone.
There are thousands of others living with this disease, and there are people and resources to help you find the information you need to help you make the best choices, and the support you need to get you through.
Whether you have to wait just half an hour or two weeks for results, it will seem like forever. Hang on in there this is all part of you getting the best treatment.
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Symptoms Of Bladder Cancer
The most common bladder cancer symptom is blood in the pee. Blood in pee is also called haematuria. Most people with symptoms will not have bladder cancer. But if you have any symptoms, it is important to get them checked by your GP. The earlier bladder cancer is diagnosed the more likely it is to be cured.
We have more information about signs and symptoms of bladder cancer.
See also
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How Are Tumor Markers Used
Tumor markers may be used for a variety of purposes. However, they are not typically used alone. Depending on the type of cancer, they may be used in conjunction with a tissue biopsy or a bone marrow or blood smear examination, for example, and/or with other tumor markers. They are not definitive but provide additional information that can be used to help:
Examples of tumor markers that are used in each of these ways are provided in the table below.
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Changes In Bladder Habits Or Symptoms Of Irritation
Bladder cancer can sometimes cause changes in urination, such as:
- Having to urinate more often than usual
- Pain or burning during urination
- Feeling as if you need to go right away, even when your bladder isn’t full
- Having trouble urinating or having a weak urine stream
- Having to get up to urinate many times during the night
These symptoms are more likely to be caused by a urinary tract infection , bladder stones, an overactive bladder, or an enlarged prostate . Still, its important to have them checked by a doctor so that the cause can be found and treated, if needed.
Two Tests May Be Used To Screen For Bladder Cancer In Patients Who Have Had Bladder Cancer In The Past:
Cystoscopy
Cystoscopy is a procedure to look inside the bladder and urethra to check for abnormal areas. A cystoscope is inserted through the urethra into the bladder. Tissue samples may be taken for biopsy.
Urine cytology
Urine cytology is a laboratory test in which a sample of urine is checked under a microscope for abnormal cells.
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Tumor Marker Tests: Mixed Results
Technically, tumor markers are chemicals produced by cancerous cells that end up floating around in a patients blood. Some tumor markers are also made by healthy cells in the presence of cancers. That sounds like a clear sign of malignancy, but its not. Lots of people without cancer have elevated levels of tumor markers and the use of these tests in cancer diagnosis is still controversial.
Doctors usually look for proteins that accompany cancer, but recently, physicians have also started analyzing abnormalities in DNA and gene expression as tumor markers, too, according to the National Cancer Institute.
Theres no tumor marker that all cancers produce as a rule, at least not one thats been identified yet. But researchers have found proteins that specific types of tumor seem to produce:
- Alpha-fetoprotein, a blood protein produced by amniotic fluid during normal fetal development, may be elevated in the presence of liver cancer and germ cell tumors like ovarian cancer and testicular cancer.
- CA 19-9 is an antigen, a protein that may be manufactured by cancer cells and causes an immune system response. CA 19-9 levels are usually studied to manage pancreatic cancer, but a patients levels may also be elevated because of colorectal or esophageal cancer.
Finding cancer markers in blood work isnt enough to diagnose cancer, or screen patients for developing malignancies.
How Does Ultrasound Work
Ultrasound, or sonography, uses high frequency sound waves to help diagnose all sorts of medical conditions. As the sound waves hit things like soft tissue, fluid, or bone, the waves are reflected back to the transmitter to create a simple, two-dimensional image.
Unlike X-rays or other imaging tests, ultrasound does not use any form of radiation. This makes this test both safe and noninvasive.
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What Is A Cea Test
A carcinoembryonic antigen test measures a specific blood glycoprotein called CEA. It means a protein with a lot of sugars added to it by normal or cancerous cells. Scientists first discovered CEA in 1968 when they isolated extracts of liver metastasized by colorectal cancer and also from normal fetal digestive tract. Everyone is born with high levels of this protein. CEA decreases as you get older, but some conditions, including certain types of cancer, can increase your blood CEA levels.
CEA is sometimes called a tumor marker or tumor antigen. Tumor markers are substances that some cancer cells make and shed into bodily fluids at times. Healthy cells also may make tumor markers in very low levels. Many healthy people have normal level of tumor makers, which is called normal range, reference range or reference interval on lab reports.
Diagnosis Of Bladder Cancer
Diagnosis is the process of finding out the cause of a health problem. Diagnosing bladder cancer usually begins with a visit to your family doctor. Your doctor will ask you about any symptoms you have and may do a physical exam. Based on this information, your doctor may refer you to a specialist or order tests to check for bladder cancer or other health problems.
The process of diagnosis may seem long and frustrating. Its normal to worry, but try to remember that other health conditions can cause similar symptoms as bladder cancer. Its important for the healthcare team to rule out other reasons for a health problem before making a diagnosis of bladder cancer.
The following tests are usually used to rule out or diagnose bladder cancer. Many of the same tests used to diagnose cancer are used to find out how far the cancer has spread . Your doctor may also order other tests to check your general health and to help plan your treatment.
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Tests Of Liver And Gallbladder Function
Lab tests might be done to find out how much bilirubin is in your blood. Bilirubin is the chemical that causes jaundice. Problems in the gallbladder, bile ducts, or liver can raise the blood level of bilirubin.
The doctor may also do tests for albumin, liver enzymes , and certain other substances in your blood. These may be calledliver function tests. They can help diagnose liver, bile duct, or gallbladder disease.
Tests Are Used To Screen For Different Types Of Cancer When A Person Does Not Have Symptoms
Scientists study screening tests to find those with the fewest harms and most benefits. Cancer screening trials also are meant to show whether early detection helps a person live longer or decreases a person’s chance of dying from the disease. For some types of cancer, the chance of recovery is better if the disease is found and treated at an early stage.
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