How Are Samples Collected
Requirements for urine sampling vary depending on the test/s being performed. Often the timing of collection is random, as dictated by the logistics of a doctor consult or access to a laboratory service. However, depending on the purpose of the test, certain urine voids of the day may be preferred. Collection of urine from all voids over a defined time period or sample collection at specific times after eating may also be necessary.
Urine samples are usually obtained by spontaneous voiding, using the clean-catch, midstream urine collection method. This involves voiding the first portion of urine into the toilet, collecting the midstream portion into a clean container, then voiding the remaining portion into the toilet. This method greatly reduces the risk of contaminants entering the sample. Less commonly, an invasive method of urine collection, such as placement of a urinary catheter, may be required.
Learn about Cxbladder’s easy-to-use in-home sampling system
What Are The Stages Of Bladder Cancer
Bladder cancer staging, or how much the body is affected, is complex. Stage 0 is the earliest bladder cancer can be diagnosed and stage 4 is the most advanced. Your doctor will explain what stage your cancer is and what it means.
- Stage 0: Early cancer found on the surface of the bladders inner lining. Cancer cells are grouped together and often can be easily removed.
- Stage 1: Cancer is in the bladders inner lining, but not yet in the bladder muscles wall, lymph nodes, or other organs.
- Stage 2: Cancer has spread to the bladder muscles wall, but not to other parts of the body.
- Stage 3: Cancer has spread to the bladder muscles wall and fatty tissue, and nearby lymph nodes or organs .
- Stage 4: The cancer has spread parts of the body further away from the bladder.
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
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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.
Cxbladder Is A Genomic Urine Test For Bladder Cancer That Improves Overall Detection Accuracy
Cxbladder is a non-invasive and easy-to-use genomic urine test that quickly and accurately detects or rules out bladder cancer. The test combines clinical risk factor markers with genetic information, measuring five biomarker genes to detect the presence or absence of bladder cancer.
When should you use Cxbladder?
- When you’ve seen blood in your urine
- If tests reveal you have blood in your urine
- When you have had bladder cancer and are being monitored for recurrence
Cxbladder provides greater certainty, resolving diagnostic ambiguity and improving overall detection accuracy. The use of Cxbladder can also reduce the need for further invasive procedures and testing.
Bladder cancer has a high risk of recurrence so patients who have been treated have unique monitoring needs to protect against the threat of the disease returning. Besides monitoring for signs and symptoms of bladder cancer, a cystoscopy to examine the inside of the bladder and urethra is recommended every 312 months for several years after completing bladder cancer treatment, depending on the risk of recurrence. For many patients, the frequency of cystoscopy required can be reduced with the use of Cxbladder, a non-invasive surveillance alternative.
Cxbladders proven accuracy makes it a reliable choice. With performance proven in over 10 peer-reviewed studies, Cxbladder is trusted by over 1,800 urologists in over 40,000 patients. The test is covered by Medicare and comes with the option of in-home sampling.
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Urine Culture Testing To Check For Utis
Urine culture testing can be used to check for urinary tract infections.1 The symptoms of bladder cancers and urinary tract infections can be quite similar, so it is important for healthcare providers check for both infection and cancer if either could be the cause. To carry out this test, the urine sample is left in a dish in the laboratory for several days, which allows any bacteria that may be contained in the urine to grow.
Early Detection And Screening
Because bladder cancer causes urinary symptoms such as blood in the urine, it may be found early. However, because blood in urine is caused by a lot of conditions other than cancer, urinalysis isnt a useful screening test for the general population.
There isnt a test yet that is able to screen the general population for bladder cancer. Doctors may recommend specific tests to screen for bladder cancer based on known risk factors.
Expert cancer care
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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.
Two Tests May Be Used To Screen For Bladder Cancer In Patients Who Have Had Bladder Cancer In The Past:
What Are The Treatment Options For Bladder Cancer
There are four types of treatment for patients with bladder cancer. These include:
Sometimes, combinations of these treatments will be used.
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.
Role Of Urine Markers
Several reviews have been performed to assess the myriad urine markers proposed for bladder cancer surveillance. They note that none of the markers has been proven sensitive and specific enough to replace cystoscopy. While commercially available urinary markers are promising, the clinical evidence is insufficient to warrant the substitution of the cystoscopic follow-up scheme with any of the currently available urine marker tests. If FISH and NMP-22 are considered to have some utility when used to complement or replace cytology, a dilemma arises when their results conflict with each other. Of particular interest is how to treat a patient with positive cytology and/or FISH findings when cystoscopy findings are negative.
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Can A Urine Test Detect Bladder Cancer
Several types of urine test have an important role in the overall process of diagnosing bladder cancer. Among these tests, urine cytology and urine tumor marker tests are used to detect the presence or absence of bladder cancer. Urine cytology has been used to assist bladder cancer diagnosis for over 75 years and has well-established strengths and limitations which are discussed in more detail below. Molecular tumor marker tests such as Cxbladder have been more recently developed, and provide high diagnostic accuracy in both detection and rule-out.
Notably, no single test is best able to detect bladder cancer, and usually different types of tests are used in combination. For example, the Cxbladder genomic urine test in combination with ultrasound or computed tomography imaging has been shown to identify the presence or absence of bladder cancer with high accuracy in patients with hematuria. The specific diagnostic tests selected depend on several factors, including a patients symptoms and their risk for bladder cancer.
