Carcinoma in situ can be difficult to see during a routine cystoscopy. Your urologist may take random biopsies of the bladder and send them to pathology, hoping to catch the area that has carcinoma in situ. New technology is available that uses fluorescent lighting through the cysto-scope to help identify areas suspicious for carcinoma in situ. A chemical called a photosensitizer is instilled into the bladder and is absorbed by the carcinoma in situ cells. When the fluorescent light hits the sensitized cells, they fluoresce, making them easier to see.
Cysview (hexaminolevulinate hydrochloride, GE health-care) 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 Pho-todynamic 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.