Thomas Jefferson University Hospital adopts new imaging agent to improve detection of bladder cancer

Thomas Jefferson University Hospital is one of a select number of medical centers nationwide - and currently the only one in the Northeast - offering a newly approved optical imaging agent for the detection of papillary cancer of the bladder in patients with known or suspected bladder cancer.

The availability of imaging agent known as Cysview signals the arrival of an innovative diagnostic technology for patients who have or may have bladder cancer, and underscores Jefferson’s reputation as a leading comprehensive medical facility in the Delaware Valley.

The imaging agent is used to detect bladder cancer in individuals suspected or known to have lesion(s) in the bladder, based on a prior cystoscopy (the examination of the bladder and urethra using a cystoscope, a thin, tube-like instrument with a light and a lens for viewing). It is used with a white light setting to illuminate the bladder during a routine cystoscopy, and a blue light setting to induce and view fluorescence, thereby enabling physicians to detect lesions in the bladder.

More than 70,000 people in the United States were diagnosed with cancer of the bladder in 2009, and an estimated 14,000 Americans died from the disease last year, according to the National Cancer Institute

Bladder cancer is the fourth most common type of cancer in men, and the eighth most common in women. Smoking is the most likely cause of bladder cancer. The most common initial sign of the disease is red-colored urine, which calls for urine cytology (tests performed on cells in urine to detect disease) and cystoscopy.

Bladder cancer is difficult to detect. A missed diagnosis can result in delayed or incomplete treatment, which may lead to serious complications and a lower chance of survival for patients with potentially aggressive tumors,” said Leonard Gomella, M.D., F.A.C.S., the Bernard W. Godwin, Jr. Professor of Prostate Cancer, associate director for Clinical Affairs at the Kimmel Cancer Center at Jefferson, and Chair of the Department of Urology at Thomas Jefferson University Hospital. “Cysview represents an important advance in diagnostic technology, enabling more accurate diagnosis of bladder tumors compared to the standard technique.

“Patients with known or suspected bladder cancer can now come to Jefferson to undergo diagnostic procedures administered by physicians who have been specially trained in the use of this innovative technology.”

The standard diagnostic procedure for bladder cancer combines urine cytology and white light cystoscopy. Although cytology provides specificity and sensitivity in detecting high-grade (highly abnormal) lesions, it provides no information on the location and extent of the disease. If the cells test positive for cancer, the next step is direct visual inspection of the urothelium and mucosa (the inside of the bladder) with white light cystoscopy to localize the tumors. Physicians perform transurethral resection (TUR), a form of cystoscopy-guided biopsy, of suspicious areas of the bladder, and then test the tissue samples to determine if they are malignant.

Types of bladder cancer

Transitional cell bladder cancer (TCC) is the most common type of bladder cancer. Nearly all cancers of the bladder start in the layer of cells (transitional cells) which form the lining of the bladder (transitional epithelium). These cancers are called transitional cell or urothelial cell cancers.

Bladder cancer may appear as a tumour which has grown into the muscle wall of the bladder. This is known as invasive bladder cancer.

Bladder cancer may also begin as a small growth only on the inner lining of the bladder (called papillary cancers). Sometimes these early cancers can start to grow into the muscle of the bladder and become invasive bladder cancer.

Carcinoma in situ (CIS) is a type of early bladder cancer which appears as a red, ulcerated area in the bladder. In CIS the cells are very abnormal or high-grade, so it can grow quickly. If it’s not treated effectively, there’s a high risk that CIS will become an invasive cancer.

Rarer types of bladder cancer are squamous cell cancer and adenocarcinoma. Squamous cell cancers start from one of the types of cell in the bladder lining. Adenocarcinoma starts from glandular cells which produce mucus. Both of these types are usually invasive.

“We are dedicated to finding new ways to improve the lives of patients living with serious diseases such as cancer, and Cysview is the latest example,” said Dr. Gomella. “By facilitating early diagnosis of bladder cancer, this innovative imaging agent can enable appropriate, timely treatment that may improve patients’ chances of survival.”


Steve Graff
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Thomas Jefferson University

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