Had a cystoscopy this morning. All looks good. MD is going to run some other tests - CT Kidney urogram with and without contrast, another FISH and another urine analysis. Will see him again in two months.
Below is a good video for understanding urine bio-marker like FISH by Urovision. FISH is FDA approved urine biomarker test, which was approved in 2005, a bit old technology. There are several new urine bio-markers that are better than FISH, but not all are FDA approved.
1. Only 5 -10% of patients who come to a urologist's office are bladder cancer. 90-95% chance that you do not have bladder cancer according to Dr. Black -the speaker.
2. AUA guideline states that Fish has 73% sensitivity (when FISH is positive, 73% has bladder cancer) and 95% specificity ( when FISH is negative, 95% has no bladder cancer) when FISH is used for diagnosis.
3. Sometimes it can pick up when cystoscopy misses because of Carcinoma Insitu (CIS) or the tumor is in the upper part of the ureter.
4. Urologists are using cytology more than urine bio-marker as it can pick up what cystoscopy misses. Dr. Black, the speaker once said that he does cytology every time he does cystoscopy. If cytology says negative, it is almost certain that there is not cancer. But if cytology says positive and cystoscopy is negative, he has to look for the source.
I am guessing that if Dr. Black - the speaker in the video is your urologist, I would think that he would recommend cytology first as it is not invasive. If it is negative, he would say that you less likely have cancer because cystoscopy also showed negative.
If cytology is positive, he may ask for Bluelight cystoscopy, which can highlight carcinoma-in-situ better than white light cystoscopy. But this is invasive and not all hospitals have Bluelight cystoscopy, especially flexible cystoscopy which has become available recently.
If the upper section of the ureter needs to be checked, another cystoscopy needs to be done unless your urologist already did it. This is invasive too.
Not all descriptions may not be correct, but hope it helps you to prepare for the meeting with your doctor.
The holidays are the worst times to feel the need to consult with our docs!!
You cannot help worrying, but remember that this has been going on for a long time with no sign of bladder cancer. As you know, urinary blood is a relatively common occurrence and in many cases a cause is never found. Interestingly, a post on a somewhat similar topic is currently being discussed on this Forum:
One more thing to remember is that one problem with using FISH tests to diagnose bladder cancer is that they are notorious for providing false positive results, indicating the presence of cancer when none is present.
I realize that none of this is going to alleviate your anxiety, but my "guess" is that you probably will be OK.
Diagnosis 2-08 Small papillary TCC; CIS
BCG; BCG maintenance
Vice-President, American Bladder Cancer Society
Good afternoon, I went to a urologist last December for a work up re some microscopic blood in urine discovered at my GYN office. I have had this before on many occasions but decided to investigate since I lost my husband to colon cancer. The cystoscopy was normal, the contrast CAT scan normal and negative FISH. Fast forward to December of this year, a higher red blood cell count (13-30) and a positive FISH. Just noticed a pale stripe of blood on the tissue. Am very nervous. Contacted my doctor who is away until next week. Any thoughts?