Detecting Bladder Cancer With A Urine Test
Urine is made up of several components including water and waste materials filtered from the blood by the kidneys, as well as small numbers of cells such as epithelial cells shed from the lining of the urinary tract and possibly red and white blood cells. The type and quantity of the different components and cells contained in urine can provide important information regarding an individuals health, which can help in the diagnosis of diseases such as bladder cancer.
Detecting Bladder Cancer With A Cystoscopy
Cystoscopy enables the inside of the urethra and bladder to be examined and sampled. Alongside urine testing and diagnostic imaging procedures, cystoscopy is used in both the initial diagnosis of bladder cancer and in ongoing surveillance for recurrence. In addition, cystoscopy-based procedures are commonly used to remove or treat small bladder tumors.
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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Biopsies To Look For Cancer Spread
If imaging tests suggest the cancer might have spread outside of the bladder, a biopsy might be needed to be sure.
In some cases, biopsy samples of suspicious areas are taken during surgery to remove the bladder cancer.
Another way to get a biopsy sample is to use a long, thin, hollow needle to take a small piece of tissue from the abnormal area. This is known as a needle biopsy, and by using it the doctor can take samples without surgery. Sometimes a CT scan or ultrasound is used to help guide the biopsy needle into the changed area.
Is A Cystoscopy Painful
You may feel discomfort when the cystoscope goes into the urethra and bladder. Youâll probably feel a strong need to pee when your bladder gets full. You may feel a slight pinch if the doctor takes a biopsy.
After the procedure, your urethra may be sore and it might burn when you pee for a day or two.
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Medical History And Physical Exam
Your doctor will want to get your medical history to learn more about your symptoms. The doctor might also ask about possible risk factors and your family history.
A physical exam can provide information about possible signs of bladder cancer and other health problems. The doctor might do a digital rectal exam , during which a gloved, lubricated finger is put into your rectum. If you are a woman, the doctor might do a pelvic exam as well. During these exams, the doctor can sometimes feel a bladder tumor, determine its size, and feel if and how far it has spread.
If the doctor finds things that aren’t normal, you may to have lab tests done and you might be referred to a urologist for further tests and treatment.
Possible Side Effects Of A Ct Scan
Sensitivity or allergic reaction to the contrast dye can occur in some patients, which may manifest as rash, nausea, wheezing, shortness of breath, or itching or swelling of the face. Symptoms are usually mild and clear on their own. Uncommon but more severe manifestations are low blood pressure and breathing difficulties.
Of additional note, while the amount of radiation used in CT scans can vary in clinical practice, CT scans deliver considerably more radiation than a typical x-ray. Therefore CT scans can carry risks associated with increased radiation exposure, such as radiation-induced future cancer.
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What Are The Risk Factors For Bladder Cancer
Some factors increase the risk of bladder cancer:
- Cigarette smoking is the biggest risk factor it more than doubles the risk. Pipe and cigar smoking and exposure to second-hand smoking may also increase one’s risk.
- Prior radiation exposure is the next most common risk factor .
- Certain chemotherapy drugs also increase the risk of bladder cancer.
- Environmental exposures increase the risk of bladder cancer. People who work with chemicals, such as aromatic amines are at risk. Extensive exposure to rubber, leather, some textiles, paint, and hairdressing supplies, typically related to occupational exposure, also appears to increase the risk.
- Infection with a parasite known as Schistosoma haematobium, which is more common in developing countries and the Middle East.
- People who have frequent infections of the bladder, bladder stones, or other diseases of the urinary tract, or who have chronic need for a catheter in the bladder, may be at higher risk of squamous cell carcinoma.
- Patients with a previous bladder cancer are at increased risk to form new or recurrent bladder tumors.
Other risk factors include diets high in fried meats and animal fats, and older age. In addition, men have a three-fold higher risk than women.
Radiological Test: What Is A Ct Urogram
The CT urogram is a radiological test to explore possible reasons for blood in the urine or other symptoms. This specialized scan uses intravenous contrast . A CT urogram examines the upper urinary tract in detail.
This test is good at finding tumors of the kidney, renal pelvis, and ureter, as well as other urologic abnormalities. It may identify kidney stones and hydronephrosis . In addition, the entire abdomen and pelvis is also imaged. This allows a radiologist to identify other abnormalities in these parts of the body. In patients with cancer, it will help identify signs of spread to lymph nodes or other organs like the liver.
