An NCI-designated Comprehensive Cancer Center
By Katie Neith | May 18, 2017
cysview 650 On the left, a tumor is observed using traditional white-light cytoscopy. On the right, the same tumor is observed with Blue-Light Cytoscopy with Cysview.
Using a simple but unique approach called Cysview, physicians at City of Hope are getting a better look at tumors and other abnormalities within the bladder.
While bladder cancer accounts for less than 5 percent of all new cancers in the United States, it is the fourth most common cancer in men, according to the American Cancer Society (ACS). As with most diseases, early detection is key to better treatment options.
When bladder cancer is suspected — typically because of blood in the urine, changes in bladder habits or painful urination — a cystoscopy is usually performed, in which a rigid or flexible tube that contains a camera and a light is placed into the bladder via the urethra. Traditionally, conventional white light is utilized to identify and visualize bladder tumors. 
But City of Hope is one of a select number of medical centers nationwide offering Blue-Light Cystoscopy with Cysview (hexaminolevulinate hydrochloride), an optical imaging agent for the detection of early-stage cancer of the bladder in patients with known or suspected bladder cancer. Cysview is the only Food and Drug Administration-approved imaging agent for use with blue-light cystoscopy and City of Hope is one of only a handful of area hospitals to offer the service.
Here’s how it works: Cysview is delivered, via a catheter, into a patient’s bladder before the cystoscopy procedure. Once the drug is in contact with the mucus membrane of the bladder, it penetrates rapidly proliferating cells, leading to the accumulation of fluorescent compounds within the tumor. Then, a blue light is used to illuminate the concentration of compounds.
Kevin Chan Kevin Chan, M.D.
“When placing Cysview in the bladder one hour prior to the cystoscopy, bladder cancer appears fluorescent pink under blue light,” explained urologic surgeon Kevin G. Chan, M.D., associate clinical professor in the Division of Urology and Urologic Oncology and head of reconstructive urology at City of Hope. “This can help us identify subtle tumors that otherwise would have been missed with conventional white light.”
He pointed out that sometimes inflammation and earlier stages of bladder cancer can look very similar, so the pink fluorescence can also sometimes help distinguish areas of cancer from areas of inflammation. 
In addition, Blue-Light Cystoscopy with Cysview can aid in the removal of tumors during a procedure called a transurethral resection of the bladder tumor. This is of importance since surgery to remove the cancer, either alone or along with other treatments, is part of most treatment plans for bladder cancer patients, according to the ACS.  
“Getting a clearer picture of the cancer allows for more thorough cystoscopic tumor removal, which is critical when this may be the only treatment a patient needs,” said Chan.

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