Bladder Cancer Markers, Urine


Also found in: Encyclopedia, Wikipedia.

Bladder Cancer Markers, Urine

Synonym/acronym: Nuclear matrix protein (NMP) 22, BTA, cytogenic marker for bladder cancer.

Common use

To assist in diagnosing bladder cancer.

Specimen

Urine (5 mL), unpreserved random specimen collected in a clean plastic collection container for NMP22 and Bard BTA; urine (30 mL), first void specimen collected in fixative specific for FISH testing.

Normal findings

(Method: Enzyme immunoassay for NMP22 and bladder tumor antigen [BTA], fluorescence in situ hybridization [FISH] for cytogenic marker)

NMP22: Negative: Less than 6 units/mL, borderline: 6 to 10 units/mL, positive: Greater than 10 units/mL

BTA: Negative

Cytogenic Marker: Negative

Description

Cystoscopy is still considered the gold standard for detection of bladder cancer, but other noninvasive tests have been developed, including several urine assays approved by the U.S. Food and Drug Administration. Compared to cytological studies, these assays are believed to be more sensitive but less specific for detecting transitional cell carcinoma. FISH is a cytogenic technique that uses fluorescent-labeled DNA probes to detect specific chromosome abnormalities. The FISH bladder cancer assay specifically detects the presence of aneuploidy for chromosomes 3, 7, and 17 and absence of the 9p21 loci, findings associated with transitional cell cancer of the bladder.

NMP22: Nuclear matrix proteins (NMPs) are involved in the regulation and expression of various genes. The NMP identified as NuMA is abundant in bladder tumor cells. The dying tumor cells release the soluble NMP into the urine. This assay is quantitative.

Bladder tumor antigen\ (BTA): A human complement factor H-related protein (hCFHrp) is thought to be produced by bladder tumor cells as protection from the body’s natural immune response. BTA is released from tumor cells into the urine. This assay is qualitative.

This procedure is contraindicated for

    N/A

Indications

  • Detection of bladder carcinoma
  • Management of recurrent bladder cancer

Potential diagnosis

Increased in bladder carcinoma.

Critical findings

  • Bladder carcinoma
  • It is essential that critical findings be communicated immediately to the requesting health-care provider (HCP). A listing of these findings varies among facilities.

  • Timely notification of a critical finding for lab or diagnostic studies is a role expectation of the professional nurse. The notification processes will vary among facilities. Upon receipt of the critical finding the information should be read back to the caller to verify accuracy. Most policies require immediate notification of the primary HCP, hospitalist, or on-call HCP. Reported information includes the patient’s name, unique identifiers, critical finding, name of the person giving the report, and name of the person receiving the report. Documentation of notification should be made in the medical record with the name of the HCP notified, time and date of notification, and any orders received. Any delay in a timely report of a critical finding may require completion of a notification form with review by Risk Management.

Interfering factors

  • NMP22: Any condition that results in inflammation of the bladder or urinary tract may cause falsely elevated values.
  • BTA: Recent surgery, biopsy, or other trauma to the bladder or urinary tract may cause falsely elevated values. Bacterial overgrowth from active urinary tract infection, renal or bladder calculi, gross contamination from blood, and positive leukocyte dipstick may also cause false-positive results.
  • Cytogenic marker: Incorrect fixative, gross contamination from blood, bacterial overgrowth from active urinary tract infection, inadequate number of bladder cells in specimen.

Nursing Implications and Procedure

Pretest

  • Positively identify the patient using at least two unique identifiers before providing care, treatment, or services.
  • Patient Teaching: Inform the patient this procedure can assist in establishing a diagnosis of bladder disease.
  • Obtain a history of the patient’s complaints, including a list of known allergens.
  • Obtain a history of the patient’s genitourinary system, symptoms, and results of previously performed laboratory tests and diagnostic and surgical procedures.
  • Note any recent procedures that can interfere with test results.
  • Obtain a list of the patient’s current medications including herbs, nutritional supplements, and nutraceuticals (see Effects of Natural Products on Laboratory Values online at DavisPlus).
  • Review the procedure with the patient. Address concerns about pain and explain that there should be no discomfort during the procedure. Inform the patient that specimen collection takes approximately 5 min, depending on the cooperation and ability of the patient.
  • Sensitivity to social and cultural issues, as well as concern for modesty, is important in providing psychological support before, during, and after the procedure.
  • Note that there are no food, fluid, or medication restrictions unless by medical direction.

Intratest

  • Potential complications: N/A
  • Instruct the patient to cooperate fully and to follow directions.
  • Observe standard precautions, and follow the general guidelines in Patient Preparation and Specimen Collection. Positively identify the patient, and label the appropriate specimen containers with the corresponding patient demographics, initials of the person collecting the specimen, date and time of collection.
  • Obtain urine specimen in a clean plastic collection container. Promptly transport the specimen to the laboratory for processing and analysis.

Post-Test

  • Inform the patient that a report of the results will be made available to the requesting HCP, who will discuss the results with the patient.
  • Recognize anxiety related to test results, and be supportive of fear of shortened life expectancy. Discuss the implications of abnormal test results on the patient’s lifestyle. Provide teaching and information regarding the clinical implications of the test results, as appropriate. Educate the patient regarding access to counseling services. Provide contact information, if desired, for the American Cancer Society (www.cancer.org) or the National Cancer Institute (www.cancer.gov).
  • Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP. The greatest risk factor for bladder cancer is smoking. Inform the patient of smoking cessation programs as appropriate. Answer any questions or address any concerns voiced by the patient or family.
  • Depending on the results of this procedure, additional testing may be performed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patient’s symptoms and other tests performed.

Related Monographs

  • Related tests include biopsy bladder, cytology urine, cystoscopy, IVP, and US bladder.
  • Refer to the Genitourinary System table at the end of the book for related tests by body system.