Feeling anxious around needles is common – the NHS estimates that around 1 in 10 people have a fear of medical procedures that involve needles or injections.
We commonly detect cancer by using a needle – however, Cancer Research UK thinks other bodily fluids might give us an insight into a person’s health, and now diagnosing cancer with a urine test may be a possibility.
Mr Richard Bryan from the University of Birmingham, a Cancer Research UK-funded bladder cancer surgeon who’s working on a test to detect the disease in its early stages, said: “Urine gives a great insight into what’s going on inside our bodies.
“The beauty of urine is that it is abundant, and nobody really wants it other than people like me. It’s very helpful when patients give permission for us to use their urine for research.”
Detecting cancer with a urine test
Naturally, bladder cancer is perhaps the most obvious cancer to find in urine, but evidence suggests that remnants of other cancers – like kidney, prostate and cervical cancer – can also get into pee.
There are two main ways for cancer to end up urine – through the kidneys or from the bladder and ureters.
Molecules released by cancer cells can travel to the kidneys via the blood. However, to pass through the kidney’s delicate filtering system and enter the bladder, these molecules need to be small. They’re usually molecular building blocks that make up cancer cells, like proteins.
If a useful clue doesn’t have to come from the cancer directly. There are promising studies that show that the human papillomavirus virus (HPV), a virus responsible for the majority of cervical cancer cases, can be detected in the urine.
Larger clues – like entire cancer cells or their DNA – are too big to pass through the kidneys and will have to come from the bladder or ureters.
Urine contains normal bladder cells that have dropped off from the lining of the urinary tract as part of the normal cell lifecycle.
Bryan, whose research is looking for the DNA of bladder cancer cells in urine, said: “If you have disease, diseased cells will be there too.”
Bryan says there’s already an effective way to pick up bladder cancer in people who have symptoms, called cystoscopy, where a flexible camera is inserted into the urethra.
At the moment the biggest ‘reg flag’ that a person might have bladder cancer is blood in their urine. It’s a symptom that usually puts a person in line for cystoscopy.
Bryan said: “Only around a fifth of people with blood in their urine will actually have bladder cancer, so we’re hoping to develop a urine test that will help narrow this down.” Then those given the cystoscopy would be the ones most likely to need it.
To make this test, Bryan and his team are trying to pin down the DNA fragments from bladder cancer cells that appear in the urine, which would flag up those who need further tests.
He continued: “The aim then would be to take those with a positive urine test into the operating theatre to have a cystoscopy and treat them for the cancer right there and then, as soon as we see it We have a very promising experimental test that identifies the most common genetic changes seen in bladder cancer.”
The team are looking at whether they have managed to pick up cancer using these clues. If they do find the test can detect cancer, it will then need to be validated in large clinical trials.
A urine test to detect signs of bladder cancer could mean a swift and less invasive tool to decide if someone needs more tests. However, where urine tests really have the power to transform the future for patients is pancreatic cancer.
Pancreatic cancer clinical trials
At the moment there’s 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. However, by the time they show signs of illness, the disease is usually too advanced to be treated successfully.
Urine is a lot less crowded. Around 40% of material found in urine is from outside the kidneys and urinary tract.
There will now be clinical trials testing this pancreatic cancer-detecting tool.
Professor Tatjana Crnogorac-Jurcevic from Queen Mary’s University of London, who will be running the trials, said: “We’re hoping that by the time we have the results of our clinical study we’ll be ready to offer this test to patients.”
Pancreatic cancer also isn’t very common, so once a test is ready to go it will mostly likely be used on those who are known to have a higher risk of developing the disease, like people with certain genes.
It might be a few years until needles are a thing of the past when detecting the early stages of certain cancer types, but there’s no doubt of the impact a urine test could have on a patient’s wellbeing and how well they do.