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Query: UMLS:C0005684 (bladder cancer)
 16,431 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Data presented in the preceding paragraphs should highlight to the reader several important features of clinical bladder cancer staging. Irrespective of the staging level being addressed, the available techniques uniformly have limitations, as well as advantages and disadvantages with respect to each other. A common shortcoming of both plain and cross-sectional techniques employing conventional X-rays is their lack of specificity. Every radiographic finding has an associated differential diagnosis in which neoplasia-related change is but one of many possibilities. Solitary abnormalities on bone scan or chest film serve as an excellent examples of this dilemma. The specificity of conventional imaging techniques is further compromised by attempts to increase sensitivity. As long as nonspecific anatomic changes are used as discriminating criteria, increases in test sensitivity will always occur at the price of specificity. It is hoped that advances in PET scanning and the use of isotope-labeled, tumor-selective monoclonal antibodies will overcome the limitations of currently available techniques. The significance of the limitations of a given test depends to some degree on whether the test is being used for clinical decision making or for patient stratification in a clinical trial. As an example, an aggressive transurethral resection of bladder tumors provides excellent information for clinical management but may introduce bias into multicenter studies in which this technique is not uniformly practiced. Similarly, the results of bimanual examination under anesthesia are important in the reference framework of the managing physician but are a poor quantifier of disease extent in multi-investigator clinical trials. Which staging studies are indicated and their optimal sequence for performance are influenced by pre-existing clinical information. Recognizing this, the staging algorithm in Figure 6 is intended to serve only as a guide to assist the clinician in the evaluation of patients with bladder neoplasms. As clarifications, several points concerning this algorithm merit mention. The literature suggests that as a single study, transurethral ultrasonography provides excellent local staging information. However, given that it is not widely available, the authors have chosen not to incorporate it into the staging schema. Optimally, it would be used immediately prior to transurethral resection of bladder tumors and bimanual examination. In addition, the algorithm lists MRI interchangeably with CT. While MRI appears to have slightly better sensitivity and specificity for both local and regional tumor stage relative to CT, its benefits are to some degree offset by its greater cost and the need to image the patient in multiple planes for lengthy intervals.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Staging of advanced bladder cancer. Current concepts and pitfalls. 144 Oct 24

Prostate carcinoma is the most common cancer in men and the second most lethal malignancy among the American male population. Nevertheless, it is potentially curable if detected early and treated appropriately. Treatment options vary depending on the extent (stage) of the cancer. MRI has no role as a screening method for prostatic carcinoma because it is expensive, time consuming, and unable to differentiate benign from malignant disease, but it can detect early prostatic cancers in patients with known tumor and can accurately stage these tumors. MRI is becoming the imaging modality of choice for local staging of prostate cancer and is rapidly replacing CT and ultrasonography for this purpose. Treatment protocols for bladder carcinoma also depend on the stage of the tumor. Clinical staging of bladder cancer has been limited. MRI is as good as or better than CT in bladder tumor staging when extravesical tumor involvement is present. MRI also has the potential to become useful in determining the depth of wall invasion in tumors confined to the bladder.
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PMID:Magnetic resonance imaging of the prostate and bladder. 218 60

26 urothelial carcinomas studied with MRI and CT have been reviewed. The results are connected with surgical and histological data. The assessment of the size and number of tumoral sites is more accurate with MRI, which allows a correct assessment of bladder wall infiltration in 20 of the 22 tumors studied with T2-weighted sequences. The sensitivity of both techniques is the same for the invasion of fat (92%) and the involvement of neighboring organs (67%), although MRI seems to be more specific (85% and 95% for 77% and 89%). The results are similar for the study of lymph node invasion (71% sensitivity). The performances of MRI for the assessment of bladder cancer extension are therefore comparable to those of CT. The advantages of the former technique include the clearer visualization of the tumor itself, especially for cancers of the neck and dome of the bladder owing to exploration in several planes. In addition, it allows a reliable assessment of the degree bladder wall infiltration and differentiates tumors that are not or not very infiltrating from highly infiltrating tumors.
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PMID:[Comparison of MRI and CT X-ray in the evaluation of bladder cancer. Apropos of 26 cases]. 259 9

