Atypical Cells: What does that mean?

Mom's urinalysis came back showing atypical cells. Doctor said there was no concern but he should do a cystoscope next month. (FYI. her urinalysis 2 months ago was clear). So, what does it mean? Is a tumor growing?

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Hi, Cynthia
This is the definition of atypical cells from the Mayo Clinic. Your Mom's Uro is being proactive in doing a Cysto, which is very good.

Atypical cells appear abnormal, but they ARE NOT necessarily cancerous. Many factors can make normal cells appear atypical, including inflammation and infection. Even normal aging can make cells appear abnormal.

Atypical cells can revert to normal if the underlying cause is removed or resolved. In some cases this happens spontaneously. In other cases, it's the result of a specific treatment.

Although atypical cells don't necessarily mean cancer, it's important to remember that some cancers first appear as atypical cells. If your doctor identifies atypical cells, close follow-up is essential. In some cases, the doctor may simply monitor the atypical cells to make sure they don't become more abnormal. In other cases, the doctor may recommend a particular treatment to try to reverse the process that's causing the atypical cells. And sometimes, the doctor may need to obtain a larger sample of tissue — such as a biopsy — to make sure cancer or another more serious condition isn't present.

Best of luck to your mom,

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Thanks for the detailed response. It is very much appreciated. I see that your profile has a link to Dr. Lamm. Are you using his Oncovite?

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Hi Cynthia

No, I do not use his Oncovite. I am one to use pills if absolutely necessary only.
All the best,

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After dealing with bladder since Dec '95 and repeatedly told that I had atypical cells I finally asked last week. The urology nurse said that they are not normal, but not cancer. I don't know why it took me so long to ask.

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Hi, Cynthia,

You've asked an excellent question, and one that I think deserves a candid answer. My purpose is not to alarm you, but to suggest that you look at an atypical result as a "yellow-light warning." It is true that aypicality can be caused by many things other than cancer, but if one has previously been diagnosed with bladder cancer, the greatest probability is that an atypical result is an early signal of a recurrence. I have been treated for high-grade bladder cancer for about 7 years, with numerous recurrences after treatment. Most of my cytologies have been "atypical." In my case, atypical cytologies have always been followed by a positive biopsy, cytology or FISH test within 6 months. If the cytology result says "atypical, suspicious for transitional cell carcinoma," another type of test should also be performed, in my opinion (ask for a copy of the test results, as the docs and nurses don't always add that qualifying phrase). I prefer the FISH test, which has a higher degree of accuracy than the cytology, but is more expensive. Other tests are also available, such as the NMP-22 test. A cystoscope exam is not conclusive on its own, especially if one has CIS, or if the malignancy is in the upper tract, as mine is.

I am not a professional - just a patient who has learned to be proactive the hard way.

Good luck,

Paul R.

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Hi Cynthia,

I am a retired pathologist and I can tell you that urine cytology is the most difficult thing we do. Urotheilial cells pretty much fall into 4 categories; normal,atypical, suspicious, and malignant. Many bladder cancers shed cells that are only slightly abnormal in appearance, but occur in groups that correspond to the papillary structures seen in many cancers. Unfortunately, other things cause this same abnormality including catheters, cysto, and stones. Usually these mild findings are called atypical and most of the time they prove to be something other than cancer. Follow up for that finding is variable, but as a patient and bladder cancer survivor I would feel more comfortable with cystoscopy for that finding.
Various infections also cause abnormalities that may mimic those of cancer in urine cytology. Suspicious indicates that the cells share many of the characteristics of malignant cells, but fall short of possessing enough of the features to be determined as definitely malignant. In my opinion, anyone with suspicious cytology should be investigated with cystoscopy. Certainly anyone with a malignant interpretation should have cystoscopy. As with any test there are false negatives (ie called negative when in fact there is cancer) and false positives (called positive when in fact there is no cancer). Pathologists try very hard to avoid the latter which means there will be more false negatives. Unfortunately, no test is 100% accurate including cytology and cystoscopy. Best wishes for uneventful follow-up and findings that your atypical cells do not reflect cancer. One thing I forgot to mention is that many of the treatments result in marked cellular abnormalities that are quite difficult to separate from suspicious or malignant findings.


