Bladder cancer diagnosis and urine cytology

Bladder Cancer Diagnosis

Anyone who manifests signs and symptoms of bladder cancer needs a medical evaluation. Besides, specific pelvic regions that need examination are kidneys, bladder, and urethra, especially if the individual is over 40 years of age. This examination includes one or more urine tests, cystourethroscopy and an imaging test of the kidneys and ureters.

Bladder cancer diagnosis and urine cytology

The following are important urine tests to take if there is a suspicion of cancer in the bladder.

  • Urinalysis is a test that employs a chemical indicator that changes color in the presence of certain features in the urine like white blood cells, red blood cells and glucose (sugar). Furthermore, the urine needs a microscope evaluation.
  • Besides this, a pathologist conducts a urine cytology which examines the sample of the urine under a microscope to check for abnormal-appearing cells that shed from the lining of the bladder.
  • Moreover, a urine culture is when a sample is placed in a growth medium to check for signs of bacterial growth. If there are traces of bacteria, the diagnosis may show an infection rather than cancer.

Imaging tests help detect any lumps or abnormalities in the kidneys, ureters, bladder or the urethra. The optimal imaging assessment (with computed tomography [CT] scan, magnetic resonance imaging [MRI], intravenous pyelogram [IVP], or kidney ultrasound) is necessary to stage the disease and formulate subsequent treatment plan.

CT Scan:

A CT scan is an imaging test that examines the structure of the kidneys, ureters and the bladder. This helps determine if there is a blockage in the urinary tract, and determine if the cancer has spread to regions of the body outside the bladder. In this procedure, a contrast dye helps image these structures.

Pyelogram:

This is a contrast dye injected into the bladder either by a vein or by a direct catheter. The dye outlines the bladder and associated organs, making any tumors visible on the X-rays.

Ultrasound and sonography:

They determine the size and the spread of the tumor particularly with the help of sound waves to image abnormalities.

MRI:

A magnetic resonance imaging of the kidneys, ureters, and bladder is employed to evaluate the urinary tract. Moreover, this imaging may provide useful information in staging of the bladder cancer.

IVP:

Here a radiopaque dye (one that is visible on X-ray) is injected into the vein. The kidneys expel the dye. As the dye passes through the urinary drainage system any abnormal lumps manifest on the X-ray images. However, it might be useful to note that there is a small risk of having an allergic reaction to the dye. Moreover, people who are allergic to contrast dye, iodine or shellfish should let the radiologist know.

Cystoscopy:

A cystoscopy (or cystourethroscopy) is a procedure that directly visualizes the lining of the urethra and bladder. A urologist/oncologist conducts a cystoscopy in an operating room. An anesthetic gel is to the urethra helps avoid discomfort and a small tube with a camera (cystoscope) passes into the bladder through the urethra.

Biopsy

Apart from these imaging tests, there may be a biopsy to examine abnormal tissue that goes for examination in a laboratory or an operating room.

Transurethral resection of bladder tumor (TURBT)

There may be imaging tests after the diagnosis of bladder cancer. Resection of bladder mass by cystoscopy under anesthesia helps confirm the extent of tumor. This resection procedure (TURBT) may follow diagnosis. Further the tumor may either be invading the muscle or not which has a bearing on further treatment planning.

Bladder cancer staging

The treatment and prognosis of bladder cancer depend upon its stage, its grade, and the risk that the cancer will recur. After diagnosis of bladder cancer, the doctor sets out to determine if it has spread and how far it has spread. Moreover, staging helps determine the treatment plan and gauge its success.

Bladder cancer staging is based upon how far the cancer has penetrated into the tissues of the bladder, whether the cancer involves lymph nodes near the bladder, and if the cancer has reached nearby organs and distant sites. Staging is dependent on the physical examinations, imaging tests, and biopsies that have been listed out at length above.

Understanding the stages of bladder cancer

The American Joint Committee on Cancer (AJJCC) has developed a system of staging called the TNM staging which is based on three important elements of the cancer.

T determines the extent to which the (primary) tumor has grown through the bladder wall and whether it has grown into nearby tissues.

N indicates if the cancer has spread to lymph nodes near the bladder. Lymph nodes are bean-sized collections of immune system cells, to which cancers often spread first.

M indicates if the cancer has spread (metastasized) to other organs in distant sites like the lungs or liver, or lymph nodes that are not near the bladder.

More importantly, the number stages also aid in determining the spread of the cancer.

Stage 0

The cancer is in the origin of its site in the inner layer of the bladder lining (stage 0a) or R there are very early, high grade cancer cells only in the inner layer of the bladder lining (stage 0is).

Stage 1

Invasion of cancer cells into the the connective tissue beneath the bladder lining.

Stage 2

Metastasis of tumor cells through the connective tissue layer into the muscle of the bladder wall.

Stage 3

The cancer spreads beyond the muscle into the fat layer and perhaps to the prostate, womb or vagina or lymphnodes.

Stage 4

The cancer spreads to the wall of the tummy (abdomen) or between the hips (pelvis), to other distant parts of the body like the bones, lungs, or liver.

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