genitourinary disorders
Bladder Cancer
Diagnosis of Bladder Cancer
Cystoscopy with biopsy Urine cytology Bladder cancer is suspected clinically. If patients present with hematuria, work-up is risk-stratified and involves a combination of diagnostic cystoscopy and imaging (CT urogram or renal ultrasound [ Diagnosis reference ]). Urine cytology, which can detect malignant cells, should also be done. Cystoscopy with blue light after intravesical instillation of hexyl-aminolevulinate can improve initial detection of bladder cancer as well as recurrence-free survival. Higher detection rates are expected to improve clinical outcomes by reducing future recurrences and by facilitating earlier recognition that certain tumors are unresponsive to therapy (thus, sparing some patients unnecessary treatments). For nonmuscle-invasive bladder cancer (carcinoma in situ, Ta, T1) tumors, which comprise 70 to 80% of bladder cancers, cystoscopy with biopsy (with simultaneous complete resection) is sufficient for staging. However, if biopsy shows the tumor is more invasive than a superficial flat tumor, then resection should be repeated, taking care to include muscle tissue. If a tumor is found to invade the detrusor muscle (≥stage T2), blood tests, abdominal and pelvic CT, and chest x-ray are done to determine tumor extent and evaluate for metastases. MRI can be considered for local staging. Patients with invasive tumors undergo bimanual examination (rectal examination in men, rectovaginal examination in women) while under anesthesia for cystoscopy and biopsy. The standard TNM (tumor, node, metastasis) staging system is used (see tableand table). 1.Barocas DA, Boorjian SA, Alvarez RD, et al: AUA/SUFU Guideline.J Urol204(4):778-786, 2020. doi: 10.1097/JU.0000000000001297 