Understanding Your Lab Tests: A Guide for Newly Diagnosed Non-Muscle Invasive Bladder Cancer Patients

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If you have been diagnosed with non-muscle invasive bladder cancer (NMIBC), it means that the cancer is located in the inner lining of your bladder and has not spread to the deeper muscle layer.(1) Laboratory tests play a vital role in helping your doctors understand the characteristics of your cancer, plan the most effective treatment, and monitor your health in the future. This guide will walk you through the common lab tests you might encounter, explaining what they measure and what the results could mean for you.

Urine Tests: The First Line of Detection

Often, the initial investigations for suspected bladder cancer involve examining your urine.2 These tests can reveal important clues about what's happening in your urinary system.3

Urinalysis: This is a straightforward test that analyzes a sample of your urine to check for the presence of blood and other substances.(2) One of the most common signs of bladder cancer is blood in the urine, a condition known as hematuria.(2) This blood might be visible to the naked eye, causing your urine to appear pink or red, or it might be present in very small amounts that can only be detected under a microscope (microhematuria).(3) While hematuria can be a significant indicator of bladder cancer, it's important to remember that it can also be caused by other, more common conditions such as urinary tract infections (UTIs) or kidney stones.(2) Sometimes, urinalysis is even performed as part of a routine health check-up.(3)
Urine Cytology: This test involves taking a sample of your urine and examining it under a microscope to see if any cancer or pre-cancer cells are present.(2) Urine cytology can also be performed on bladder washings, which are collected during a procedure called cystoscopy.(4) This test is particularly helpful in diagnosing high-grade tumors, which are more aggressive, and a condition called carcinoma in situ (CIS), where abnormal cells are present in the lining of the bladder.(14) CIS can sometimes be difficult to see during a cystoscopy, making urine cytology a valuable tool.(19) When your urine sample is examined, the results might fall into a few categories, such as negative for high-grade urothelial carcinoma (meaning no cancer cells were found), atypical urothelial cells (indicating some abnormalities but not clearly cancer), suspicious for high-grade urothelial carcinoma (suggesting abnormal cells that could be cancerous), or positive for high-grade urothelial carcinoma (meaning cancer cells were found).(14) While urine cytology plays a key role, it has some limitations. It is less sensitive in detecting low-grade tumors because these tumors tend to shed fewer cells into the urine.(16) Therefore, a negative result doesn't always guarantee that you are cancer-free.(4) The accuracy of this test can also be influenced by the experience of the person examining the cells, known as the cytologist.16 Overall, the sensitivity of urine cytology is around 48%, with lower sensitivity for low-grade tumors (16%) but higher for high-grade tumors (84%).16
Urine Culture: If you are experiencing urinary symptoms, your doctor may order a urine culture to determine if these symptoms are caused by a bacterial infection.(4) UTIs can sometimes mimic the symptoms of bladder cancer. For this test, a sample of your urine is placed in a special dish in the lab to see if any bacteria grow. It can take a few days to get the results of a urine culture.(4) It's important to note that while a urine culture can identify an infection, it cannot determine whether or not you have bladder cancer.(15)
Urine Tumor Markers (Biomarkers): These are newer types of tests that look for specific substances in your urine that may be produced by bladder cancer cells or by your body in response to the cancer.(3) These substances are also referred to as tumor markers.3 Urine tumor marker tests are often used in conjunction with urine cytology to aid in the detection of bladder cancer.(2) Some of the commonly used and FDA-approved biomarkers include:
NMP22 (Nuclear Matrix Protein 22): This test measures the level of the NMP22 protein in your urine, which is often found at higher levels in people with bladder cancer.(2) It's available as a quick, point-of-care test (NMP22 BladderChek) or as a more detailed quantitative test done in a lab.(21) Studies have reported varying sensitivity (from 33% to 90.6%) and specificity (from 32.4% to 99%) for this test in detecting bladder cancer.33 The sensitivity of NMP22 might be better for high-grade tumors.40 It's worth noting that elevated NMP22 levels can sometimes occur due to inflammation or urinary tract infections, leading to false-positive results.(21)
BTA tests (Bladder Tumor Antigen tests): These tests look for a substance called bladder tumor antigen (BTA), also known as complement factor H-related protein (CFHrp), in your urine.(2) There are two main types: BTA stat, which is a qualitative test done at the point of care, and BTA TRAK, which is a quantitative test performed in a lab.24 Reported sensitivity for BTA tests ranges from 53% to 83%, and specificity ranges from 51% to 75%.28 Similar to NMP22, false positives can happen if there is blood in your urine, if your urine is very concentrated, or if you have a UTI.(22)
UroVysion (FISH - Fluorescence In Situ Hybridization): This test uses fluorescent probes to detect specific chromosome changes (aneuploidies on chromosomes 3, 7, 17 and loss of a region on chromosome 9) that are commonly found in bladder cancer cells.2 UroVysion tends to be more sensitive than urine cytology but may have a similar or lower specificity for detecting recurrent bladder cancer.50 Its sensitivity can range from 42% to 83% for early-stage tumors (Ta/T1) and from 92% to 100% for more advanced tumors (T2-4).30 This test is also used to see how well you are responding to BCG treatment and to clarify uncertain cytology results.(25)
ImmunoCyt (uCyt+): This test uses fluorescently labeled antibodies to examine urine cells for certain substances, such as mucin and carcinoembryonic antigen (CEA), that are often present on cancer cells.(2) It can sometimes help make urine cytology more sensitive in detecting cancer cells.(21) ImmunoCyt generally has a higher sensitivity but a lower specificity compared to UroVysion FISH.21 It is approved for monitoring patients who have a history of bladder cancer.(24)
Cxbladder: This is a non-invasive urine test that looks at the activity of five specific genes (MDK, HOXA13, CDC2, IGFBP5, CXCR2) to help determine if bladder cancer is likely.(15) It may be able to distinguish between low- and high-grade tumors and might be more accurate than some of the protein-based markers.(21) A version called Cxbladder Monitor can be used to reduce the need for frequent cystoscopies in people being monitored for cancer recurrence.(15)
Other Biomarkers: Researchers are continuously working to find new and better urine markers for bladder cancer. Some other markers that are being studied or used in certain situations include survivin, telomerase, and various tests that look for specific genetic material (mRNA and DNA) in urine.(9) For example, Bladder EpiCheck measures changes in DNA called methylation (9), AssureMDx looks for methylation and mutations in genes commonly altered in bladder cancer (31), and Xpert Bladder Cancer checks for specific mRNA in urine.(24)

