Bladder Cancer

About Bladder Cancer

The bladder is a hollow organ with muscular walls where the body stores urine before it leaves the body.

Urine is the liquid waste made by the kidneys. The urine is carried to the bladder through ureters. When you go to the bathroom, the muscles in bladder will contract and they then push urine out through a tube called the urethra.

When cells of the bladder grow uncontrolled, they can become bladder cancer. A person with bladder cancer will usually have one or more tumors in his/her bladder.

The bladder wall has many layers, made up of different types of cells. Most bladder cancers start in the inside lining of the bladder.

Stage 4 Bladder Cancer

Bladder cancer worsens when it grows into or through other layers of the bladder wall. The cancer may grow outside the bladder into tissues nearby.

Bladder cancer may spread to lymph nodes nearby and the bones, the lungs or the liver and other parts of the body. When this happens, the cancer is called “Stage 4 metastatic bladder cancer”. With Non-muscle invasive bladder cancer, NMIBC, the tumor will not have spread outside the bladder as the bladder muscle is not involved.

The existing therapies used on stage 4 metastatic bladder cancer are not curative. The National Cancer Institute, NCI, highlights the fact that for a certain group of bladder cancer patients, the best treatment option is to join one of the many clinical trials existing worldwide aiming to increase their chances of therapeutic success.

Bladder Cancer Risk Factors

• Smoking – the cause of half of all bladder tumors
• Exposure to chemicals used to make plastics, paints, textiles, leather and rubber
• Genes / Family history
• Certain types of infections
• Patients with other cancers, such as lymphomas and leukemia, who receive treatment with Cyclophosphamide

Symptoms

Some people may have symptoms while others may feel nothing at all.

Some symptoms should never be ignored, such as blood in the urine or frequent and urgent urination. You need to talk to an urologist if you have any symptoms.

• Blood in the urine – which is the most common symptom
• Frequent and urgent urination
• Pain when passing urine
• Pain in the lower abdomen
• Back pain

Treatment Goals

In metastatic stage 4 disease, the primary objective of the treatment is to slow down and control disease progression and help reduce symptoms as well prolong life and improve patient’s quality of life.

The existing therapies used on stage 4 metastatic bladder cancer are not curative. The National Cancer Institute, NCI, highlights the fact that for a certain group of bladder cancer patients, the best treatment option is to join one of the many clinical trials existing worldwide aiming to increase their chances of therapeutic success.

Standard Treatments

A number of therapies are possible, and many patients shall receive more than one type of therapy

Surgery

• Radical Cystectomy

Removal of the bladder, tissue around it and other organs. Is sometimes recommended for treatment of metastatic patients to control local spread and the complications this creates.
Surgery is also utilized after an incomplete response of the primary cancer to radiation therapy and/or chemotherapy.

Two main types of treatment may be offered to patients before and after surgery

Treatment prior to surgery is known as ‘Neoadjuvant’ 

Usually this stage of treatment will involve chemotherapy and/or radiotherapy intended to reduce the tumor’s size and improve the success of surgery.

Post-surgery treatment, also known as ‘Adjuvant’ 

This treatment seeks to cure and prevent the appearance of metastases or recurrence of the tumor.

Radiotherapy

This involves use of radiation at higher levels of energy aims to kill the cancer cells remaining in the post-operative area.

Radiation may also cause decelerated growth of the localized tumor remaining in the area, or local recurrence.

In many cases, Neoadjuvant radiation will be used to shrink and reduce the tumor.

Chemotherapy

Chemotherapy is a medicated therapy which aims to shrink and erase cancerous cells and allow control over the disease.

Chemotherapy carries serious side effects, while its effectiveness is insufficient.

Chemotherapy’s impact has a range of side effects such as hair loss, loss of appetite, changes to bowel movements, fatigue, infection, hemorrhaging, incontinence, pain, and more.

Common chemotherapy treatments for bladder cancer include

Gemzar (Gemcitabine) and Cisplatin
Methotrexate, Vinblastine, Doxorubicin (Adriamycin), and Cisplatin

Targeted therapies (per mutation or per protein)

A mutation is a change in the cell’s DNA sequence, the genetic code of the cell.

Mutations may occur when mistakes happen during the cell’s division process, or they may be caused by exposure to DNA harming agents such as free radicals, asbestos and others. At times healthy cells mutations may cause the generation of cancer in the body.

HER2 Biological Antibody Treatment

An example of a common mutation in bladder cancer and a drug that acts to fight it

Herceptin® (Trastuzumab)

Immunotherapy

Immunotherapy drugs assist the immune system in attacking the tumor. This type of treatment is very different from chemotherapy, for example, which directly attacks the cancerous cells but unfortunately also damages healthy tissues.

The immune system has “immune barriers” which serve to regulate the immune system and prevent it from attacking the body. In cancer these functions are readily activated and as a result, the immune system ceases to attack cancerous cells, enabling the tumor to grow and proliferate in the body.

Barriers known as PD-L1, PD-1 and CTLA-4 are found on T-cells and cancer cells. Immunotherapy is a revolutionary strategy, and one of the most widely studied worldwide for its application to numerous types of cancer and various stages of the disease’s development. Treatment is generally provided in the form of an intravenous infusion.

PD-1 drugs
• Keytruda® (Pembrolizumab)

PD-L1 drugs
• Tecentriq® (Atezolizumab)

Clinical Trials for Bladder Cancer

Facts

1. The existing therapies used on stage 4 metastatic bladder cancer are not curative, and this is a source to the need for innovative and effective treatment strategies in order to fight the disease.
2. The National Cancer Institute, NCI, highlights the fact that for a certain group of bladder cancer patients, the best treatment option is to join one of the many clinical trials existing worldwide aiming to increase their chances of therapeutic success.
3. Currently, every patient will be offered the standard protocols described above. Sometimes the oncologist may suggest integrating these therapies with trials carried out in the institute.

The Opportunity

1. Advances in cancer therapies may be found in clinical trials prescribing cutting edge, innovative drugs, some of which have already been recognized by the US Food & Drug Administration, the FDA, as “breakthrough drugs” and require further information to be approved.
2. An entire world of clinical trials, Compassionate drugs and advanced new cancer treatments are available worldwide.
3. It is important to know and have access to cutting edge cancer treatments that best match the unique medical condition of the patient and increase chances in winning the fight against compared to the standard care offered.

Note to remember!

Not every patient is eligible to enter a specific clinical trial. The eligibility conditions must be fully met and each case is reviewed separately to ensure that the clinical trial matches to the specific cancer patient and vice versa.

References:
ttps://www.fda.gov
https://www.ema.europa.eu
https://www.health.gov.il/Pages/HomePage.aspx
https://www.cancer.gov
https://www.cancer.org
https://www.cancerresearchuk.org
https://www.cancercenter.com

Dear Reader
This information is provided as a source of knowledge and does not constitute a medical consultation. For professional medical advice, see your attending physician. Information regarding drugs and commercial names belongs to the pharmaceutical companies