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could be growing and why is he waiting to do the cystoscope? atypical generally means not normal but not cancerous, Still I would not want to wait.


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oh guys! thank you all for your thoughtful and intelligent responses. This is such a not reason only issue. I just want her to enjoy her life.

Unfortuantely, my mom's been through so much this year. I know she doesn't want to do any more tests let alone surgeries. But she does want to live. I'll find out when the cystoscope is planned.

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Hi, anyone out there able to answer my concerns.

In Dec 2005, i was diagnosed with a grade 3 TPI multi focal with squamous change cancer of the bladder.

I was given bcg and cut a long story short, last November i was told the check ups was being extended to 12monthly, as a precaution my urine was being sent off for analisis. I must add i watched the procedure when the camera was in my bladder on a monitor, i didnt see anything, though I probably wouldnt have understood what to look for anyway.

Received a letter last week from hospital, stating that the test has come back atipical. They want to carry out
another test and will let me know the results.

I suppose after reading somwe of the posts and replies on this subject has worried me now.

So i rang the oncoligist specialist nurse, and wish i had not !

The problem being with most cancer patients and i am generalising, when it was my own experience, if or when you are discussing issues with regard to your own well being, you perhaps can easily mis constrew what is being said to you.

I thought she said, that if they didnt know my medical history, the result returned on my urine, would have suggested a bladder cancer was present ! Because during November when having a check up they found my bladder was clear, the test might indicate a cancer present elsewhere, it could be in tubes leading off from bladder wall etc.

I am concerned, they obviously have to have a second sample, i am snowed in at present and getting increasingly worried after reading issues on this site regarding atipical cells.

What am i to think ?

She also said that if the second sample returns same result, its likely they will want to carry out a full body scan. Again worrying !

Can somebody comment please,


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Craig just had a cysto that looked clean, but because he was grade 3 (like you) the doc also wants to go in and get biopsys from a few locations. This is a couple months after his 1st course of bcg. I think with high grade, they will want to be very conservative and aggresive in keeping on top of it. as has been said, the abnormal cells may be nothing but....
Then again, Craig's urine tests have been clean every time even when he had a 3 cm high grade tumor so...

This is an unnerving disease. I'm just caretaker but going from treatment to test to treatment to test ... and we've only been thru this since July. Others here doing it for years. and years.

Need to balance vigilance with finding a way not to go nuts with worry. i don't know that there is a good answer for that we're just starting this journey.

so, be strong, be vigilant, and stay calm.

(oh, and for best results here, you might want to repost as a fresh discussion, things get lost in the middle of other discussions...)

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Atypical urine cytology covers a wide range of abnormalities from reactive/inflammatory changes to neoplastic. Usually, in high grade lesions, a cytology will be positive or suspicious as these are quite different from normal urothelial cells. That is not to say that sometimes an atypical goes with a cancer, particularly low grade tumors. So follow up is a good idea, but with negative cystoscopy and/or biopsies, the cytology is more suspect. As someone noted, you can have urothelial neoplasms in the upper tract (ureters and kidneys) so these can also be a source of atypical/suspicious/positive urine cytology. Best wishes and hoping this is a false positive


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I read your recent post expressing concern about having to have a full body scan. That in itself should not alarm you - in fact, it just means your doctor is doing a thorough job. When I was first diagnosed with bladder cancer, I was given a full body scan also, and had another several years later when I got a positive FISH result from my upper tract. I was relieved both times when the results showed no "hot spots" except where I had arthritic joints. That was seven and five years ago.

In my previous post I mentioned that an atypical cytology should not be interpreted as "negative," but neither should it be interpreted as "positive." In my case the latter has mostly turned out to be an early signal of a recurrence, but I have survived 7 years of atypical cytologies without any visible tumors or metatastasis. I do believe that one should not let his guard down with an atypical result, and should be examined further to see if there are any other indications of a possible problem. It sounds like your doc is doing that.

Best wishes,


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