After 40 years of limited progress treating patients with advanced bladder cancer, there has now been a new breakthrough. A senior oncologist at Rambam Health Care Campus (Rambam) in Haifa, Israel, explains the importance of early diagnosis, trends in bladder cancer treatment, and the reason for optimism.
Dr. Avivit Peer is an attending oncologist at Rambam’s Genitourinary Clinic in the Joseph Fishman Oncology Center and the director of the hospital’s Clinical Trials Unit in oncology. In collaboration with MSD, a leading cancer research company, Peer provides insights and recommendations regarding bladder cancer treatment in Israel.
In Israel, 1,800 new patients are diagnosed annually with bladder cancer—it is the fifth most common type of cancer and most prevalent in men. While smoking is the primary risk factor for this and other malignant diseases, other risk factors include recurring urinary tract infections, genetics, exposure to volatile industrial substances, and some drug therapies.
Bladder cancer originates in the cell layer lining the inside of the bladder, known as transitional cells. It is also called transitional cell carcinoma (TCC) or urothelial cell carcinoma (UCC). These cells line the inner layer of the bladder, ureters, urethra, and renal pelvis. The tumor forms when these cells grow rapidly and uncontrollably, unlike normal cells.
There are two main types of bladder tumors, depending on how deeply the tumor has penetrated the bladder wall: superficial and invasive. Superficial tumors are early-stage and have not penetrated beyond the superficial layers lining the bladder. Most patients are diagnosed at this stage. Non-invasive tumors are surgically removed, sometimes with additional localized drug therapy.
However, one-quarter of cases are diagnosed at an advanced stage, when the tumor has invaded the muscle of the bladder wall or beyond, or when there are affected lymph nodes or metastases in organs outside the urinary tract. Treatment must be comprehensive to prevent spread of the disease, show its progression, shrink the tumor, and extend the patient’s life expectancy. Treatment may involve surgical removal of the bladder, radiotherapy combined with chemotherapy, and biological therapies such as immunotherapy.
Not just a man's disease
The main warning sign of a malignant bladder tumor is the presence of blood in the urine. Sometimes the blood is visible, but it might only be detectable in small amounts via laboratory tests. If you notice a change in the color of your urine and suspect it contains blood, promptly seek medical advice. Identifying the underlying cause and ruling out potential reasons is crucial for proper diagnosis and treatment.
Other symptoms of bladder tumors include a burning sensation, increased frequency, or pain during urination, as well as back pain. Since these symptoms are often associated with other conditions such as kidney stones or urinary tract infections (UTIs), there is sometimes difficulty in diagnosing the disease, especially in women. Unfortunately, many women in their fifties are misdiagnosed with recurring urinary tract infections, leading to a delayed diagnosis until the disease has reached an advanced stage. Hence, it is essential to raise awareness—bladder cancer is not just a man’s disease; it can also affect women.
The rules have changed
The rules have changed: even patients with advanced bladder cancer have a realistic hope for longer more fulfilling lives.
Since the 1970s, treatment for advanced bladder cancer was largely unchanged, relying primarily on chemotherapy. However, the recent introduction of immunotherapy, which harnesses the body’s own immune system to attack cancer cells, has changed everything. Today, the most promising treatment approach combines immunotherapy with other therapies, offering the potential for greater effectiveness and even, in some cases, a cure.
Reflecting on her many years of experience, Peer concludes: “These advances are significant. Expanding therapeutic options to treat bladder cancer improves patient outcomes and extends their lives. Additionally, physicians are better able to manage the disease.”
Based on a Hebrew article that first appeared on YNet.
