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By: Aroga | Date: August 7, 2020

Blue Light Cystoscopy in Bladder Cancer Diagnosis

Blue light cystoscopy is an advanced procedure that helps in improved diagnosis of cancerous tumours developed in the bladder. It is used to enhance the effectiveness of a procedure called Transurethral Resection of Bladder Tumour (TURBT), which is performed to diagnose & treat bladder cancer.

During a TURBT surgery, the bladder is illuminated to detect and examine any tumours. If the tumours are found to be cancerous, the doctor removes it along with some surrounding healthy tissue to ensure all of the cancer is removed. 

Although this is a very frequently performed surgery for bladder cancer, the rate of relapse is high due to possibility of residual disease (incomplete removal of tumour) or understanding (incorrect detection of the stage of cancer).

Traditionally, TURBT is performed along with white light cystoscopy. However, blue light cystoscopy in bladder cancer diagnosis is a much more recent and recommended option. 

Blue Light Cystoscopy vs White Light Cystoscopy in Bladder Cancer Diagnosis

When cystoscopy during TURBT is performed under white light, it is not always possible to distinguish tumours and lesions from healthy tissues, making diagnosis and treatment difficult. 

Blue light cystoscopy serves as a more preferable alternative for diagnosis of bladder cancer as it allows better and more accurate detection of cancerous tumours.  

This blue light procedure also has the following advantages over white light cystoscopy – 

  • Since blue light cystoscopy allows better identification and resection of the tumour, it decreases the need for a total cystectomy (removal of the entire bladder).
  • It helps in better detection of small or flat tumours.
  • It allows the doctor to diagnose the stage of the cancer, and detect whether the tumour is high risk or low risk. This in turn can ensure the patient gets early & right treatment.
  • Doctors can repeat blue light cystoscopy after surgery more easily as compared to white light cystoscopy.
  • In blue light cystoscopy, any remaining cancer tissue (after the surgery) will glow pink even if there is inflammation caused due to the procedure.
  • It has been found to have lower chances of recurrence of bladder cancer and thus fewer follow-ups.

How is Blue Light Cystoscopy used in TURBT surgery?

Before the blue light cystoscopy, a catheter (a thin, hollow tube) is inserted into the bladder through your urethra. A clear, optical imaging solution called Cysview is fed through the catheter to the bladder.

This Cysview solution is preferentially absorbed by cancerous cells. This solution is left in your bladder for an hour and is immediately followed by surgery.

During the surgery, a cystoscope that has a camera at its end is inserted into your bladder.

The bladder is first illuminated by the cystoscope’s white light. Tumours may or may not be detected under the white light. It is then switched to a blue light. When cast with this blue light, the cancer cells that have absorbed the Cysview glow pink and indicate the edges of the tumour which helps in removing the complete tumour.

This cystoscopy procedure may be completed within 30 minutes. You may generally be able to go home immediately after surgery.

How is White light Cystoscopy used in TURBT?

White light cystoscopy does not use any imaging solution in TURBT surgery. It uses regular white light to illuminate the bladder. 

On the basis of the kind of probe (cystoscope) used, white light procedure is classified into two types – flexible cystoscopy and rigid cystoscopy.

Flexible cystoscopy uses a flexible probe and is less painful for the patient. Although white light procedure does not perform cancer detection as accurately as the blue light method, flexible cystoscopy poses an even greater risk of letting certain kinds of tumours go undetected. 

Therefore, rigid cystoscopy is more preferable for TURBT surgery while use of flexible cystoscopy is restricted to initial inspection.

What are the limitations of Blue Light Cystoscopy?

This method is only effective for the identification and diagnosis of non-muscle invasive bladder cancer.  Muscle-invasive bladder cancer, which is relatively uncommon, occurs when the cancer has grown into deeper layers and may have possibly spread to other parts of the body.

Due to the advanced nature of this cancer, diagnosis of MIBC may require biopsies, manual examinations and other diagnostic tests in addition to cystoscopy.

Is Blue Light Cystoscopy right for me?

Your doctor may recommend this procedure due to a number of reasons. These may include –

  • If you have persistent symptoms that indicate bladder cancer and you still test negative in a white light cystoscopy procedure.
  • Treatment of your NMIBC has caused inflammation in the bladder tissues which is, in turn, interfering with diagnosis via white light cystoscopy.
  • The doctor needs to confirm whether your cancer is NMIBC or a more advanced MIBC.
  • The doctor has to check for recurrence of your bladder cancer.

Are there any risks and side effects of Blue Light Cystoscopy?

Usually, this procedure is well-tolerated by patients and does not pose any major risks. There may, however, be exceptions.

Blue light cystoscopy and white light cystoscopy in bladder cancer diagnosis, generally have the same side effects associated with their procedures. These include –

  • Frequent urges to urinate
  • Pain in the bladder
  • Pain or stinging sensation while urinating
  • Blood in your urine

A few more side effects that are relatively uncommon include –

  • A mild infection
  • Increased heart rate, chest pain and fever – all of which are hypersensitivity reactions to the Cysview solution.

What is the cost of Blue Light Cystoscopy?

Blue light cystoscopy costs are higher than white-light procedures. In Kolkata, blue light cystoscopy costs may range from 10000 INR to 70000 INR.

Consult your doctor to find out if Blue Light Cystoscopy is the right option for you.

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