While these urine biomarker tests can be helpful, it's important to know that cystoscopy is still considered the most reliable way to detect bladder cancer.(2) Some of these biomarker tests might be more useful for checking if the cancer has come back after treatment rather than for the initial diagnosis.(2)

Blood Tests: Assessing Overall Health and Kidney Function

Blood tests are another important part of the evaluation process for bladder cancer.5 Although no blood test can definitively tell if you have bladder cancer (11), they provide valuable information about your overall health and how well your organs, like your kidneys and liver, are functioning.

Complete Blood Count (CBC): This common blood test measures the different types of cells in your blood: red blood cells (RBCs), white blood cells (WBCs), and platelets.(57) A CBC is important in bladder cancer because it can help detect anemia, which is a low number of red blood cells. Anemia can occur if there has been long-term bleeding from the urinary tract due to the cancer.(56) The test also checks your white blood cell count, which can be high if you have an infection or inflammation (58), and your platelet count, which is important for blood clotting.(57) Sometimes, a high platelet count can be seen in people with cancer.(63) Here are some general normal ranges for adults, but keep in mind that these can vary slightly depending on the lab and individual factors (64):
Red Blood Cell Count (RBC): Men: 4.3-5.9 million cells/mcL; Women: 3.5-5.5 million cells/mcL.
Hemoglobin (Hgb): Men: 13.5-17.5 g/dL; Women: 12.0-16.0 g/dL.
Hematocrit (Hct): Men: 41%-53%; Women: 36%-46%.
White Blood Cell Count (WBC): 4,500-11,000 cells/mm3.
Platelet Count: 150,000-400,000/mm3.

