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An endoscopic exam involves using an instrument, inserted
into natural openings or man-made openings, to examine internal
passages or the inside of hollow organs or viscera. This can
be effective in the nasopharynx, larynx, esophagus, stomach,
large bowel, bladder and parts of the lungs. The common endoscopic
procedures used in cancer diagnosis are listed in the table
below.
Common Endoscopic Examinations
| Examination |
Site Examined |
| bronchoscopy |
bronchi |
| colonoscopy |
colon and rectum |
| cystoscopy |
urinary bladder |
| esophagoscopy |
esophagus |
| gastroscopy |
stomach |
| laryngoscopy |
larynx |
| nasopharyngoscopy |
nasopharynx, pharynx |
| ophthalmoscopy |
interior of the eye |
| panendoscopy |
urinary bladder and urethra |
| proctoscopy |
rectum |
| sigmoidoscopy |
colon up to sigmoid flexure |
A bronchoscopy is the examination of the bronchi in the lungs.
The scope can be inserted through the oral or nasal cavity.
The pharynx, larynx, and trachea can be seen as the bronchoscope
goes through to the bronchi. Using the flexible bronchoscope,
the interior segmental and subsegmental bronchi can be visualized.
The endoscopist looks for irregular bronchial folds, mucosal
thickening, stenosis,
friable tissue, and many other abnormalities such a tumor mass.
Normally, biopsies bronchial washings are obtained during a
bronchoscopic exam. A proctoscopy is often done using a rigid
scope.
A sigmoidoscope is more flexible and can be used to observe
the colon, up into the descending colon at greater than 30
cm. In the past, rigid sigmoidscopes were often used but they
have been replaced with flexible sigmoidoscopes. Flexible
scopes allow greater visualization of the sigmoid colon. A
fiberoptic colonoscope is a flexible instrument that examines
the colon to the cecum. Often, the physician will photograph
and biopsy any abnormalities or suspicious areas seen during
colonoscopy.
A cytoscope is used to examine the interior of the bladder.
It is inserted through the urethra, so the urethra can also
be examined. Abnormalities can be surgically removed or electrocauterized
during the cystoscopic procedure.
The entire endoscopic procedure report must be read to obtain
pertinent information. Endoscopic reports define certain observations,
tumor location, pertinent findings, diagnosis, or the impressions
of cancer. For example, colonoscopy reports should state the
distance of the abnormality from the anal verge. Esophagoscopy
reports should state the distance of the abnormality from
the incisors to help determine the exact location of the tumor.
Any biopsies or washings sent for microscopic examination
should be noted. It is important to locate copies of the pathology
and cytology reports to confirm the diagnosis of cancer.
Some endoscopic procedures can be accomplished through natural
openings in the body. Others must be performed through incisions
into the body. For example, thoracoscopy is used to examine
the pleural cavity. The instrument is inserted through an
intercostal space. Mediastinoscopy is performed through an
incision in the neck and allows visualization of the area
between the lungs. The mediastinal lymph nodes that are examined
for potential involvement by metastatic cancer can determine
the unresectability of a lung cancer.
Laparoscopy, performed through an incision in the abdodminal
wall, allows the visualization of intra-abdominal structures.
Laparoscopy is useful in gastrointestinal and gynecologic
malignancies to diagnose both the primary organ and metastatic
involvement. Needle biopsies of the liver are often done under
the direct visualization of the laparoscope. Some surgeries
can be completed as laparoscopic or lararoscope-aided procedures.
A culdoscopy
incision is made through posterior vaginal wall and allows
visualization of the cul-de-sac.
The endoscopic retrograde cholangiopancreatogram (ERCP) allows
direct visualization and contrast x-rays of the ampulla of
Vater and the duodenal mucosal ERCP is helpful in diagnosing
both pancreatic and bile duct cancers.
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