Bladder cancer

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Research in bladder cancer

We are always learning more about cancer. Researchers and healthcare professionals use what they learn from research studies to develop better practices that will help prevent, find and treat bladder cancer. They are also looking for ways to improve the quality of life of people with bladder cancer.

The following is a selection of research showing promise for bladder cancer. We’ve included information from PubMed, which is the research database of the National Library of Medicine. Each research article in PubMed has an identity number (called a PMID) that links to a brief overview (called an abstract).

Preventing bladder cancer

Researchers look at substances or behaviours that might lower the risk of developing bladder cancer. They may study people who eat certain foods, take certain drugs or vitamin supplements or do physical activity to see if they develop bladder cancer less often than people with different habits (Investigative and Clinical Urology, PMID 27326403; Anticancer Agents in Medicinal Chemistry, PMID 25482719; BMJ, PMID 27297008; Medicine, PMID 25929912).

Find out more about research in cancer prevention.

Diagnosis and prognosis

A key area of research looks at better ways to diagnose and stage bladder cancer. Researchers are also trying to find ways to help doctors predict a prognosis (the probability that the cancer can be successfully treated or that it will come back after treatment). The following is noteworthy research into diagnosis and prognosis.

Biomarkers are substances, such as proteins, genes or pieces of genetic material like DNA and RNA, that are found naturally in the body. They can be measured in body fluids like blood and urine or tissue that has been removed from the body. A gene mutation or a change in the normal amount of a biomarker can mean that a person has a certain type of cancer. If your doctor thinks you might have bladder cancer, urine tests that look for these changes may help confirm the diagnosis. Biomarker tests can also help doctors predict the prognosis or response to treatment in people with bladder cancer. Researchers are looking at biomarkers such as MMP-9, urine-based peptide biomarker panels and emmprin to see if they can help doctors diagnose, find a recurrence in, predict a prognosis for and find out which treatments will benefit a person with bladder cancer (Oncology Letters, PMID 26998151; Clinical Cancer Research, PMID 27026199; Journal of Urology, PMID 26119672; International Journal of Cancer, PMID 24917520).

Gene-based tests find differences between normal genes and genes that are changed (mutated) in cancer cells. Microarray analysis is a type of gene-based test that allows researchers to look at many genes together to see which ones are turned on and which ones are turned off. Analyzing many genes at the same time to see which are turned on and which are turned off is called gene expression profiling. Researchers hope that developing more gene-based tests will help doctors identify the best treatments for certain cancers, including bladder cancer. Gene-based tests will also help doctors tailor more treatments to each person’s cancer based on their unique genetic makeup (American Journal of Translational Research, PMID 26807194; British Journal of Cancer, PMID 26812572; European Urology, PMID 28390739).

Virtual cystoscopy uses a CT scan or an MRI to make images of the bladder. A regular cystoscopy uses an endoscope that is passed through the urethra to reach the bladder. Virtual cystoscopy doesn’t use an endoscope, so it is less invasive and more comfortable than a regular cystoscopy (Advances in Urology, PMID 26600802; International Journal of Computer Assisted Radiology and Surgery, PMID 26092656). Researchers are still studying virtual cystoscopy to determine its role in clinical practice.

Narrow-band imaging (NBI) cystoscopy seems to be better than white light cystoscopy at finding carcinoma in situ and cancer that hasn’t grown into the muscle layer of the bladder. NBI cystoscopy also improves visibility of bladder tumours and surgical removal of the tumours, which lessens the rate of tumour recurrences (Scientific Reports, PMID 26046790; PloS One, PMID 28192481; European Urology, PMID 27117749).

Find out more about research in diagnosis and prognosis.

Treatment

Researchers are looking for new ways to improve treatment for bladder cancer. Advances in cancer treatment and new ways to manage the side effects from treatment have improved the outlook and quality of life for many people with cancer. The following is noteworthy research into treatment for bladder cancer.

Laparoscopic cystectomy is surgery to remove the bladder using a laparoscope that is placed in the abdomen through small cuts (incisions). Surgeons may use laparoscopic cystectomy to avoid making the large incision needed to do an open radical cystectomy. Laparoscopic cystectomy is more complicated, but people who have this surgery usually have a shorter recovery time, less blood loss and fewer blood transfusions than those who have open surgery. Research to date shows that laparoscopic cystectomy is as effective as the standard open surgery (BJU International, PMID 25294421; Actas Urologicas Espanolas, PMID 28624175; Current Urology Reports, PMID 28634646).