MRI of bladder cancer was accomplished in 28 patients. All of the 28 patients were simultaneously studied by CT, and 22 were also studied by transurethral US before operation. MRI is not as useful as US for local staging of bladder cancer. However, MRI is more useful for diagnosing extravesical extension and covers the deficit of the overdiagnosing tendency of US.
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PMID:[Clinical application of MRI for urological malignancy. 2: Usefulness of various imaging modalities for local staging of bladder cancer; a comparison between MRI, CT and transurethral ultrasonography]. 307 Nov 22

We performed MRI in several recent cases of bladder cancer and prostatic cancer using a general coil or a 5-inch general purpose surface coil with or without Gd-DTPA. The surface coil improves the spacial resolution, density resolution and signal to noise ratio but reduces the field and the signal detection drops off as the depth from the surface increases. Moreover, additional time is required for patient positioning. In Gd-DTPA enhanced images of bladder cancer, the muscle layer became more distinct, and the images of tumor and bladder mucosa were enhanced, suggesting that facilitates evaluation of the extent of bladder wall invasion of the tumor. In Gd-DTPA enhanced images of prostatic cancer, the area conside to correspond to the tumor was enhanced. MRI using a surface coil and Gd-DTPA is considered to provide detailed information of bladder and prostatic cancer.
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PMID:[Clinical application of MRI for urological malignancy. 3: A new trial of MRI for bladder cancer and prostatic cancer; surface coil and GD-DTPA]. 323 21

Endoscopic photography, double contrast cystography, transurethral echography, X-ray CT scan, and MRI (magnetic resonance imaging) were utilized for the staging diagnosis of the four patients with carcinoma of the bladder. In the first case, a 70-year-old man, since all of the five imaging procedures suggested a superficial and pedunculated tumor, his bladder cancer was considered T1. The classification of stage T3 carcinoma was made for the second 86-year-old male. Because all of his imaging examinations showed a tumor infiltrating deep muscle and penetrating the bladder wall. The third case was a 36-year-old male. His clinical stage was diagnosed as T2 or T3a by cystophotography, double contrast cystogram, ultrasonography, and X-ray CT scan. However, MRI showed only thickened bladder wall and the infiltrating tumor could not be distinguished from the hypertrophic wall. The last patient, a 85-year-old female, had a smaller Ta cancer. Her double contrast cystography revealed the small tumor at the lateral bladder wall. But, the tumor could not be detected by transaxial, sagittal and coronal scans. Multiple imaging procedures combining MRI and staging diagnosis of the bladder carcinoma were discussed.
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PMID:[Multiple imaging procedures including MRI in bladder cancer]. 352 52

We report a case of tuberculous spondylitis after intravesical bacillus Calmette-Guerin (BCG) instillation. A 71-year-old man was administered BCG (80 mg per week) for 8 weeks for prophylactic treatment of bladder cancer. After the first instillation he experienced miction pain, pollakisuria, and febrile episodes. Two months after the completion of BCG instillation, he complained to back pain and spinal X-ray showed a lytic lesion of Th7 vertebra. Diagnosis of metastatic transitional cell carcinoma was made based on MRI and bone scan. But pathological findings at laminectomy revealed tuberculous spondylitis. Antituberculous therapy (SM, RFP, and INH) was instituted and anterior supine fusion was performed. Now he is free from bladder cancer and tuberculous infection. Intravesical BCG instillation is effective for superficial bladder cancer, but it should be kept in mind that complications related to this treatment could occur and the adequate antituberculosis treatment has to be insisted if indicated.
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PMID:[Tuberculous spondylitis after intravesical BCG instillation: a case report]. 747 40

