BLADDER CANCER TESTING

[CIN40]

I HAD BLOOD IN MY URINE,  PAIN IN THE BLADDER AREA, BUT NO URINARY INFECTION.  WENT TO A UROLOGIST WHO ORDERED CT SCAN OF MY ABDOMEN , PELVIS, AND KIDNEY, AND DID A CYSTASCOPE, WHICH WERE ALL NORMAL.  MY URINE CYTOLOGY CAME BACK SUSPICIOUS CELLS AND MY DOCTOR ORDERED A PHISH TEST.  HE SAID IF IT COMES BACK POSITIVE IT DOES NOT MEAN I HAVE CANCER.  HE WOULD JUST DO FOLLOW-UP CYSTASCOPES.  IS THIS THE CORRECT WAY TO PROCEED OR ARE THERE OTHER TESTS THAT SHOULD BE DONE IF THE PHISH TEST IS POSITIVE?  IF THE RESULTS ARE NORMAL WHY ARE THERE SUSPICIOUS CELLS?

[HeinrikMD]

Hi,

The cytology involves sloughed off lining of the bladder. If the cancer is very early - it will not be visible to the eye of the urologist, because it will still look like its normal neighbors.

Is it possible that there is no cancer and the cytology is FISH positive. The answer is still yes. The FISH will only detect that there is a predisposition for cancer. Whether or not this will convert into cancer is a question of time. It may be there at its early stages, or still in a stage of transition.

[CIN40]

the cystascope did not show any signs of cancer and the doctor said he would just do follow-up cystascopes if the FISH test is positive.  How would you find an area to remove if it is not visible?  Can the test be positive and there be no cancer?

[HeinrikMD]

if the FISH is positive, then  the urologist would look for the area involved and assess whether it is possible to remove it without taking out the entire bladder

discuss the pain with your doctor and inquire if it is possible that is represents involvement of bone. Bone involvement is not that common, in general the doctor looks at a test called alkaline phosphatase (a blood test)  in estimating the chances of cancer in the bone.

[CIN40]

Thank you for your help.  I forgot to mention my age, which is 40. I also didn't mention that I am having pain the pelvic area.  If the FISH test is positive what is the next step?

[HeinrikMD]

Hi,
I am ssuming you meant FISH (Fluoroscence in situ hybridization). The cells seen on the urine are inspected by a pathologist looking at the structure of the cells. The FISH testing inserts colored probes to look for specific patterns within the genetic material in the cells which would predict behavior whether cancerous or not.
The appearance of cells are not hard lines, this looks malignant, this looks benign. There are appearances that are in between (some of these may mean transition phases from benign to malignant). IF the FISH is negative, we’ll now you don’t have cancer, but it would be prudent to monitor as the findings may mean pre-cancer. Attempting to remove the bladder now to prevent conversion of pre-cancers into cancers is not recommended because a good number of these so-called pre-cancers do not become cancers within the span of a human lifespan.
Hope this helped.