Madrid, May 9, 2022.- In 2022, 22,295 new cases of bladder cancer will be diagnosed in our country, a number that makes this tumor the fifth most common cancer in Spain.1 The development of this type of cancer is associated with environmental factors, with smoking as the main risk factor, along with the consumption of alcohol and exposure to pollution. The initial approach in bladder cancer is common to all patients, with the tumor being resected, with histology then defining whether it is infiltrating or not. "But the fundamental difference is that in tumors which are infiltrating, because then you have to remove the patient's bladder," warns Dr. Fernando Lista, head of the Endourology Section at MD Anderson Cancer Center Madrid. The usual thing in these cases is that, after surgery, a bag must be built, similar to a colostomy bag, using a segment of the intestine.
"In 90% of cases, unless it is surgically contraindicated or because the urethra is involved, we build a neobladder, which tends not to be done due to the complexity of the procedure and because the postoperative period is more complicated," explains the doctor. This unique operation consists of building a "new bladder" for the patient, creating a kind of bag with a segment of intestine, which is then attached to the urethra and ureters so that the new bladder can function correctly.
As explained by Dr. Lista, although apparently the quality of life of the patient should not be affected by the fact that they have a stoma or can urinate normally, the reality is that it does matter. "It exponentially improves the patient's quality of life and, without a doubt, their self-esteem, because the perception of 'I had a tumor and they removed it and I don't see anything on the outside' is really important", the specialist points out. This type of approach is indicated for patients aged 50-60, who are generally healthy and do not have many accompanying pathologies. “Today, at MD Anderson Madrid, a neobladder is done in 90% of cases.”
Multidisciplinary management maximizes the patient's chances of recovery
The most common symptom of bladder cancer is the presence of blood in the urine (hematuria), which leads to the patient consulting the doctor immediately and most cases are diagnosed when the disease is localized, in practically 90% of cases. For that reason, despite the fact that it is a common tumor, mortality is relatively low. "So, multidisciplinary management of the surgical side of things, the radiotherapy side and the systemic treatment or intravesical treatments are essential", explains Dr. Enrique Grande, head of the Medical Oncology Service at MD Anderson Madrid and Head of Clinical Research at MD Anderson Foundation Spain. "The patient’s options increase, the chances of preserving the bladder are greater and the possibilities of curing the patient increase if the center offers the full range of specialists to deal with the tumor," says the doctor.
In localized type cancers, the usual treatment is resection of the tumor. But the key is the treatment and the multidisciplinary discussion of each case within the team, in which the pathologist, the urologist, the medical oncologist, the radiation oncologist, the radiologist and even nuclear medicine are all involved, “because this type of tumor may want to get close to the bones and you have to act quickly. If the oncologist sees this or suspects it during the consultation, that very same day I see the patient, I do a cystoscopy and I look at the bladder. If you have a tumor, you will be operated on within 3-4 days. The limit between it being superficial or infiltrating can be weeks”, says Dr. Fernando Lista.
Access to innovative therapies
Rapid access to innovative therapies plays an essential role in the survival of patients with bladder cancer. Between 8% and 22% of patients have alterations in the FGFR gene (fibroblast growth factor receptor) and "at MD Anderson Madrid we have therapies that target this alteration," says Dr. Grande. The hospital also has clinical studies that are aimed at another gene, the HER2, the breast cancer gene, in which patients who have mutations (not amplifications, which is what is seen in the breast) also have a targeted therapy.
Another of MD Anderson Madrid's projects on bladder cancer focuses on improving the quality of life of patients with metastatic urothelial cancer by reducing the number of chemotherapy treatments, without deteriorating survival rates. This is the objective of the DISCUS study which the cancer center leads worldwide in conjunction with St. Bartholomew,s Hospital in London, and which was launched at the end of April.
The development of genetic tests carried out on the urine, which detect the probability of someone suffering from bladder cancer in a hematuria episode in which nothing in particular is found in the bladder, the upper urinary tract or the ureter, is another of the options the center offers its patients and which detects the mutation of tumors that are difficult to see with traditional techniques.
In addition, the center leads a clinical trial with patients who have had their bladders removed, who undergo a blood test to see the circulating DNA of the tumor; that is, the genetic material of the tumor circulating in the blood. "If we detect this, it logically means there are tumor cells circulating, so the risk of relapse is greater and we have treatments for that," Dr. Grande states.