Robotic-assisted radical cystectomy is a type of laparoscopic cystectomy. During robotic surgery, the surgeon sits near the operating table and controls robotic arms to remove the bladder through several small incisions in the abdomen. The robotic arms have wristed instruments that turn and bend like the human wrist. Robotic-assisted radical cystectomy is more complicated than an open radical cystectomy. A study showed that robotic-assisted techniques did not have a large advantage over standard open surgery. Both approaches to radical cystectomy had similar complication rates, lengths of hospital stay and outcomes (European Urology, PMID 25985883, PMID 25496767; Pakistan Journal of Pharmaceutical Sciences, PMID 27005509).

Intravesical therapy is a treatment that gives a drug directly into the bladder. Researchers are studying intravesical therapy using different combinations and schedules of drugs to treat bladder cancer. They are giving drugs, including mitomycin and interferon alfa-2b (Intron A, Wellferon) with or alternating with bacillus Calmette-Guérin (BCG), which is standard intravesical therapy for cancer that hasn’t grown into the muscle layer of the bladder. Researchers are studying disease-free survival, time to recurrence, time to progression, safety, quality of life and overall survival of these treatments (BMC Cancer, PMID 26014129; European Urology, PMID 27085624, PMID 25301758, PMID 25748117). Other studies looked at the efficacy, safety and quality of life using low-dose BCG. The results appear to show no difference in tumour response, toxicity and quality of life compared to standard-dose BCG (International Journal of Urology, PMID 25256813; Journal of Urology, PMID 26307162). Another study compared intra-arterial chemotherapy combined with intravesical chemotherapy and intravesical chemotherapy alone. The results show that the combined therapy could lower the risk of progression and recurrence compared to intravesical therapy alone (Cancer Chemotherapy and Pharmacology, PMID 28421294).

Chemotherapy given before or after surgery for advanced bladder cancer may provide better disease control, progression-free survival and overall survival. Researchers are looking at different combinations of drugs. A phase 3 trial found that chemotherapy given immediately after surgery lengthened progression-free survival compared to treatment given later, but there was no significant improvement in overall survival. Oncologists generally agree that giving chemotherapy around the time of surgery for advanced bladder cancer is helpful and should be considered in some situations where a tumour has grown deeply into the layers of the bladder wall and has spread to the lymph nodes (Lancet Oncology, PMID 25498218; European Urology, PMID 24472710; Journal of Urology, PMID 26410730; Canadian Journal of Urology, PMID 26267024; European Journal of Cancer, PMID 26707593; Anticancer Drugs, PMID 26053279).

Targeted therapy uses drugs to target specific molecules (for example, proteins) on the surface of or inside cancer cells. These molecules help send signals that tell cells to grow or divide. By targeting these molecules, the drugs stop the growth and spread of cancer cells while limiting harm to normal cells. Researchers are studying different targeted therapy drugs to see how well they work to treat bladder cancer. Targeted therapy drugs are often studied in combination with chemotherapy. These studies are still in the early stages, but many results are encouraging (PLoS One, PMID 26270481; Medical Oncology, PMID 26310889). Some of the targeted therapy drugs that researchers are studying include:

  • lapatinib (Tykerb)
  • ponatinib (Iclusig)
  • sorafenib (Nexavar)

Immunotherapy is a type of biological therapy that uses the immune system to help destroy cancer cells. It is commonly used to treat bladder cancer. New immunotherapy drugs that show promise in treating bladder cancer include atezolizumab (Tecentriq) and pembrolizumab (Keytruda) (Lancet, PMID 26952546; Lancet Oncology, PMID 28081914).

Find out more about research in cancer surgery, research in chemotherapy and research in targeted therapy.

Learn more about cancer research

Researchers continue to try to find out more about bladder cancer. Clinical trials are research studies that test new ways to prevent, detect, treat or manage bladder cancer. Clinical trials provide information about the safety and effectiveness of new approaches to see if they should become widely available. Most of the standard treatments for bladder cancer were first shown to be effective through clinical trials.

Find out more about cancer research and clinical trials.

cystoscopy

A procedure that uses an endoscope (a thin, tube-like instrument with a light and lens) to examine or treat the bladder and urethra.

Cells or tissue may be removed for examination under a microscope. Doctors may also use cystoscopy to remove the prostate or small tumours or stones from the bladder.

The type of endoscope used for this procedure is called a cystoscope.

laparoscopy

A procedure that uses an endoscope (a thin, tube-like instrument with a light and lens) to examine or treat organs inside the abdomen and pelvis.

Cells or tissue may be removed for examination under a microscope. Doctors may also use laparoscopy to perform different surgical procedures in the abdomen and pelvis.

The type of endoscope used for this procedure is called a laparoscope.

Stories

Lusomé Founder and CEO Lara Smith Seeing my sister Erin – a young mother – struggle with the emotional blow and then the physical toll of cancer treatment made me want to do something to help women feel confident.

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