Staging Of Urinary Bladder Carcinoma By Computed Tomography:

Mahmoud Azab Ahmed

Bladder cancer represents a major health problem not only in ourcommunity (where Bilharziasis is endemic) but also allover the world.Preoperati ve tumor staging is still of prime importance for bothtreatment planning and prognostic assessment.Still cystoscopy and biopsy are the first diagnostic and stagingmodality. However, it cannot assess valuable prognostic data namelyperivesical tumor invasion, lymphatic (lymph vessels and Iyrr.ph nodes)metastasis and distant metastases.In this situation, computed tomography can play not only anadditive role, but also a unique role. Although C1’ cannot probablydifferentiate stages 1’2 from Da, C1’ can accurately diagnose stage Db.using proper C1’ technique, C1’ can probably identi (y lymph nodemetastasis when it identifies lymph nodes larger than I.Scm. By this, itcan guide to select the mode of treatment of invasive bladder cancer(more than 1’2) from superficial bladder cancer where the later will betreated by cystoscopic resection, while the former will be treated bycompound therapy using choices of surgery, radio-and chemotherapy.It should be taken in consideration that in addition to the CTtechnique, the timing of CT examination will raise to diminish thediagnostic capability if the CT examination is done before cystoscopy asthis will avoid lack of tissues definition by the oedema and superaddedinfection.-- - -- - -- ---------------- ----- ------- --------- -----------------------Summary lSI: Condiuion”””””’’’’’’’’’’’’’’’’’’’’’’’’’ _------ CT also plays an important role in the assessment of bladder cancerafter treatment. A base line study (in addition to the pretreatment study)1-8 weeks after treatment (whether by surgery, radio-or chemotherapy)should be obtained to avoid confusion made by postoperative scar,postopcrati vc or post irradiation fibrosis.CT in distant metastasis is not the first line or assessment,practically and economically. However, it will be the tinal line ofassessment after positive bone scan, chest X-ray and ultrasound withadditional role of CT guidance for ohtaining a biopsy from metastaticlesions.Comparing out study (25 patients) to other studies, we found outthat both agree upon the finding that male, has much higher incidencethan females (80% males, 20% females).The pathological evidence in our study was 36% transitional cellcarcinoma, 64% squamous cell carcinoma as the commancst pathology,as we had our studies bilharzial and nonbilharzial patients.In our study, we tabulated cases of different stages as identified byCT findings and presented the cases that can demonstrate the capabi lityofCT to identify the findings that can separate different stages of urinarybladder cancer. We also presented cases that demonstrate the importantrole of CT in demonstration of post-treatment (of bladder cancer)recurrence. In this respect we met an incidence different from otherstudies that found out that recurrence at pelvic lymph nodes alone wasrare, while in our study it was as high as 24%.Summary e1. ConeIn spite of its higher cost and lesser availability, MRl hatechnical facilities and resolution ability that allows it to pIcompetitive role with CT role described before, with even much hecapabilities when IV contrast is used.