'abnormal' cells?

[drpepper]

I went to PCP for gross hematuria. There was no UTI so I was sent to Urologist. At the first visit, I gave a urine sample results pending at that time (i guess these results must have been questionable?)and they did a quick ultrasound and pelvic exam which were normal (yea!). I was scheduled for an IVP - which also came back normal (yea!). Next I was scheduled for a cystoscope and a bladder wash which he sent out for a urine cytology. The cystoscope was normal (you guessed it..yea!, but the cytology came back with "abnormal cells, suspicious of cancer".I was then scheduled for a biopsy of my bladder and they were going to look at my urethers and kidneys too. I think he did the equivilent of a kidney wash too. Do they take a biopsy of your kidney this way if you are under general? Anyway the Doc found a kidney stone which he removed and put in a stent.  He told me at the time that he felt confident that the abnormal cells were caused by the stone. The biopsy came back still showing abnormal cells. He said he didn't see anything odd looking when he scoped me and I trust him completely, However, the IVP and the ultrasound missed the stone, so everything is foulable. Short of it is, what does "abnormal cells" mean? Since anything in the kidney eventually goes through everything else do you concur that the abnormal cells likely came from the stone and not from something separate like some sort of a precancerous condition like CIS?
I never even knew the stone was there. I never had any pain with urination. I've had slight back pain off and on for years, but it was never awful and I always associated it with endometreosis. I had a partial hysterectomy last May but my back pain was really never that bad.
Anyway, my Doc doesn't seem to be too concerned becaused I don't have to go back until the middle of June, first for an IVP and then for results.
Sorry, lots of questions, but if he was so surprised by the abnormal results of the biopsy it makes me wonder what they might be and I'm not even sure what "abnormal" cells mean and why they can't get more specific or not at all or why they can't figure out where they are coming from. I know you can't tell me where they are coming from.
Thanks!!

[Kevin Pho, MD]

The cystoscopy is a very comprehensive test to evaluate cancer in the bladder.  In your case, you have suspicious cells with a negative cystoscopy.  This warrants further evaluation of the upper GU tract (including ureters).

In patients with positive urine cytology and no visually apparent tumor within the bladder, in addition to biopsy of apparently normal bladder urothelium, selective catheterization of the ureters is required with retrograde studies to evaluate for the presence of upper urinary tract disease.

In addition to selective catheterization, you may also want to consdier selective ureteral and renal pelvis washings. Some investigators report an accuracy rate of up to 80 percent in detecting cancer of the upper tract with appropriate washing technique.

You may want to discuss these further options with your urologist.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

Bibliography:
Donat et al.  Clinical presentation, diagnosis, and staging of bladder cancer.  UptoDate, 2004.