Urine tests: detecting cancer early in the pee – Cancer Research UK

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Feeling anxious around needles is common. The NHS estimates that about 1 in 10 people experience trypanophobia, a fear of medical procedures that involve needles or injections.

Unfortunately, the use of needles in medicine is often necessary to monitor a person’s health. But looking in the blood may not be the only way to find clues left behind by disease. Other bodily fluids, such as urine, can also reveal what is happening in our bodies.

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“Urine gives a great insight into what goes on in our bodies,” said Mr Richard Bryan of the University of Birmingham, a Cancer Research UK-funded bladder cancer surgeon who is working on a test to detect the disease at an early stage.

β€œThe great thing about urine is that it’s abundant, and no one really wants it other than people like me. It really helps if patients give us permission to use their urine for research.”

Bladder cancer may be the most obvious cancer found in the urine, but there is some evidence that remnants of other cancers, such as kidney cancer, are prostate and cervical cancer – can also get into the puddle.

How does cancer cues end up in the urine?

There are two main ways cancer can get into the urine: through the kidneys or through the bladder and ureters (the tubes that connect the kidneys to the bladder).

Molecules released by cancer cells can travel to the kidneys via the blood. But in order to pass through the delicate filter system of the kidneys and enter the bladder, these molecules must be small. They are usually molecular building blocks that make up cancer cells, such as proteins.

And a useful clue doesn’t have to come directly from the cancer. There are promising studies which show that the human papillomavirus (HPV), a virus responsible for most cases of cervical cancer, can be detected in the urine.

Larger cues β€” such as whole cancer cells or their DNA β€” are too large to pass through the kidneys and will have to come out of the bladder or ureters. Pee contains normal bladder cells that have been deposited from the lining of the urinary tract as part of the normal cell life cycle. “If you have a disease, there will also be diseased cells,” says Bryan, whose research is looking for the DNA of bladder cancer cells in urine.

Looking for bladder cancer in pee

we have previously discussed that a successful cancer test should tick certain boxes.

Bryan says there is already an effective way to pick up bladder cancer in people with symptoms called cystoscopy, in which a flexible camera is inserted into the urethra.

“Whether that’s acceptable to use as a screening test is open to debate,” Bryan says, adding that while the unpleasant procedure is reliable, it’s also expensive and labor-intensive, and patients sometimes have to be put to sleep to receive it.

At this point, blood in the urine is the biggest ‘reg flag’ that a person can have bladder cancer. It’s a symptom that usually puts a person in line for cystoscopy.

“But only about a fifth of people who have blood in their urine will actually have bladder cancer, so we hope to develop a urine test that will help narrow this down.” Then those who get the cystoscopy are the ones who probably need it.

To make this test, Bryan and his team try to pin the DNA fragments of bladder cancer cells appearing in the urine, which would notice those who need further testing.

“The goal then would be to take those with a positive urine test to the operating room for a cystoscopy and treat them there and then for the cancer, as soon as we see it.”

The team has tested 800 urine samples for these DNA fragments. “We have a promising experimental test that identifies the most common genetic changes in bladder cancer.”

Now they’re starting to see if they’ve been able to pick up cancer with these clues. And if they find that the test can detect cancer, it needs to be validated in large clinical trials.

Bryan also says the test is not intended to screen the entire population, as it would not be cost-effective to give the test to everyone at this time. But as well as those concerned about blood in their urine, the test is likely helpful for those at higher risk for bladder cancer. β€œThese could be people who have smoked for a long time or who have worked with certain industrial chemicals for extended periods of time,” he says.

A urine test to detect signs of bladder cancer can be a quick and less invasive tool for deciding if someone needs more tests. But where urine tests really have the power to transform the future for patients is pancreatic cancer.

Pee testing for pancreatic cancer

At present, there is no easy way to diagnose pancreatic cancer at an early stage. A diagnosis usually involves a series of scans and invasive biopsies that are normally done once a person has developed symptoms. But by the time they show signs of illness, the disease is usually too advanced to be treated successfully.

A group of our scientists in London wants to change this.

“We started like everyone else,” says Queen Mary, University of London, Professor Tatjana Crnogorac-Jurcevic, “and started looking in the blood for pancreatic cancer.” Her team soon realized that the blood was teeming with molecules released from all sorts of other cells.

Urine is a lot less pressure. Crnogorac-Jurcevic says that about 40% of the material found in urine comes from outside the kidneys and urinary tract. “The blood plasma is filtered by the kidneys, so you can discover a lot in it.”

After 15 years of hard work, Crnogorac-Jurcevic and her team have found 3 important proteins linked to pancreatic cancer successfully signaling its presence in pee.

She says people often use the early detection analogy as “looking for a needle in a haystack.” “We’ve already gone through the haystack and found our needles, so now it’s really a matter of evaluating our test on large samples of patients.”

Exciting, the clinical trial testing this pancreatic cancer detection tool is about to recruit patients.

“We hope that by the time we have the results of our clinical trial, we will be ready to offer this test to patients,” says Crnogorac-Jurcevic. Pancreatic cancer is also uncommon, so once a test is ready to go, it will likely be used in those known to be at higher risk of developing the disease, such as people with certain genes.

It may be a few years before needles are a thing of the past in detecting the early stages of certain cancers, but there’s no question about the impact a urine test can have on a patient’s well-being and how well they do.

Crnogorac-Jurcevic says it was extremely difficult for researchers looking at urine to get projects going because “nobody really thought you could find cancer markers in urine.” But the perseverance pays off: β€œI am constantly looking ahead and I am very happy with where we are now.”


Follow our early detection series to discover all the other ways β€” and bodily fluids β€” our scientists are looking for cancer to detect it earlier and increase the chances of people surviving the disease.

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