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The steady and lastly outstanding development in the biochemistry and physics of light and optics has been polarised in the last two years in the use of 5-amino leveolinic acid (5-ALA). The method is highly sensitive and specific for the early detection of bladder cancer in particular the superficial one. The use of the photodynamic diagnosis and therapy provides a sophisticated method for the improvement of the quality of life of the patients.
Bladder cancer is a disease that affects the lining mucous membrane of the bladder due to its contact with some hazardous substances. This results in hyperactivity of the cells that grow unlimited and on the costs of the surrounding cells and the whole body. This starts first slow and superficial. The early detection of this growth on the primary cellular level enables its limitation and early treatment with simple methods aiming at achieving a better quality of life and increasing the intervals of follow up and avoiding the necessity of a more aggressive treatment modality if ever needed.
The method depends on increasing a certain fluorescing substance (5-amino leveolinic acid) that is naturally secreted during the cell internal activity (metabolism). If this substance is stimulated by light of a certain wave length (xenon light of violet colour) it emits light in the red spectrum in a violet background and thus makes the secreting cells visible in spite of its few numbers enabling a very specific and accurate diagnosis and treatment of the disease.
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Who qualifies for the operation ?
Patients that have a suspicion of early bladder cancer as revealed on a chronic resistant bladder infection or unclear bladder irritability.
The detection of red blood cells under microscope or the observation of blood in urine is an indication for the application of the method. Patients that have a histologicaly documented cancer profit in that the lesion is very accurately and completely resected from their bladder leading to the above mentioned results as well.
How does the operation work ?
The patient lies on the back. A local anaesthesia with a lubricant gel is installed into the urethra. The 5-amino levleolinic acid (ALA) is installed into the bladder through the catheter which is then removed. The patient stays lying for 2 hours to guarantee the contact of the substance with the mucous membrane lining his bladder.
The patient is then taken to the Endoscopy room to lie again on the back in the gynaecological position. The bladder is inspected and resected under anaesthesia using special endoscopes and under video control. Cold biopsies are taken under local anaesthesia. The lesions are sent to the histopathological examination.
The duration of the procedure is 30-45 minutes. If the lesion is not an early one and the resection area is wide, it may be necessary to insert a catheter for a day.
Healing:
The procedure is very simple and sure. It is done on out patients basis. In case of wide lesions it may be mandatory to stay for a night in the hospital. Healing is usually smooth due to the accuracy of the method and the advantage of the use of laser.
How to prepare for the operation ?
Please see chapter on preparation of the patient.
Frequently Asked Questions (FAQ):
- What is bladder cancer ?
It is a sort of an aggressive metabolic activity taking place into he cells lining the bladder. These cells divert the energy of the body to them and start to invade the wall of the bladder and the surrounding organs through blood, lymph and directly to change the function of the invaded tissues.
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- What are the stages of bladder cancer ?
They are superficial, locally invasive and distantly invasive. It is our aim to detect the case in its early superficial stage to stop it or put the cells under medical and surgical control to improve or keep the quality of life.
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- Is ALA toxic ?
No, it is not if taken as stated and it is washed through the procedure not to use any complication after its application. The phototoxicity is also eliminated when installed in the bladder.
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- Is the procedure painful ?
No, it is only time consuming but guarantees the best possible diagnosis and results.
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- How high is the sensitivity of the examination ?
There is a sensitivity of 98% and a specificity of 60%. The areas that may simulate red light fluorescence are those of chronic infection and those of cancer cells.
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- Does the photodynamic diagnosis cure cancer of the bladder ?
No, it does not. It only enables the very precise detection and enables a complete resection of the lesions to guarantee a better quality of life. It is important to repeat it at the dates of follow up of the case.
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- Does photodynamic diagnosis detect deep infiltrations and distant metastasis ?
No, it does not. It enables the detection of the superficial lesions and its extensions. It is important to have the bladder deeply resected to be able to stage the degree of infiltration of the disease.
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