A cystoscopy is a medical procedure used to examine the inside of the bladder and urethra, the tube through which urine exits the body. This examination involves inserting a thin, lighted instrument called a cystoscope into the urethra and advancing it into the bladder. Its primary purpose is to directly visualize the bladder lining to identify abnormalities. It is commonly used to investigate symptoms such as blood in the urine or painful urination, and for diagnosing and monitoring bladder conditions, including bladder cancer.
Visual Hallmarks of Bladder Cancer
When a doctor performs a cystoscopy, several visual characteristics can suggest bladder cancer. The normal bladder lining typically appears smooth and pale pink. In contrast, cancerous areas may present as abnormal tissue growths that protrude from the bladder wall. These growths can vary in size and shape, ranging from small, subtle lesions to larger, more obvious masses.
Changes in color are also indicators. Areas affected by cancer might appear unusually red, inflamed, or even velvety, differing noticeably from the surrounding healthy tissue. Some tumors may also have a paler or discolored appearance. The texture of the bladder wall can change, becoming irregular or lumpy where cancer is present.
An altered pattern of blood vessels is another common visual hallmark. Cancerous tissues often require an increased blood supply to support their growth, leading to the appearance of dilated, tortuous, or irregularly branched blood vessels on the bladder surface. These vascular changes can indicate malignancy. Enhanced techniques, such as blue light cystoscopy, highlight abnormal areas by making cancer cells glow, helping detect tumors missed with standard white light.
Distinct Growth Patterns
Bladder cancer manifests in distinct growth patterns, each with a characteristic visual presentation during cystoscopy. One common type is a papillary tumor, appearing as finger-like projections extending into the bladder cavity. These growths often resemble small mushrooms or sea anemones, and can be singular or multiple. Low-grade papillary tumors have a more uniform structure with slender, well-defined projections. High-grade papillary tumors may exhibit more chaotic, disorganized projections, sometimes appearing irregular.
Another pattern is the sessile tumor, with a flat or broad base directly attached to the bladder wall without a stalk. These flat growths can be more challenging to detect with standard white light cystoscopy than papillary lesions.
Carcinoma in situ (CIS) is a flat, high-grade bladder cancer that does not grow outward into the bladder lumen. Instead, it appears as a flat, reddened, or velvety patch on the bladder lining, often resembling inflammation. Due to its subtle appearance, CIS can be difficult to visualize with conventional white light cystoscopy and may be easily overlooked. Blue light cystoscopy is particularly helpful for identifying CIS, as it can make these flat lesions fluoresce, making them more visible.
Confirming Cystoscopy Findings
While cystoscopy provides a direct visual assessment of the bladder lining, visual inspection alone is not sufficient for a definitive diagnosis of bladder cancer. If a suspicious area is identified during the procedure, the next essential step is to obtain tissue samples through a biopsy. This process involves passing small instruments, such as forceps, through the cystoscope to remove a small piece of the abnormal tissue.
The collected tissue samples are then sent to a laboratory for examination under a microscope by a pathologist. The pathologist determines whether cancer cells are present, the type of cancer, and its grade (how aggressive it appears). This microscopic analysis is crucial for confirming the diagnosis, guiding treatment decisions, and differentiating cancerous growths from benign conditions like inflammation or bladder stones. In some cases, the entire suspicious area or small tumors can be removed during the cystoscopy procedure itself (transurethral resection of bladder tumor, or TURBT), with the removed tissue then sent for pathological analysis.