Rosh Internal Medicine Boost Practice Exam

What is the gold standard for the initial diagnosis and staging of bladder cancer?

1. CT of the abdomen and pelvis

2. Cystoscopy

3. Intravenous pyelogram

4. Urine cytology

The correct answer is: Cystoscopy

Cystoscopy is considered the gold standard for the initial diagnosis and staging of bladder cancer due to its direct visualization capabilities. During this procedure, a cystoscope—a thin, tube-like instrument equipped with a camera and light—is inserted through the urethra into the bladder. This allows for the examination of the bladder's interior, enabling the detection of tumors or abnormal growths. Additionally, cystoscopy facilitates obtaining biopsies of suspicious areas, which are crucial for confirming a diagnosis of bladder cancer and determining its grade and stage. This level of direct inspection and tissue sampling cannot be achieved with imaging techniques like CT scans or urine cytology, which are useful but are not definitive for diagnosis. While CT of the abdomen and pelvis can provide information on the extent of disease and the presence of metastasis, it is not used as the primary diagnostic tool. Urine cytology, while helpful as a non-invasive screening tool, also cannot definitively diagnose bladder cancer since it relies on detecting cancerous cells in urine rather than directly visualizing the bladder lining.