If your RBC, hemoglobin, or hematocrit levels are low (anemia), it could suggest chronic blood loss, possibly from the tumor.(56) A high WBC count might indicate your body is fighting an infection or dealing with inflammation.(58) A low WBC count (leukopenia) is less common in the initial diagnosis but could be related to bone marrow issues or certain treatments.58 A high platelet count (thrombocytosis) is sometimes observed in cancer.63

Comprehensive Metabolic Panel (CMP): A CMP is a group of blood tests that includes checks on your kidney and liver function.(5)
Kidney Function Tests:
Creatinine: This test measures the level of creatinine in your blood, a waste product that your kidneys filter out.(76) Normal ranges typically fall between 0.7-1.3 mg/dL for men and 0.6-1.1 mg/dL for women, but can vary by lab.78 Higher levels might indicate that your kidneys aren't working as well as they should, possibly due to a tumor obstructing the flow of urine.56
BUN (Blood Urea Nitrogen): This test measures the amount of urea nitrogen in your blood, another waste product removed by your kidneys.76 Normal BUN levels are generally between 6 and 24 mg/dL, but this can also vary.86 Elevated BUN can also indicate kidney problems or dehydration.(89)

Checking kidney function is important because bladder cancer or its treatment might affect how well your kidneys work or the flow of urine.(56) Tumors can sometimes press on the tubes (ureters) that carry urine from the kidneys to the bladder, which can impact kidney function. Also, some treatments for bladder cancer can have side effects on the kidneys.

Liver Function Tests:
ALT (Alanine Transaminase) and AST (Aspartate Transaminase): These are enzymes found mainly in your liver.(102) Normal levels can vary but are often below 40-55 units per liter (U/L).(103) Elevated levels might suggest liver damage. This could be relevant if your doctors are considering certain treatments or if there's a concern about the cancer spreading to the liver, although this is less common in early-stage NMIBC.

Liver function tests help establish a baseline and can be used to monitor for any potential spread of the cancer or side effects from treatment.(76) While it's less common for non-muscle invasive bladder cancer to spread to the liver, these tests are a standard part of a comprehensive evaluation.

The Bigger Picture: How Lab Tests Guide Your Care

It's important to understand that these lab tests are not just isolated measurements. They provide crucial information that, along with imaging studies and cystoscopy, helps your doctors get a complete picture of your condition.(5) These tests are essential for:

Diagnosis: Identifying whether cancer is present.(5)
Staging: Determining the extent of the cancer, including whether it has spread (though in your case, it's non-muscle invasive) and the grade of the tumor.5 The grade, which indicates how aggressive the cancer cells appear, is determined by examining tissue samples in the lab.5
Treatment Planning: Guiding your doctors in choosing the most appropriate treatment options for you.5
Monitoring: Checking for any signs of the cancer returning after treatment.7

How Often Will These Tests Be Done?

The frequency of your lab tests will depend on several factors, including whether you are undergoing initial diagnosis or if you are in the follow-up phase after treatment.76 During the initial diagnostic process, urine tests are often done early on, and blood tests might be ordered to assess your overall health and organ function.(5)

If you have completed treatment for NMIBC, you will likely have regular follow-up appointments to monitor for any recurrence.(76) The frequency of these appointments and the tests involved will depend on your individual risk of recurrence, which is often determined by the initial grade and stage of your tumor.(76) A common follow-up schedule involves regular cystoscopy exams, often combined with urine cytology, typically every 3 to 6 months for the first few years after treatment.8 Blood tests to check your kidney and liver function might also be done periodically, especially if you are receiving certain types of treatment or if there are any concerns about the cancer spreading.76 If you have had surgery to remove your bladder and have a urinary diversion created using a part of your intestine, your doctor may also check your vitamin B12 levels annually.(51) In some cases, newer urine biomarker tests might be used to help reduce how often you need to have a cystoscopy.(15)

Where to Find Reliable Information

It's natural to want to learn more about your condition. Here are some trusted sources where you can find additional information about bladder cancer and the tests used to diagnose and monitor it:

American Cancer Society (3)
National Cancer Institute (5)
Urology Health Foundation (5)
Mayo Clinic (6)
Cancer Research UK (54)
American Urological Association (20)
National Comprehensive Cancer Network (NCCN) (22)
Reputable medical journals (e.g., Journal of Urology, European Urology)
Websites of major academic medical centers (e.g., Johns Hopkins (143), Cleveland Clinic (14))

Remember, this guide provides general information. It is essential to discuss your specific test results and follow-up plan in detail with your own healthcare team. They are the best resource for answering your questions and tailoring your care to your individual needs.

