A cystoscopy is a medical procedure where a doctor uses a thin, lighted tube called a cystoscope to examine the inside of the bladder and urethra. This instrument is inserted through the urethra into the bladder to investigate various bladder conditions.
Understanding Cystoscopy
Cystoscopy can use either a flexible or rigid cystoscope. Flexible cystoscopy uses a bendable tube, often with local anesthesia, for visual examinations. Rigid cystoscopy uses a straight, wider instrument, usually under general anesthesia, for tissue sampling or tumor removal.
Patients lie on their back, and a lubricating gel is applied to the urethra to minimize discomfort. The cystoscope is then gently guided through the urethra into the bladder. Fluid is often used to fill the bladder, allowing the doctor a clearer view of the bladder wall. The procedure typically takes 5 to 20 minutes, depending on the type and any additional steps.
How Cystoscopy Identifies Bladder Cancer
Cystoscopy identifies bladder cancer through visual inspection. The doctor examines the bladder lining for abnormalities like growths, suspicious lesions, or tissue changes. The cystoscope’s light and viewing lens allow for a detailed view of the internal bladder structures.
If suspicious areas are observed, a biopsy is often performed during the procedure for diagnosis. A small piece of the abnormal tissue is removed using instruments passed through the cystoscope. This tissue sample is sent to a pathologist for examination under a microscope, confirming cancer cells and determining type and grade. Small tumors can sometimes be removed during the cystoscopy itself, a procedure called transurethral resection of a bladder tumor (TURBT). Advanced techniques, like blue light cystoscopy, enhance detection by making cancer cells glow pink after absorbing a special dye, identifying tumors potentially missed with standard white light.
Cystoscopy’s Role in a Full Diagnosis
While cystoscopy is a primary tool for diagnosing bladder cancer, it is often part of a broader diagnostic approach. It is combined with other methods to provide a comprehensive diagnosis and determine the cancer’s stage. Additional tests include urine cytology (examining urine for abnormal cells), imaging tests like CT scans or MRIs, and urine markers (detecting specific substances associated with bladder cancer).
Despite its utility, cystoscopy has some limitations. It can miss very flat lesions or microscopic cancer that is not visually apparent. Cystoscopy may fail to detect residual muscle-invasive bladder cancer in some patients. The procedure’s accuracy also depends on the urologist’s skill and experience. Integrating cystoscopy with other diagnostic tools helps maximize cancer detection.
What Happens After a Bladder Cancer Diagnosis
If bladder cancer is detected, the next steps focus on further staging and treatment planning. Additional tests determine if the cancer has spread beyond the bladder. This involves advanced imaging scans or other procedures to assess the disease’s extent.
Treatment options are discussed, tailored to the cancer’s type, stage, grade, and the patient’s overall health. Common treatments include surgery to remove the tumor or the bladder, chemotherapy administered directly into the bladder or systemically, radiation therapy, and immunotherapy. Following treatment, regular follow-up appointments, often including repeat cystoscopies, monitor for recurrence.