Bladder Cancer

Background

Early Stage squareBladder cancer usually arises from the endothelial cell layer lining the inside of the bladder. Risk factors include age, smoking, occupational exposures, chronic bladder irritation or infection, and arsenic. Men are almost 4 times more likely to develop bladder cancer, but most are highly treatable because of early diagnosis. However, there is a high risk of recurrence even for early stage cases, so follow-up testing is needed for years after treatment is completed to monitor for recurrence.

Bladder cancer accounts for more than 72,000 new diagnoses and more than 15,000 deaths each year in the US. 

Current Treatment

Surgery to remove the tumors is the most common form of treatment. Complete removal of the bladder is another option but carries a high risk of complication and side effects. The chief concern in the treatment of bladder cancer is the risk of recurrence, so if the whole bladder is not removed, other treatment methods are often employed to mitigate the risk of recurrence.

Intravesical therapy, in which drugs are delivered directly into the bladder through a catheter, is used mainly in early stage cancers because its effects are limited to cells lining the inside of the bladder.

Chemotherapy drugs are used for more advanced stage cancers because of their ability to effect cells throughout the body.

Radiation therapy can be used to treat bladder cancer of all stages. Combining radiation therapy with surgery or medical therapy can make the radiation more effective.

Focused Ultrasound Research

Focused ultrasound could potentially destroy bladder tumors noninvasively without affecting nearby tissue or structures. Although the concept of focused ultrasound treatment originated in the field of urology with studies on prostate cancer, little work has explored the use of focused ultrasound in bladder cancer.

One preclinical study in the 1990s found that focused ultrasound could be used to destroy bladder tissue. There has been some recent work looking at the concept of using focused ultrasound to provide organ sparing surgery for patients with bladder cancer at UCLA. This pre-clinical work showed that one can use focused ultrasound in a transmural, full thickness ablation of an intact bladder wall. Further work needs to be done to demonstrate the impact of these approaches in patient care.

Notable Papers

de Castro Abreu AL, Ukimura O, Shoji S, Leslie S, Chopra S, Marien A, Matsugasumi T, Dharmaraja A, Wong K, Zaba N, Ma Y, Desai MM, Gill IS. Robotic transmural ablation of bladder tumors using high-intensity focused ultrasound: Experimental study. Int J Urol. 2016 Jun;23(6):501-8. doi: 10.1111/iju.13083.

Niedworok C, Shaleva A, Rübben H, Stenzl A. [Organ-sparing treatment of bladder cancer]. Urologe A. 2016 May;55(5):609-14. doi: 10.1007/s00120-016-0086-5. German.

Bastide C, Paparel P, Guillonneau B. Minimally invasive surgery in oncologic urology: a recent review. Curr Opin Urol. 2008;18(2):190-7.

Watkin NA, Morris SB, Rivens IH, Woodhouse CRJ, ter Haar GR. A feasibility study for the non-invasive treatment of superficial bladder tumors with focused ultrasound. Br J Urol. 1996;78(5):715-21.

Click here for additional references from PubMed.