Presentation of clinico-pathological correlation in a series of patients with bladder carcinoma. All of them had a complete pathological and clinical staging following TNM guidelines (UICC 1987). Clinical evaluation consisted of a clinical examination, urography and/or ultrasound, cystoscopy, bimanual palpation under anaesthesia and biopsy. As an option, pelvic CAT, MRI and a bone scan were performed. In all cases a reliable pathological staging was obtained, either from cystectomy or complete TUR. Overall, there is a 66% clinico-pathological correlation (60% for Ta category, 78% for T1, 25% for T2, 57% for T3, and 74% for T4). There is a global error of 34% (40% of cases clinically considered Ta were invasive, 16% T1 were pT2 or more, 42% T2 were pT3 or more, and 10% T3 were pT4; while 6% of those considered T1 were pTa, 33% of T2 were pTa or pT1, 33% of T3 were pT2 or less, and 26% of T4 were pT3 or less). We therefore conclude that when T is lower the risk of being clinically understaged is greater, while higher T values increase the risk of clinical overstaging. From a practical point of view, the most severe errors are in the understaging of T2 and T3 (pT3-pT4) tumours and the overstaging of T2 (pT1) tumours. When cystectomy is performed, the risk of understaging is greater for tumours interpreted as T2-T3 while the risk of overstaging T4 tumours is lower. We conclude that, even when adequate staging of bladder cancer is attempted, pre-treatment tumour classification using the diagnostic methods currently available is far from satisfactory.
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PMID:[Staging error in bladder carcinoma: anatomo-clinical correlation]. 771 56

Correct preoperative staging of malignant tumors is a prerequisite for an adequate therapy. This is not always possible with the imaging techniques available. Often, only an exploratory laparotomy can give the final diagnosis. Therefore, the search is on for a non-invasive technique for staging. Positron emission tomography (PET) is a new method in nuclear medicine; it is used for the diagnosis of primary tumors, for staging, and for follow-up after therapy. With PET, biochemical pathways and physiological functions are studied, in contrast to CT and MRI, with which anatomy and morphology are examined. In our department PET was used in 26 patients with invasive bladder cancer, in 11 patients with renal cell carcinoma and in 1 patient for follow-up after testicular cancer. The primary bladder tumor was found in 85% of cases; in 4 a non-organ-confined tumor was diagnosed preoperatively. Specificity in staging of lymph nodes was 86% (18/21); in 3 patients lymph nodes were false-positive on PET. However, in 5 patients all lymph node metastases were found by PET. Renal cell carcinoma were found in 8 out of 9 patients; in 2 patients with high-grade tumors an FDG-uptake defect was found. Lymph node staging was accurate in 9 patients without metastases and in 2 with metastases. One patient had a slightly enlarged retroperitoneal lymph node in the follow-up of a non-seminomatous germ cell tumor, which was positive on PET. Histology confirmed that it was the only positive lymph node within the whole specimen after retroperitoneal lymphadenectomy. PET gives new insights in uro-oncology by examination of the metabolism. Our initial results are promising and warrant further studies.
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PMID:[Positron emission tomography. Introduction of a new procedure in diagnosis of urologic tumors and initial clinical results]. 775 85

A 67-year-old man was admitted with the chief complaint of macroscopic hematuria in May 1990. Endoscopic examination showed a bladder tumor at the right lateral wall. Biopsy proved Grade 3 transitional cell carcinoma. Transurethral ultrasonogram, CT scan and MRI revealed T2-T3a invasive bladder cancer. Preoperative chemotherapy by balloon occluded arterial infusion using CDDP 75 mg, etoposide 100 mg and pirarubicin 50mg was performed. Repeat endoscopy after chemotherapy revealed significant necrotic change of tumor. Radical cystectomy and pelvic node dissection with ileal conduit urinary diversion were performed in August 1990. Significant necrosis of bladder wall was observed and no cancer cells were recognized in the cystectomy specimen. The patient is alive at this writing with no evidence of disease for 2 years.
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PMID:[A case of complete response was achieved with arterial infusion chemotherapy including CDDP, etoposide and pirarubicin]. 851 37


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