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Urinalysis / Cytology
See also urinemarkers for more information about the different types of tests used in bladder cancer diagnosis, such as NMP22, BTA, FISH and others.
Fluorescent (blue light) cystoscopy This technique is currently only available in Europe, see Hexvix , and is an improvement over standard, white light cystoscopy.
CT-Urography (aka: Virtual Cystoscopy) Computed Tomographic Virtual Cystoscopy for the Detection of Urinary Bladder Neoplasms - the newest tool, still in trials in Europe and the US, shows improvement over regular cystoscopes:
Aug: 2006 CT urography to evaluate macroscopic hematuria possibly due to bladder cancer obviates the need for intravenous urogram and ultrasound and can help determine whether cystoscopy is warranted, new research suggests."Our results support the use of CT urography as a first-line screening tool for this high-risk group, the use of which will obviate the need for flexible cystoscopy in patients with a negative CT urography and allow those with an obvious tumor to be referred directly for rigid cystoscopy and resection," the authors conclude. "The remaining patients should be referred for flexible cystoscopy." BJU Int 2006;98:345-348.
Bladder Mapping or Random Biopsy
Intravenous pyelography (IVP).An IVP involves an intravenous injection of constrast material which is then filtered out of the blood in into the urine by the kidney. Plain x-rays taken during this process show the uninary tract. This test is especially helpful in visualizing the upper tract.
Computed tomography (CT)
CTU (CT Urography)
If you are wondering why a doctor will send you to X-Ray, then Ultrasound, then IVP, then CT, while saving what may debatably the best test for last, the MRI, it may be that the doctor had to prove to your insurance company that an MRI was warranted because the other tests were incloncusive. If money is no object, you probabaly wouldn’t have too much trouble convincing your doctor to prescribe the MRI, or even the PET, as he would most likely be interested in the findings.
MRU (MR Urography)
Electrosurgery uses an electric current to remove the cancer. The tumor and the area around it are burned away and then removed with a sharp tool.
Laser therapy uses a narrow beam of intense light to remove cancer cells. Laser surgery is often used to destroy small low grade tumors. This is done through a cystoscope.
Urethral wash cytopathology-what does a positive result portend? This procedure is used to monitor male bladder cancer patients after they've had radical surgery. See also: metatcc.asp#uwc
Pathology tests see also: Review Pathology: why it is critical: padova1.asp#path
In the case of carcinoma in situ, mulitple tumors and mulitple tumors of mixed cellular origin, or at any evidence of subepithelial invasion (stage T1), resected bladder tumors should always be submitted for pathological testing in order to determine the pT (post surgical stage) category.
A tumour is staged as pTx if there is insufficient or inadequate material available to the pathologist for a proper assessment of invasion. Since it is frequently not possible to determine whether or not invasion has occurred, a pTx tumour may be entirely superficial and non invasive. The text of the pathology report should state clearly whether or not invasion has been identified in the material examined. It is generally not possible to differentiate between superficial and deep detrusor muscle in biopsy samples, and a cystectomy specimen is necessary before a pathologist can reliably subdivide muscle invasive tumours into pT2 or pT3 categories.3
There are many new biomarkers being studied, which can give an indication not only of potential aggressiveness but of probable response to treatment. However, these markers are neither in common use, nor yet an exact science. Bladder cancer patients are very eager for biomarkers to be better understood, and so help us find our best path in the confusing world of cancer treatments. Although great headway is being made in the field of biomarker studies, at this point in time pathological assessment of stage and grade is still the best index of prognosis in common use.
When getting a second opinion, it may be wise to seek a second opinion of your pathology. In a recent study of more than 6,000 patients by Johns Hopkins researchers found that one or two out of every 100 people who come to larger medical centers for treatment following a biopsy arrive with a diagnosis that's "totally wrong." The results suggest that second opinion pathology exams not only prevent errors, but also save lives and money.
Please refer to an article at Steve Dunn’s CancerGuide for an article on biopsy and pathology techniques by Ed Uthman M.D; The Biopsy Report: A Patients Guide
1. Evaluation of new resectoscope loop for transurethral resection of bladder tumors. Herr HW; Reuter VE
2. Superficial bladder cancer: Progression and recurrence. Heney, N.M., Ahmed, S., Flanagan, M.J., et al J Urol 1983; 130:1083-1086 As reviewed by Drs. Emmanuel Schenkman, M.D. and Donald L. Lamm, M.D.; http://www.duj.com/Article/Schenkman.html
Superficial Bladder Cancer Therapy3. Transitional Cell Carcimoma of the Bladder: Back to Basics
Dr. Ken Grigor MD, FRCPathSenior Lecturer and Consultant Pathologist, Edinburgh University and Western General Hospital, Edinburgh.Chairman of the Scottish Urological Oncology Group. Special Feature; Urology News Online Vol.1/4.
|Last Updated ( Friday, 14 November 2008 )|