Are there any urine tests for bladder cancer?
The most commonly employed urine test right now is called urine cytology, which is simply collecting urine. Generally, it is first morning urine that's collected in a container, which is then sent to the pathologist. The specimen itself is ultra-centrifuged - it's spun down very fast to collect any loose cells in the urine, and a specially trained cytopathologist examines it to look for malignant cells. Cytology has been around for a long time. The downside of cytology is that it is very sensitive and reasonably accurate in patients who have high grade and high stage tumors. However, it is not reliable - in the 15-20% range - in diagnosing patients who have low grade, low stage tumors, and most patients with bladder cancer present with low grade, low stage tumors. Additional urine diagnostic or screening tests are in development now, based on proteins that are either secreted by tumors, or enzymes that are secreted by tumors. There are a number of new diagnostic or screening tests that are in development and will soon be available. Many of them are available today. Combining one of these urinary diagnostic tests with cystoscopy often raises the accuracy of the examination. Using one of these diagnostic tests combined with cystoscopy will alert the urologist that the tumor may not be in the bladder, but somewhere else in the urinary tract. If he examines the bladder and doesn't see an obvious tumor within the bladder, and yet the cytopathologist keeps telling him that there are malignant cells in the urine, then he has to start examining the ureters or the renal pelvis, to see if there is an upper tract source of tumor.