Table 1: Common Lab Tests for Non-Muscle Invasive Bladder Cancer

Test Name	What it Measures	Purpose in Bladder Cancer	Typical Normal Range (Adults)	Potential Implications of Abnormal Results	Snippet IDs
Urinalysis	Blood, other substances in urine	Initial screening; may detect hematuria	Absence of significant blood or other abnormal substances	Presence of blood (hematuria) may indicate bladder cancer, but can also be other conditions	2
Urine Cytology	Cancer/pre-cancer cells in urine	Detection of cancer cells; particularly useful for high-grade tumors and CIS	Negative for high-grade urothelial carcinoma	Presence of atypical, suspicious, or malignant cells suggests possible bladder cancer	4
Urine Culture	Bacteria in urine	Rule out infection as cause of urinary symptoms	No significant bacterial growth	Growth of bacteria indicates a urinary tract infection	4
NMP22	Nuclear Matrix Protein 22 in urine	Aid in diagnosis and monitoring of bladder cancer	Typically < 10 U/mL (check lab reference)	Elevated levels may suggest bladder cancer, but can also be due to inflammation, UTI	21
BTA Test	Bladder Tumor Antigen (CFHrp) in urine	Aid in diagnosis and monitoring of bladder cancer	BTA stat: Negative; BTA TRAK: < 14 U/mL (check lab reference)	Elevated levels may suggest bladder cancer, but can also be due to hematuria, concentrated urine, UTI	21
UroVysion FISH	Chromosome abnormalities in urine cells	Aid in diagnosis and monitoring, assess response to BCG, clarify cytology	Negative (no significant abnormalities detected)	Detection of chromosomal gains or loss consistent with urothelial carcinoma	21
ImmunoCyt (uCyt+)	Glycoproteins on urine cells	Enhance sensitivity of cytology for bladder cancer detection	Negative (no cancer-associated glycoproteins detected)	Presence of glycoproteins may indicate bladder cancer	21
CBC	Red blood cells, white blood cells, platelets	Assess overall health, detect anemia	RBC: M 4.3-5.9, F 3.5-5.5 million/mcL; WBC: 4.5-11.0 x10^3/mm3; Platelets: 150-400 x10^3/mm3 (ranges vary)	Low RBC/Hgb/Hct (anemia) may be due to bleeding; high WBC may indicate infection; abnormal platelets may suggest underlying condition	57
Creatinine (CMP)	Creatinine level in blood	Assess kidney function	Men: 0.7-1.3 mg/dL; Women: 0.6-1.1 mg/dL (ranges vary)	Elevated levels may indicate impaired kidney function	76
BUN (CMP)	Blood Urea Nitrogen level	Assess kidney function	6-24 mg/dL (range varies)	Elevated levels may indicate impaired kidney function or dehydration	76
ALT (CMP)	Alanine Transaminase level	Assess liver function	7-56 U/L (range varies)	Elevated levels may indicate liver damage	103
AST (CMP)	Aspartate Transaminase level	Assess liver function; also found in other tissues	5-40 U/L (range varies)	Elevated levels may indicate liver damage or damage to other organs	103

Table 2: Sensitivity and Specificity of Urine Tumor Markers (Examples from Research Snippets)

Marker Name	Sensitivity (%)	Specificity (%)	Snippet IDs
NMP22	70	80	33
NMP22	85	77	35
NMP22	33	92	41
BTA stat	53-83	67-72	28
BTA TRAK	66-72	51-75	28
UroVysion FISH	84	92	18
ImmunoCyt	68	72	28
Cxbladder	91-97	88-91	15

Note: Sensitivity and specificity values can vary significantly between different studies and patient populations. Always discuss your results with your doctor.

Table 3: Normal Ranges for Complete Blood Count (CBC) in Adults (Examples from Research Snippets)

Component	Male Normal Range	Female Normal Range	Units
Red Blood Cell Count (RBC)	4.3-5.9	3.5-5.5	million/mm3
Hemoglobin (Hgb)	13.5-17.5	12.0-16.0	g/dL
Hematocrit (Hct)	41-53	36-46	%
White Blood Cell Count (WBC)	4.5-11.0	4.5-11.0	x 10^9/L
Platelet Count	150-400	150-400	x 10^9/L

Note: Normal ranges can vary between laboratories. Always refer to the specific reference range provided by your lab.

Conclusion

Understanding the lab tests involved in the diagnosis and monitoring of non-muscle invasive bladder cancer is a key part of navigating your healthcare journey. While urine tests often serve as the first indicators, blood tests provide essential information about your overall health and organ function. The results of these tests, in combination with other diagnostic procedures like cystoscopy and imaging, help your medical team develop the most appropriate treatment plan and monitor your condition effectively. Remember to always discuss your individual test results and any concerns you may have with your doctor. They are your best resource for personalized guidance and care.