Your healthcare provider will request blood work to see if you have normal kidney function before you can receive the contrast required for a CT urogram. If the contrast cannot be given, your doctor may decide to perform a CT scan without contrast or other imaging study. A procedure called cystoscopy with retrograde pyelograms may be suggested. The urologist performs x-rays while injecting dye into the ureters. Like a CT urogram, it can help to identify abnormalities of the ureter and renal pelvis.
While some bladder tumors may be found on a CT urogram or other imaging test, others will not. A urologist will often recommend a cystoscopy to evaluate the lower urinary tract for a source of blood in the urine or to workup other urologic symptoms.
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What Are The Treatment Options For Bladder Cancer
There are four types of treatment for patients with bladder cancer. These include:
- Surgery
Sometimes, combinations of these treatments will be used.
Surgical options
Surgery is a common treatment option for bladder cancer. The type of surgery chosen will depend on the stage of the cancer.
- Transurethral resection of the bladder is used most often for early stage disease . It is done under general or spinal anesthesia. In this procedure, a special telescope called a resectoscope is inserted through the urethra into the bladder. The tumor is then trimmed away with the resectoscope, using a wire loop, and the raw surface of the bladder is then fulgurated .
- Partial cystectomy is the removal of a section of the bladder. At times, it is used for a single tumor that invades the bladder wall in only one region of the bladder. This type of surgery retains most of the bladder. Chemotherapy or radiation therapy is often used in combination. Only a minority of patients will qualify for this bladder-sparing procedure.
- Radical cystectomy is complete removal of the bladder. It is used for more extensive cancers and those that have spread beyond the bladder .
This surgery is often done using a robot, which removes the bladder and any other surrounding organs. In men, this is the prostate and seminal vesicles. In women, the ovaries, uterus and a portion of the vagina may be removed along with the bladder.
Chemotherapy
- Methotrexate
Intravesical therapy
Radiation therapy
Questions To Ask The Doctor
- What treatment do you think is best for me?
- Whats the goal of this treatment? Do you think it could cure the cancer?
- Will treatment include surgery? If so, who will do the surgery?
- What will the surgery be like?
- How will I pee after surgery?
- Will I have other types of treatment, too?
- Whats the goal of these treatments?
- What side effects could I have from these treatments?
- Is there a clinical trial that might be right for me?
- What about treatments like special vitamins or diets that friends tell me about? How will I know if they are safe?
- What should I do to be ready for treatment?
- Is there anything I can do to help the treatment work better?
- Whats the next step?
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Advanced Diagnostics With Blue Light Flexible Cystoscopy
Blue light cystoscopy is a newer type of flexible cystoscopy that is available through the University of Michigan Rogel Cancer Center for both diagnosis and treatment. Using the blue light technique versus a white light has been shown to improve diagnosis accuracy, as well as delay tumor recurrence.
Blue light cystoscopy uses a special chemical that is absorbed by tumors. This makes tumor cells appear as bright blue tissue in the bladder. As a result, a small tumor that is difficult to see becomes much more obvious. Other benefits of blue light cystoscopy include:
- Slower tumor recurrence: A study found bladder tumor recurrence took seven months longer with the blue light technique, allowing patients to avoid invasive procedures and potentially reducing the frequency of bladder checks.
- Better high-risk identification: The blue light technology is able to identify high-risk tumors in addition to low-risk tumors. Early detection of this type of tumor means patients can begin treatment quicker, when theres the greatest chance for a cure.
How Is Bladder Cancer Found
If your urine shows blood , you should be tested for bladder cancer. Many patients will have on and off blood in the urine, so just because the blood goes away, does not mean that you are cancer-free. Your urologist will find bladder cancer with two tests:
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What Is Bladder Cancer
Cancer can start any place in the body. Cancer that starts in the bladder is called bladder cancer. It starts when cells in the bladder grow out of control and crowd out normal cells. This makes it hard for the body to work the way it should.
Cancer cells can spread to other parts of the body. For instance, cancer cells in the bladder can travel to the bone and grow there. When cancer cells spread, its called metastasis.
Cancer is always named for the place where it starts. So when bladder cancer spreads to the bone , it’s still called bladder cancer. Its not called bone cancer unless it starts in the bone.