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.
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Genetic Aberrations In Bladder Cancer
The study of genetic aberrations commonly associated with urothelial carcinoma provides a more objective assessment for diagnosing and detecting recurrent disease. Homozygous loss of band 9p21, the site for the tumor suppressor gene P16, is a known early genetic event in the development of papillary carcinoma and urothelial carcinoma in situ .
Increased chromosomal instability and aneuploidy have been implicated in tumor progression. A study by Sokolova et al of 9 genetic markers for detecting urothelial carcinoma showed that polysomy of chromosomes 3, 7, and 17 and deletion of 9p21 were the most sensitive and specific markers, detecting 95% of recurrent urothelial carcinomas. Halling et al established that a threshold of 5 or more cells with polysomy was 84% sensitive and 92% specific for detecting recurrent urothelial cancer. Tests for mutations in the FGFR3 oncogene may also hold promise for diagnosing and predicting recurrence.
For muscle-invasive bladder cancer , a consensus on molecular classification has emerged. The consensus recognizes six molecular subgroup classes of MIBC, as follows:
- Luminal papillary
Differentiation patterns, oncogenic mechanisms, tumor micro-environments and histological and clinical associations are distinct for each of the six classes. However, research still needs to be conducted on the best clinical use of this classification.
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.
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Magnetic Resonance Imaging Scan
Like CT scans, MRI scans show detailed images of soft tissues in the body. But MRI scans use radio waves and strong magnets instead of x-rays.
MRI images are very useful in showing cancer that has spread outside of the bladder into nearby tissues or lymph nodes. A special MRI of the kidneys, ureters, and bladder, known as an MRI urogram, can be used instead of an IVP to look at the upper part of the urinary system.
Possible Risks Of Having A Blood Test
Blood sampling is a safe test. There is a possibility of:
- bleeding and bruising – pressing hard when the needle is removed can help to stop it
- pain – this is normally mild and can last for a few minutes
- swelling – ask your nurse, doctor or phlebotomist to avoid an arm that is swollen or has a risk of swelling
- feeling faint or fainting – tell the person doing your blood test if you’re feeling lightheaded or dizzy at any time
- infection – this is very rare
Oxford handbook of clinical medicine M Longmore and other
Bladder cancer: overview and disease management. Part 1: non-muscle-invasive bladder cancerB AndersonBritish Journal of Nursing, 2018. Volume 27, Issue 9, pages 27 37
Bladder cancer: ESMO Practice Guidelines for diagnosis, treatment and follow-upJ Bellmunt and othersAnnals of Oncology, 2014. Volume 25, Issue 3, Pages 40-48
BMJ Best Practice. Bladder CancerD LammBMJ Publishing Group,
The Royal Marsden Manual of Clinical Nursing Procedures L Dougherty and S ListerWiley Blackwell, 2015
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Causes Of Bladder Cancer
There are certain things that can affect the chances of developing bladder cancer. These are called risk factors.
The main risk factor is age. Bladder cancer is more common in people over the age of 60. It is rare in people under the age of 40. Another risk factor is smoking. Smoking may cause about 4 in 10 bladder cancers.
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.
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The Need For A New Test
Invasive bladder cancer is the 11th most common cancer in the UK, accounting for 3% of all new cancer cases, between 2016 and 2018. And each year, over 300,000 people in England are referred to hospital clinics for cytoscopies, usually after seeing blood in their urine .
So firstly, in the diagnosis of new cases of disease, most patients diagnosed with bladder cancer will have developed haematuria or blood in their urine. And in about 80 to 90% of those patients it will be blood that they have seen themselves when going to the toilet, says Mr Richard Bryan, director of the University of Birminghams Bladder Cancer Research Centre.
If referred, the first stage of investigation is usually a cystoscopy, an invasive and costly procedure which involves inserting a camera into the bladder.
If youre diagnosed with bladder cancer, then the vast majority of patients are diagnosed with early disease, what we call non-muscle-invasive bladder cancer, explains Bryan. And although its generally not immediately life threatening, it needs appropriate early treatment and long term follow up. And the long term follow up for those patients involves regular outpatient flexible cystoscopy that can be every as often as every three months, and for as long as for the rest of your life.
For years, researchers have been looking for a way to detect bladder cancer that is less invasive, but just as effective as cystoscopy.
What Is Bladder Cancer
The bladder, a hollow organ in the lower part of the abdomen, serves as a reservoir for urine until it is discharged out of the body through the urethra.
There are different types of bladder cancer. The cancer cell type can be transitional cell carcinoma, squamous cell carcinoma or adenocarcinomaeach named for the types of cells that line the wall of the bladder where the cancer originates.
- Most bladder cancers start from the transitional cells, which occupy the innermost lining of the bladder wall. The cancers, which originate in these cells lining the bladder can, in some instances, invade into the deeper layers of the bladder , the thick muscle layer of the bladder, or through the bladder wall into the fatty tissues that surround the bladder.
- Squamous cells are thin flat cells that line the urethra and can form in the bladder after long bouts of bladder inflammation or irritation. Squamous cell carcinoma makes up about 5 percent of bladder cancers.
- Adenocarcinoma is a very rare type of bladder cancer that begins in glandular cells in the lining of the bladder. Only 1 percent to 2 percent of bladder cancers are adenocarcinoma.
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