Bladder Cancer Testing - Frequently Asked Questions


How do I collect the urine sample?
Your doctor will ask you to go to the local LifeLabs Patient Service Centre to provide a urine sample. In some cases, your doctor may give you an NMP22 Urine Collection Kit, and ask you to collect your urine sample at home. This Urine Collection Kit contains written directions for collecting and handling the urine needed for the test. Please read the directions carefully. We will then prepare the sample for testing. If you have any questions, ask your doctor to answer them before you collect the urine. Your doctor will instruct you to deliver or courier overnight the urine directly to the testing laboratory, or take it to a local laboratory who will transport it for you.

How soon will I get the results?
NMP22 results will be sent to your doctor from the testing laboratory approximately 3 weeks from the time of collection. Your doctor will inform you when the results are available.

What do the results mean?
Clinical studies have shown that when normal NMP22 levels are observed, the risk of recurrence of bladder cancer is low. Your doctor may use this information, together with other observations, when deciding to schedule a follow-up cystoscopy. Studies have shown that when NMP22 levels are elevated, the risk of recurrence of bladder cancer is increased. Your doctor may decide to perform a cystoscopic examination sooner to determine whether a tumour is present.

Where can I get more information?
If you have additional questions about bladder cancer, please ask your doctor.

What is Bladder Cancer?
Bladder cancer is one of the more frequently occurring cancers in the world. Although the specific cause of bladder cancer is unknown, the disease affects three times as many men as women. Over 4000 new cases of bladder cancer are diagnosed each year in Canada. It is estimated that over two million patients worldwide are living with bladder cancer. The most common form of the disease is transitional cell carcinoma (TTC), involving the cells that line the urinary tract. This condition accounts for more than 90% of bladder cancers. One treatment for patients with early stage bladder cancer is surgical removal of the tumour. However, a major concern after surgery is the risk that the cancer will reappear, or recur. Unfortunately, the recurrence rate of bladder cancer is high. As a result, it is necessary to monitor patients frequently to detect a recurrence as soon as possible.

What is the NMP22 Test?
The NMP22 test is a urine test that is used to identify patients who have the greatest risk of bladder cancer recurrence after surgery. Your doctor has given you this brochure to answer some questions you may have about the NMP22 Test. Effective medical care depends on open communication. If you have additional questions about this or any other laboratory test, please ask your doctor.

What does the NMP22 Test measure?
The NMP22 Test is a painless, non-invasive test performed on urine samples that measures the level of NMP22, a Nuclear Matrix Protein (NMP). NMPs are found in the nucleus of cells where they contribute to the structure of the nucleus and various cell functions. In addition, some NMPs have been found to be associated with specific human cancers. NMP22 is found in both normal and cancer (TCC) cells in the bladder. These cells release NMP22 into the urine. Healthy individuals generally have very small amounts of NMP22 in their urine. However, the level of NMP22 is often elevated in the urine of patients with bladder cancer, even at the earliest stage of the disease.

Why is my doctor ordering the NMP22 Test?
After surgery has taken place, your doctor wants to detect any recurrence of bladder cancer as soon as possible. To do this, your doctor will begin a management program that may include measuring NMP22 in your urine as well as several other diagnostic tests. Clinical studies have shown that NMP22 levels in urine can be used as an early predictor of tumour recurrence after surgery. The NMP22 Test identifies patients at risk for recurrence of transitional cell carcinoma. Thus the NMP22 Test may provide important information for your doctor to improve the management of your post-operative care.

What other tests are available?
Currently the primary way of monitoring recurrence of bladder cancer is cystoscopy. Another test, urine cytology, can be used for monitoring recurrence but is more often used to assist in the original diagnosis of bladder cancer.

Cystoscopy is a procedure in which a fiber optic tube is inserted into the bladder through the urethra permitting visual examination of the bladder lining. This procedure is usually performed under local anesthesia. In the first year following surgery for bladder cancer, a cystoscopic examination is typically performed every three to four months. Thereafter the examinations may occur less frequently. Cystoscopy is a standard technique that is very useful for finding visible (often protruding) cancers but cannot predict their recurrence.

Urine cytology is a laboratory test where a microscope is used to analyze bladder cells shed into the urine. This analysis is dependent upon finding abnormal cells and usually identifies the higher grades of bladder cancer, lower grade cancers being found less frequently.