Cancer Treatment

Bladder cancer

4 min read
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Bladder Cancer

Bladder cancer is a malignant tumor that forms in the tissues of the bladder. It is the fourth most common cancer in men and the tenth most common cancer in women worldwide. The majority of bladder cancer cases are transitional cell carcinomas, which originate in the urothelial cells lining the inside of the bladder.

Epidemiology

In terms of epidemiology, bladder cancer affects approximately 550,000 people worldwide annually, resulting in around 200,000 deaths. The incidence and mortality rates are higher in developed countries compared to developing countries. This discrepancy is primarily attributed to variations in environmental and lifestyle factors, with cigarette smoking being the most significant risk factor for bladder cancer.

Diagnosis

Diagnosing bladder cancer involves a series of tests and procedures. The initial step usually involves a thorough medical history and physical examination. Subsequently, urine tests, such as urine cytology and urine culture, are conducted to identify any abnormal cells or infections. Imaging techniques, such as ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI), may be utilized to visualize the bladder and determine the extent of cancer spread. Finally, a definitive diagnosis is made through cystoscopy, where a thin tube with a camera is inserted through the urethra to examine the bladder lining and obtain biopsies if necessary.

Treatment

The treatment approach for bladder cancer depends on various factors, including the stage and grade of cancer, the patient's overall health, and personal preferences. Treatment options may include surgery, radiation therapy, chemotherapy, immunotherapy, and targeted therapy.

  • Surgery: Surgical interventions for bladder cancer include transurethral resection of bladder tumor (TURBT), partial cystectomy, radical cystectomy, and urinary diversion procedures. These procedures aim to remove the tumor, part or all of the bladder, and create a new way for urine to exit the body, if necessary.
  • Radiation therapy: This treatment modality utilizes high-energy rays to kill cancer cells and shrink tumors. It can be administered externally or internally (brachytherapy).
  • Chemotherapy: The use of drugs to kill cancer cells is known as chemotherapy. In bladder cancer, chemotherapy can be given before surgery to shrink tumors or after surgery to kill any remaining cancer cells. Additionally, chemotherapy drugs may be directly injected into the bladder (intravesical chemotherapy).
  • Immunotherapy: This type of treatment stimulates the body's immune system to recognize and attack cancer cells. One of the most common immunotherapies used for bladder cancer is Bacillus Calmette-Guérin (BCG), a type of bacteria that helps trigger an immune response.
  • Targeted therapy: Targeted drugs work by blocking specific abnormalities within cancer cells, thereby suppressing their growth and spread. Several targeted therapy drugs have shown efficacy in advanced bladder cancer.

Important Drugs for Bladder Cancer Treatment

Several drugs have been approved for the treatment of bladder cancer, including:

  • Pembrolizumab (Keytruda): An immunotherapy drug that targets a protein called PD-1 and has shown effectiveness in advanced bladder cancer.
  • Gemcitabine and Cisplatin: A combination chemotherapy regimen commonly used for patients with advanced bladder cancer.
  • Enfortumab vedotin-ejfv (Padcev): A targeted therapy drug that delivers chemotherapy directly to cancer cells expressing Nectin-4, a protein found in bladder cancer cells.

Promising Future Drugs in Clinical Trials

Bladder cancer trials are investigating various exciting treatment options. Some promising drugs in late-stage clinical trials include:

  • Erdafitinib: A targeted therapy drug that specifically targets fibroblast growth factor receptors (FGFRs), which are often mutated in bladder cancer.
  • Bavencio (Avelumab): An immune checkpoint inhibitor that blocks the PD-L1 protein, enabling the immune system to recognize and attack cancer cells.
  • Enfortumab vedotin: Similar to the already approved enfortumab vedotin-ejfv, this drug delivers chemotherapy directly to cancer cells expressing Nectin-4.

In conclusion, bladder cancer is a significant global health issue. Early detection and appropriate treatment are crucial for improving patient outcomes. While several drugs have shown efficacy in bladder cancer treatment, ongoing clinical trials offer hope for more effective and targeted therapies in the future.