Cystoscopy is the primary method urologists use for the initial detection of suspected bladder cancer and long-term monitoring for recurrence. Bladder cancer involves the abnormal growth of cells within the bladder lining, often presenting with symptoms like blood in the urine or painful urination. The procedure allows a direct, internal examination of the urinary tract, which is the most reliable way to visually identify and sample suspicious tissue.
What is a Cystoscopy
A cystoscopy is a minimally invasive procedure providing a direct view of the interior of the bladder and the urethra. It uses a specialized instrument called a cystoscope, a thin, tube-like device equipped with a light and a camera or viewing lens. Either a flexible or rigid cystoscope may be used, depending on the examination’s purpose.
The procedure is often performed in a doctor’s office or an outpatient setting. For a standard visual inspection, a local anesthetic lubricating jelly is applied to the urethra to numb the area and minimize discomfort. The patient typically lies on their back with their knees slightly bent or raised.
The lubricated cystoscope is gently guided through the urethra and into the bladder. Sterile water or saline solution is slowly instilled through the scope to expand the bladder walls. This distension allows the physician to clearly view the entire inner lining of the bladder and urethra for abnormalities. While the procedure is quick, the bladder filling can create an urge to urinate.
If the procedure involves removing tissue or a larger tumor, a rigid cystoscope is used. This requires a more involved anesthetic, such as general or spinal anesthesia, and is performed in an operating room. The choice of scope and anesthetic depends on whether the physician is only inspecting the area or planning a biopsy or minor surgical procedure.
How the Procedure Detects Bladder Cancer
Cystoscopy detects bladder cancer through two primary mechanisms: visual inspection and tissue sampling. Visual inspection, typically using standard white light, involves examining the entire bladder wall for growths, lesions, or thickened tissue. Suspicious findings range from small, finger-like papillary tumors, which grow into the bladder’s hollow space, to flat, velvety-red areas suggesting aggressive carcinoma in situ (CIS).
To enhance detection, some physicians use blue light cystoscopy. This involves placing a fluorescent drug into the bladder before the procedure. Cancer cells absorb the drug, causing them to glow bright pink or red under blue light. This advanced method significantly improves the detection rate, especially for smaller or flatter lesions that standard white light might miss.
If an area appears suspicious, the physician performs tissue sampling. Small instruments are passed through the cystoscope to collect a biopsy of the abnormal tissue. When a tumor is present, the procedure is often expanded into a surgical operation called Transurethral Resection of a Bladder Tumor (TURBT).
During a TURBT, the entire visible tumor is removed along with a layer of underlying bladder muscle. The tissue samples from the biopsy or TURBT are sent to a pathology lab. The lab provides the definitive diagnosis by confirming cancer cells and determining the cancer’s specific type and grade.
Confirmatory Tests for Staging
Cystoscopy confirms bladder cancer, but staging determines the extent of its spread. Staging requires complementary tests performed after the initial confirmation. These tests assess whether the cancer is confined to the bladder lining, has invaded the muscle wall, or has metastasized to distant organs.
One follow-up test is urine cytology, where a sample is examined under a microscope for malignant cells shed from a tumor. This test is particularly effective at detecting high-grade tumors but is less reliable for lower-grade cancers. Imaging tests are also routinely used to visualize the upper urinary tract, including the kidneys and ureters, and to check for distant disease.
A specialized CT scan, called a CT Urogram, uses an injected contrast dye to create detailed images of the entire urinary system. This helps identify tumors in the upper tract and provides information about local spread outside the bladder wall. Magnetic Resonance Imaging (MRI) may also be used to provide a clearer picture of the tumor’s depth of invasion into the bladder wall or check for spread to lymph nodes and other soft tissues in the pelvis. The combination of the diagnosis and staging information gives the medical team a complete picture necessary to plan the most effective treatment strategy.