Transurethral Resection Of A Bladder Tumour
If abnormalities are found in your bladder during a cystoscopy, you should be offered an operation known as TURBT. This is so any abnormal areas of tissue can be removed and tested for cancer .
TURBT is carried out under general anaesthesia.
Sometimes, a sample of the muscle wall of your bladder is also taken to check whether the cancer has spread. This may be a separate operation within 6 weeks of the first biopsy.
You should also be offered a dose of chemotherapy after the operation. This may help to prevent the bladder cancer returning, if the removed cells are found to be cancerous.
See treating bladder cancer for more information about the TURBT procedure.
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What Will Happen After Treatment
You’ll be glad when treatment is over. But its hard not to worry about cancer coming back. Even when cancer never comes back, people still worry about this. For years after treatment ends, you will see your cancer doctor. Be sure to go to all of your follow-up visits. People who have had bladder cancer are at high risk of having a second bladder cancer.
If you have no signs of cancer, most experts advise seeing with your doctor every 3 to 6 months. These visits might include urine tests, blood work, and other tests. If you still have your bladder, you will need regular exams of your bladder, too. The time between doctor visits may be longer after a few years if no new cancers are seen.
Having cancer and dealing with treatment can be hard, but it can also be a time to look at your life in new ways. You might be thinking about how to improve your health. Call us or talk to your doctor to find out what you can do to feel better.
You cant change the fact that you have cancer. What you can change is how you live the rest of your life making healthy choices and feeling as well as you can.
Tests That May Be Done
Physical exam: The doctor will check you for signs of bladder cancer and other health problems. This might include a rectal exam, during which a gloved finger is put into your rectum. If you are a woman, a pelvic exam might also be done. During these exams, the doctor can sometimes feel a bladder tumor.
Urine tests: For these tests, you’ll be asked to pee in a cup. Your urine is then tested for cancer cells, blood, or certain proteins .
Cystoscopy: For this exam, a doctor called a urologist looks at the inside of your bladder using a tool called a cystoscope. This is a thin tube with a tiny light and camera on its end. It’s put through the opening of your urethra and moved up into your bladder.
Blue light cystoscopy: Sometimes, special drugs are put into the bladder during the exam. Cancer cells soak up these drugs and then glow when the doctor shines a blue light through the scope. This can help the doctor see cancer cells that might have been missed with the normal light.
Bladder biopsy: This is needed to know for sure if you have bladder cancer. For this test, a cystoscope is used it to take a tiny piece of the bladder . More than one sample may be taken because sometimes cancer starts in more than one part of the bladder. Salt water washings of the inside of your bladder may also be collected to look for cancer cells. Any samples are sent to a lab and tested to see if there are cancer cells in them.
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Benefits Of Urine Testing
Urine testing has several advantages, including:
- Typically non-invasive and painless
- Ease of sampling, coupled with being quick and convenient compared with other tests and procedures
- Results can be obtained quickly
- Costs are often lower than those associated with other types of diagnostic tests and procedures
- Provides relevant, reliable information regarding patient health status
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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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
Next Steps After Urine Lab Tests
Depending on the results of the patients physical examination and urine laboratory tests, healthcare providers may need to carry out further testing to help make a diagnosis.1,2 The tests can also be used in patients who have already been diagnosed with bladder cancer to help gather more information about the cancer and develop the patients treatment plan.
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Screening For Bladder Cancer
Screening is the use of tests or exams to look for a disease in people who have no symptoms. At this time, no major professional organizations recommend routine screening of the general public for bladder cancer. This is because no screening test has been shown to lower the risk of dying from bladder cancer in people who are at average risk.
Some providers may recommend bladder cancer tests for people at very high risk, such as:
- People who hadbladder cancer before
- People who had certain birth defectsof the bladder
- People exposed to certain chemicals at work
Bladder Cancer Risk Factors And Warning Signs
Although the cause of bladder cancer is unknown, it is linked to tobacco use and exposure to certain chemicals.
- Smoking and Bladder Cancer: Smoking is responsible for approximately 47 percent of bladder cancer deaths among men and 37 percent among women, according to the American Cancer Society.
- Workplace Exposure and Bladder Cancer: Workers in the rubber, chemical, leather, textile, metal, and printing industries exposed to substances such as aniline dye and aromatic amines may have increased risk for bladder cancer. Other at-risk occupations include hairdressers, machinists, painters, and truck drivers.
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