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Have hematuria. Having pain in abdomen near belly button and frequent urination. What test should be done?

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Practicing since : 2002
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Hi, I have hematuria, and an abnormal Ultrasound(showing small mass) and was wondering if I can get a urine cytology test for cancer without a perscription. For some reason my HMO dr. won't order it even though I have had it for 6 years and in all four recent urine tests. He wants me to get a four-phase CT scan instead, but I have been accidentally exposed to large amounts of occupational radiation. I don't believe I am a candidate for those high levels, but he poo-poos my concerns. Also wondering about "FISH" analysis fluorescent in situ hybridization. I asked for an MRI instead, and he said that would not be useful. But on the US de pt. of health and human services hematuria webpage, they state MRI as useful for tumers. I have pain in my front right abdomen near my belly button, and dull constant pain in my kidneys. Have had for at least 6 years. Also frequent urination.
Posted Mon, 3 Sep 2012 in Cancer
Answered by Dr. Robert Galamaga 3 hours later
Hello and thank you for submitting your question.

Your question is a very good one and I will work on providing you with some information and recommendations.

As far as imaging studies go I believe a CT scan is the most superior way to evaluate the abdomen and pelvis given your history. Right now MRI has not been proven to be superior.

Also there is no over-the-counter urine cytology kicked at this point. This is something that your doctor what would need to request. You could potentially discuss this with a urologist to see if they have a different opinion.

FISH is another highly specialized and very expensive test which is not available over-the-counter. Again this would need to be requested by your doctor. This is a relatively new way of urinary diagnostics and is not paid for by all insurance plans.

I would encourage you to get the CT scan performed. There is not a very high dose of radiation associated with a single CT scan. If you have some type of occupational exposure then I would advise you to make sure that is quantified in some degree for future reference.

I can appreciate that you're dealing with a very stressful situation. I look forward to helping you with further recommendations. If you have additional concerns please let me know.


Dr. Robert
Above answer was peer-reviewed by
Follow-up: Have hematuria. Having pain in abdomen near belly button and frequent urination. What test should be done? 15 hours later
The doctor is recommending a four phase CT Scan with contrast. This is a huge amount of radiation. Each phase is typically 10-20mSv. With the total being 4x that for the four phase reccomended to me. Potentially 80 mSv if it is a clinic that runs high. Note that in Hiroshima, 10mSv was associated with cancer.

This information comes from the very best source, actual clinical settings. This is all reported in this publically available article accessable on the internet:

Radiation Dose Associated With Common Computed Tomography Examinations and the Associated Lifetime Attributable Risk of Cancer XXXXXXX Smith-Bindman, MD; Jafi Lipson, MD; XXXXXXX XXXXXXX BA; Kwang-Pyo XXXXXXX PhD; Mahadevappa XXXXXXX MS, PhD; XXXXXXX Gould, ScD; XXXXXXX Berrington de Gonza ́lez, DPhil; XXXXXXX L. Miglioretti, PhD(REPRINTED) ARCH INTERN MED/VOL 169 (NO. 22), DEC 14/28, 2009      WWW.WWWW.WW 2085
©2009 American Medical Association. All rights reserved.
Answered by Dr. Robert Galamaga 8 hours later
Hello and thank you for the follow up question.

In this case I cannot argue that there is some degree of radiation exposure from that CT scan. Keep in mind however that the physicians are trying to understand better the anatomy of what is going on inside your body. I would much rather have you exposed to some degree radiation in order to find a cancer which is treatable rather than avoid the test and have you deal with the consequences of widely metastatic disease.

I would not classify this as a huge amount of radiation.

If you feel that this amount of radiation is not acceptable I cannot change your mind along those lines. I would urge you to have a long discussion with your oncologist to see what they might recommend as a potential alternative.

Thanks again for submitting your question.

Dr. Robert
Above answer was peer-reviewed by
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