Despite Advances, More Work is Needed in Bladder Cancer

Every type of cancer has a different chronicle of treatment evolution over the years and what this has meant to those who are diagnosed. For some cancers, new drugs have brought about the most dramatic changes, while, for others, it is early detection or prevention that has made the biggest difference. Surgical advances have impacted other cancers by becoming more precise and effective while less invasive.

In this issue, we examine bladder cancer, which has followed a unique set of developmental stories involving multiple innovations in several fields. For one, bladder cancer possesses specific genetic characteristics amenable to early detection through molecular tests of the urine—looking for cancer-specific genetic changes that can be picked up in just a few cancer cells through the amplification of DNA. Such tests are not yet widely used, because they need to be extremely accurate since abnormal results would require cystoscopy for definitive diagnosis, a safe but involved procedure that would be needed for all “false-positive” screening tests.

One of the most challenging components of bladder cancer therapy is the type of surgery needed for most invasive cancers. This has led to divergences in how we approach surgery—with the use of innovative bladder reconstructions following a total cystectomy favored in the U.S., and pre-operative chemotherapy with bladder-sparing surgery used more often in other countries. These approaches are depicted in illustrations in this issue that highlight the complicated decisions that patients and physicians make in treating this entity.

One of the most challenging components of bladder cancer therapy is the type of surgery needed for most invasive cancers.

Why do we not have any newer targeted biological drugs approved yet for bladder cancer? Chemotherapy can help shrink tumors before surgery or possibly lower the risk of recurrence in the future, although once cancer has spread, the effects of chemotherapy are temporary and variable. We clearly need better molecular handles on bladder cancer. Antiangiogenic and growth factor therapies are being tested, but we need to expose unique vulnerabilities—maybe look for clues in the origins of this cancer, such as toxin exposure (primarily tobacco), inflammation or infection.

We hope that our story will help those affected with bladder cancer and will raise awareness for improvements needed on many fronts.

Debu Tripathy, MD

Editor-in-Chief

Professor of Medicine, University of Southern California

Co-Leader, Women’s Cancer Program at the USC/Norris Comprehensive Cancer Center