Hopkins is one of the leading national centers for bladder cancer
treatment. This cancer takes many forms, and the stage and grade
of the tumor must be considered before selecting the best treatment.
The majority of bladder cancers remain confined in the mucous layer
of transitional epithelial cells, smooth muscle, and the fibrous
layer of the bladder, and do not invade the muscle wall of the bladder.
These superficial transitional cell cancers are the easiest to treat
and the survival rate is greater than 90%.
In many cases, cautery destruction
of the superficial tumor can be achieved with a laser or electrical
force introduced into the bladder with a cystoscope. TUR (Trans
Urethral Resection) is an endoscopic procedure that is used to remove
the tumor from the urinary tract through the urethra, without making
an incision in the body. In addition, medication placed directly
into the bladder (intravesical) via a urethral catheter will effectively
treat and control these locally confined, superficial cancers. Upwards
of 68% of our patients with superficial bladder cancer have a positive
response to intravesical drug therapy (Mytomycin C and Bacille Calmette-
Guerin are two popular drugs) that is designed to either kill normal
DNA function or else force the body’s immune system to fight cancer.
cancer has a very high rate of recurrence after treatment, even
when superficial tumors are completely removed. Johns Hopkins was
one of the first institutions in the world to use intravesical gemcytabine
(Gemzar) for the treatment of recurrent superficial bladder cancer.
After noting the drug's efficacy for treating metastatic cancer,
our researchers performed the necessary pharmacokinetic studies
of intravesical instillation of the drug for local bladder cancer
therapy. This drug is now being evaluated in ongoing clinical trials.
More aggressive therapy is required
for cancers that infiltrate the bladder's muscular wall or have
spread beyond it. The cystectomy (surgical removal of the bladder)
is the most effective treatment for these advanced bladder cancers.
In many cases, our skilled surgeons will then create a neobladder,
also known as "continent orthotopic urinary reconstruction,"
from intestinal tissue. This is connected to the urethra, and it
allows the patient to void through normal channels and maintain
continence. We use a team approach for all aggressive cancers, calling
on the expertise of our urological surgeons, medical oncologists,
radiation therapists, and ostomy nurse specialists to develop a
personalized treatment plan that will minimize complications, reduce
hospital stay, and speed postoperative recuperation. In addition,
we encourage prospective patients to make use of our extensive contact
list of people who have had surgery and have volunteered to discuss
their experiences. By availing themselves of this valuable bladder
cancer support network, patients can make an informed choice about
a reconstruction procedure that will work best for them.
Brady Urological Institute urologists
and researchers have had a longstanding interest in developing new
treatment approaches for bladder cancer. In addition to constantly
refining surgical techniques, they are trying to discover biomarkers
that can be used for the identification of bladder cancer through
the evaluation of these markers in urine specimens. The hope is
that a simple test will be sufficient to tell whether a patient
has cancer in the urinary tract and whether further evaluation with
more invasive testing is needed. Mark Schoenberg, M.D., is currently
the coordinator and principal investigator of a Phase III multi-center
U.S. and Canadian study utilizing diagnostic innovations pioneered
in the laboratory of David Sidransky, M.D. at the Sidney Kimmel
Comprehensive Cancer Center at Johns Hopkins. This three-year study
will validate a test to detect the recurrence of bladder cancer.
Final study results are due in September 2007.
The test uses a technology known
as microsatellite DNA analysis. Microsatellites, also known as short
tandem repeats, are repeating units of one to six nucleotides found
throughout human chromosomes. These repeating regions are frequently
mutated in tumors. In screening for recurrent bladder cancer, DNA
can be easily extracted from cells that are normally present in
urine, and compared to DNA sequences of unaffected cells, such as
lymphocytes, from the same patients. This non-invasive analysis
can have over 90% accuracy.
In other bladder cancer research
efforts, David Y.S. Chan, M.D., is studying new technologies for
inspecting the bladder. Instead of using a traditional light source
for visualization, he utilizes noninvasive optical coherence tomography
(OCT). With OCT, a special laser penetrates tissue, offering millimeter
penetration (approximately 2 to 3 mm in tissue) with sub-micrometer
axial and lateral resolution that exposes cancer found deep in the