Urinary Tract

Bladder cancer is the sixth most common cancer in the United States, excluding certain skin cancers. The American Cancer Society has estimated there will be approximately 74,000 new cases of bladder cancer in the United States each year. It is estimated that annually there will be 16,000 deaths from bladder cancer. Kidney cancer has a slightly lower incidence, with an estimated 62,000 new cases in the United States each year, and will account for a similar number of deaths, approximately 14,000. The incidence and mortality associated with urinary tract cancers have a great impact on society. 

 

Source: American Cancer Society Cancer Facts & Figures 2015 
Atlanta: American Cancer Society; 2015

 

Diagnosis 

 

Symptoms of urinary tract cancers may include blood in the urine and increased frequency of urination. Most often, by the time clinical symptoms become apparent the cancer is more advanced. 

 

Abnormalities in the bladder and kidneys may be detected through physical exam, with imaging tests of bladder or kidney function, by urine or blood tests or by examination of the bladder wall with a cystoscope. Kidneys cannot be easily palpated, but sometimes a renal mass is detected as an incidental finding on a CT scan performed for another ailment. 

 

The stage of renal cancers depends on disease extent, size of tumor, nodal status, and the presence or absence of metastatic disease. The stage of urinary tract cancers also depends on those same factors, but in addition, the depth of the tumor invasion into the wall of the bladder or ureter is taken into consideration. 

 

It is difficult to image primary tumors in the bladder or kidneys with PET/CT imaging, because substantial excretion of the radiopharmaceutical through the kidneys and into the bladder sometimes obscures the primary tumor and small nodal metastases located immediately adjacent to the bladder. PET/CT does, however, assist physicians in determining the stage of the cancer immediately after diagnosis by imaging local or systemic metastases of bladder of renal cancer. 

 

Early determination of how far the cancer has spread helps the physician select the most appropriate treatment. 

 

Source: Atlas of Clinical Positron Emission Tomography by Sallie F. Barrington, Michael N. Maisey and Richard R. Wahl. Oxford University Press, Inc. New York, NY. 2006.

 

Treatment 

 

Surgery, alone or in combination with other treatments, is used in the majority of cases. Localized cancers may also be treated with irradiation, immunotherapy or chemotherapy directly into the bladder. Urinary tract cancers respond well to chemotherapy and reasonably well to irradiation, but like most cancers, these are most difficult to treat once they have spread to other parts of the body.   

 

PET/CT imaging is a good tool for physicians to use to help determine the precise stage of the cancer, locate distant metastases and to select the best treatment approach. 

 

A PET/CT scan can show where tumor cells are growing, which helps the doctor determine the best course of treatment. 

 

Source: American Cancer Society Cancer Facts & Figures 2015 
Atlanta: American Cancer Society; 2015

 

Follow-up 

 

Depending on the stage of the cancer, routine follow-up visits as well as urine tests, or follow-up imaging tests will be recommended. Physicians are faced with challenges when determining if lesions have fully regressed after treatment. PET/CT is a good tool for evaluating if the treatment has been successful. 

 

When other follow-up tests such as urine tests raise suspicion, imaging with PET/CT can help the physician determine if the cancer cells have returned and if treatment should be re-started. It is important that additional treatment begin immediately. 

 

A PET/CT scan can be used to image tumor response to therapy and to detect recurrence in treated lesions.

 

PET/CT Utilization 

 

PET/CT is a noninvasive test that physicians utilize to stage the body for the presence or absence of active tumor, localize the tumor, assess the tumor response to treatment and detect recurrence in treated lesions. 

 

PET/CT Utilization for Urinary Tract Cancer

  • Determining the stage of urinary tract cancer
  • Detecting local or systemic metastatic disease
  • Evaluating treatment and detecting recurrent disease

 

Source: Atlas of Clinical Positron Emission Tomography by Sallie F. Barrington, Michael N. Maisey and Richard R. Wahl. Oxford University Press, Inc. New York, NY. 2006.

Positron Emission Tomography: Basic Science and Clinical Practice. Peter E. Valk, Dale L. Bailey, David W. Townsend, Michael N. Maisey. Springer-Verlag London Limited. 2003.

 

Patient Preparation

 

Because PET imaging depends on visualizing the distributions of the glucose based radiopharmaceutical throughout your body, correct preparation for your PET study is more critical than for other commonly performed imaging studies.

 

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