Summary Of Current Tests
In studies that have compared current tests in the same cohort, there is a trend that shows more robust performance of the cell-based tests . Because these tests are focused on specific cells in the sample, they are less impacted by confounders such as urinary milieu , or by conditions caused by infection, or by instrument-induced damage associated with sampling . Of the cell-based assays, cytology remains the test with the best specificity, but UroVysion improves upon sensitivity rates . Combining the tests described above does show some improvement over single tests . For example, in a study of over 2,000 cases , the PPVs of the four individual testscytology, UroVysion, ImmunoCyt, and NMP22were improved upon when they were used in almost any combination, with the combination including all four tests performing the best . However, although combining tests improves accuracy, proprietary issues mean that this currently requires multiple, distinct tests to be performed, which is not technically or economically feasible.
Another way to combine single tests into more accurate evaluations is to include the test result in a nomogram that can predict the presence of BCa , but it is clear that the derivation of multiplex molecular assays will be an important step towards overall accuracy rates that reach those of cystoscopy and cytology.
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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.
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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What Causes Bladder Cancer
Healthcare providers and researchers dont know exactly why certain bladder cells mutate and become cancerous cells. Theyve identified many different risk factors that may increase your chance of developing bladder cancer, including:
- Cigarette smoke: Smoking cigarettes more than doubles your risk of developing bladder cancer. Smoking pipes and cigars and being exposed to second-hand smoke may also increase your risk.
- Radiation exposure: Radiation therapy to treat cancer may increase your risk of developing bladder cancer.
- Chemotherapy: Certain chemotherapy drugs may increase your risk.
- Exposure to certain chemicals: Studies show that people who work with certain chemicals used in dyes, rubber, leather, paint, some textiles and hairdressing supplies may have an increased risk.
- Frequent bladder infections: People who have frequent bladder infections, bladder stones or other urinary tract infections may be at an increased risk of squamous cell carcinoma.
- Chronic catheter use: People who have a chronic need for a catheter in their bladder may be at risk for squamous cell carcinoma.
Urinary Bladder Cancer Test
IDL Biotech recently developed UBC, a point-of-care test that qualitatively measures cytokeratins 8 and 18 in the urine,61 and UBC enzyme-linked immunosorbent assay , which is a 2-hour sandwich test.62 Cytokeratins are intermediate filament proteins that are characteristic of epithelial cells. A dark line on the test strip indicates a positive result.63 Mian and coworkers62 performed UBC tests on the urine of 180 patients and reported an overall sensitivity of 66% and specificity of 90%. This test requires investigation in multicenter trials.
Blue Light Test For Bladder Cancer
For patients with suspected or known bladder cancer, the benefits of blue light cystoscopy:
- Better inspection of the bladder for cancer, especially small or flat tumors
- Better removal of bladder tumors when they are first discovered
- Leads to fewer recurrences of bladder cancer
- Improved information to use to plan future care for bladder cancer
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?
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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What To Expect After A Cystoscopy
Patients usually leave the hospital on the same day of a cystoscopy. Depending on the type of anesthesia used, it may be necessary to arrange a ride home with a friend or family member.
For 1 or 2 days after a cystoscopy, patients may notice blood in the urine and/or a burning sensation when passing urine. Drinking plenty of fluids usually helps to minimize these symptoms. Returning to work, physical, and sexual activities is usually quick, for example later the same day after a flexible cystoscopy and 1 to 2 days after a rigid cystoscopy. If discomfort is severe or symptoms do not improve as expected, it is important to promptly seek medical help.
What To Expect During Cystoscopy
The procedure generally takes about 15 to 20 minutes.
- Youâll need to pee first. The test is done with an empty bladder.
- Youâll lie down. The position depends on the type of scope your doctor uses:
- Standard rigid cystoscope. Youâll lie on your back with your knees up and apart. Your feet will probably be in stirrups.
- Flexible cystoscope. No special position is needed. The doctor will help you find a comfortable position.
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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.
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
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What Happens During A Cystoscopy
During flexible cystoscopy, the patient lies on their back and an anesthetic gel is passed into the urethra to make the area numb. Once the local anesthetic is working, the doctor inserts the cystoscope through the urethra and then into the bladder. Sterile water may be injected through the cystoscope into the bladder to help make the inner surface of the bladder easier to see. The cystoscope is moved around inside the bladder so that the entire inner surface can be examined.
During rigid cystoscopy, the procedure is similar to flexible cystoscopy but as the patient is usually under general anesthesia they will not be aware of any associated physical sensations. If the doctor sees an abnormal area, biopsies will be taken or a transurethral resection of bladder tumor may be carried out to remove the suspected tumor. The extracted tissues are then sent to a laboratory to be tested for cancer.
How Bladder Cancer Is Diagnosed
There are many tests used for diagnosing bladder cancer. Not all tests described here will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:
The type of cancer suspected
Your signs and symptoms
Your age and general health
The results of earlier medical tests
The earlier bladder cancer is found, the better the chance for successful treatment and cure. However, there is not yet a test accurate enough to screen the general population for bladder cancer, so most people are diagnosed with bladder cancer once they have symptoms. As a result, some people have more advanced disease when the cancer is found. Still, most people are usually diagnosed with noninvasive bladder cancer .
The following tests may be used to diagnose and learn more about bladder cancer:
The following imaging tests may be used to find out if the bladder cancer has spread and to help with staging. Imaging tests show pictures of the inside of the body.
After diagnostic tests are done, your doctor will review the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer. This is called staging and grading.
The next section in this guide is Stages and Grades. It explains the systems doctors use to describe the extent of the disease and the way cancer cells look under a microscope. Use the menu to choose a different section to read in this guide.
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Smoking Can Affect The Risk Of Bladder Cancer
Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer not having risk factors doesn’t mean that you will not get cancer. Talk to your doctor if you think you may be at risk for bladder cancer.
Risk factors for bladder cancer include the following:
- Using tobacco, especially smoking cigarettes.
- Having a family history of bladder cancer.
- Having certain changes in the genes that are linked to bladder cancer.
- Being exposed to paints, dyes, metals, or petroleum products in the workplace.
- Past treatment with radiation therapy to the pelvis or with certain anticancer drugs, such as cyclophosphamide or ifosfamide.
- Taking Aristolochia fangchi, a Chinese herb.
- Drinking water from a well that has high levels of arsenic.
- Drinking water that has been treated with chlorine.
- Having a history of bladder infections, including bladder infections caused by Schistosoma haematobium.
- Using urinarycatheters for a long time.
Older age is a risk factor for most cancers. The chance of getting cancer increases as you get older.
Urine Tumor Marker Tests
Different urine tests look for specific substances made by bladder cancer cells. One or more of these tests may be used along with urine cytology to help see if you have bladder cancer. These include the tests called NMP22® , BTA Stat®, Immunocyt® , and UroVysion®, which are discussed in Can Bladder Cancer Be Found Early?
Some doctors find these urine tests useful in looking for bladder cancers, but they may not help in all cases. Most doctors feel that cystoscopy is still the best way to find bladder cancer.
Some of these tests are more helpful for finding bladder cancer that has come back in someone who has already had it, rather than first diagnosing it.
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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.
What Kind Of Treatment Will I Need
There are many ways to treat bladder cancer. You might want to get a second opinion about the best treatment plan for you.
Bladder cancer is most often treated with:
Sometimes more than one type is used. The treatment plan thats best for you depends on:
- The stage and grade of the cancer
- Whether the cancer has spread into the bladder wall
- The chance that a type of treatment will cure the cancer or help in some way
- Other health problems you have
- Your feelings about the treatment and the side effects that come with it
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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.