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BLADDER CANCER

Our researchers have had a longstanding interest in developing new treatment approaches for bladder cancer.


Bladder cancer is the second most commonly occurring genitourinary cancer in adults.
Approximately 61,420 new cases of bladder cancer will be diagnosed in the U.S. in 2006, with about 13,000 people dying from the disease.
Bladder cancer can occur at any age, although the average age at the time of diagnosis is in the 60s.
Although bladder cancer is two to three times more common in men, women are twice as likely to die from bladder cancer because they are initially diagnosed with higher stages of disease.
The majority of bladder cancers arise from the lining of the bladder. Over 75% of these superficial transitional cell cancer tumors remain confined to the lining layer and do not invade into the bladder wall.
Bladder cancer has an unusually high propensity for recurring after treatment.

Johns 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.

Bladder 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 tissue.