Actos and Bladder Cancer Action
Actos and Bladder Cancer : An intravenous pyelogram (IVP) is an X-ray study that shows the general outline of the kidneys and better detail of the collecting system than an ultrasound. X-ray contrast is given to the patient intravenously. The kidneys then filter and concentrate the contrast, creating an image on an X-ray taken a few minutes after the injection is given. A small tumor or stone inside the collecting system can be seen as a dark spot inside the collecting system. Historically, the IVP was a common test to evaluate upper tracts. However, due to the decreased cost of CT scans and the increased availability, it has largely been replaced by CT scanning.
CT scanners use X-rays to create a detailed image of the internal organs. The scanner takes many X-rays at once and uses a computer to combine all of the images into the one picture that you see. When getting a CT scan of the kidneys, the patient is usually scanned three times. The first scan is performed without contrast and will reveal any kidney stones. The second scan is performed with contrast, which helps to show tumors in the kidneys. The third scan is obtained a few minutes later, after the kidney has had time to process the contrast. The contrast fills the collecting system similar to the IVP but with greater detail. A CT scan is very good for seeing tumors in both the kidneys and the collecting system. In addition to the ability to see the kidneys and ureters better, the CT scan allows for visualization of the entire abdomen and lymph nodes, helping to identify metastases or unrelated diseases. Over the last several years, the cost of CT scans has come down, and the availability of scanners to patients has increased, making the CT scan the most common upper tract study. As with the IVP test, CT scans meant to examine the kidneys
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Although ureteroscopy is not technically an “upper tract study,” it gives us the most definitive examination. It is similar to cystoscopy but uses a smaller scope. In the operating room or well-equipped office, the ureteroscope is carefully passed into the ureter as it opens into the bladder. This allows the urologist to see the inside of the ureter. It is gently passed all of the way up the ureter into the kidney. Like cystoscopy, there are both rigid and flexible uretero- scopes. The flexible scope allows doctors to see all or most of the deep corners of the collecting system within the kidney. Biopsies of any suspicious areas can be taken and sent to pathology for analysis. Although ureteroscopy provides the best view of the collecting system, it usually requires anesthesia, and there is some small risk of damage to the kidney or ureter; thus, it is usually reserved for those patients who have had an abnormal upper tract study.
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Cysview (hexaminolevulinate hydrochloride, GE healthcare) has recently been approved as an optical imaging agent for use in the cystoscopic detection of non-muscle invasive papillary bladder cancer among patients suspected or known to have lesion(s) on the basis of prior cystoscopy. When used in combination with blue light (fluorescence) cystoscopy (Karl Storz D-Light C Photodynamic Diagnostic [PPD] system) it identified at least 1 more noninvasive papillary bladder tumor than routine cystoscopy in about one third of the patients with such tumors. It is also useful in detecting carcinoma in situ, identifying 28% more patients with carcinoma in situ than standard cystoscopy.
Urine cytology is commonly used to screen for bladder cancer in patients who have hematuria as well as to monitor for recurrences in patients who are being treated for bladder cancer. Overall, urine cytology is able to detect 40% to 60% of bladder cancers, but the ability of cytology to detect a tumor varies depending on the grade, stage, and location of the tumor. In low-grade, low- stage tumors, cytology will detect only 25% to 40% of the tumors. It will perform better as the grade and stage of the tumor increase, with the best detection rate being for carcinoma in situ. Cytology detects approximately 90% of cases of carcinoma in situ.
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