Classic and New Methods for Bladder Cancer Treatment

Bladder cancer is the most common cancer of the urinary tract and the sixth most common type of cancer in the United States. In the United Kingdom, bladder cancer is the 11th most common cancer. It usually forms as one or more tumors in the mucous membrane inside the bladder. Approximately two percent of people in the U.S. as well as three percent of people in the UK will be diagnosed with bladder cancer at some point in their life. On average, men are significantly more affected than women.

The risk of bladder cancer increases in both sexes from around the age of 75. The most important risk factor for bladder cancer is smoking. Other risk factors include genetic predisposition, increased exposure to certain chemicals such as aromatic amines (used primarily in manufacturing paints and pigments), chronic inflammation of the bladder lining, medications such as certain chemotherapy drugs or diabetes medications, and previous radiation therapy to the pelvic area.

Non-Muscle-Invasive Bladder Cancer

In this form, the tumor only grows on the surface of the inner bladder wall (bladder mucosa and, in some cases, connective tissue). It has not grown into the muscle layer of the bladder.

Non-muscle-invasive bladder cancer includes stages pTa (urothelial: non-invasive, wart-like bladder carcinomas in the mucosa), pTis (in situ: broad growth of tumors in the mucosa of the bladder), and pT1 (tumor has grown under the mucosa into the connective tissue).

About 75% of bladder tumors are non-muscle-invasive or are diagnosed at an early stage, so the cancer has not yet grown into the muscle layer.

In most cases, bladder cancer is removed surgically. Chemotherapy or instillation therapy may also be used. However, there is still a risk that the bladder cancer will continue to progress or return.

Muscle-Invasive Bladder Cancer

In this form, the tumor has grown into the muscle layer of the bladder and may even have spread to surrounding tissue or other parts of the urogenital tract.

Muscle-invasive bladder cancer includes stages pT2 (the cancer has grown into the muscle layer of the bladder), pT3 (the cancer has grown into the surrounding fat tissue) and pT4 (the cancer has grown into the prostate, seminal vesicles, uterus or vagina, or has spread to the pelvic or abdominal wall).

To treat this form of bladder cancer, the entire bladder and pelvic lymph nodes are usually surgically removed. Those affected then require an artificial urinary diversion.

In men, the prostate and seminal vesicles are typically removed as well. In women, the uterus, ovaries, fallopian tubes, and part of the vaginal wall are usually removed as well.

Bladder cancer treatment depends on various factors, including the severity of the cancer, the number of tumors, location and size, the stage of the disease, the tumor grade (aggressiveness of the tumor) and the patient's general state of health. It is also important to know whether this is a first diagnosis or a recurrence (relapse).

Based on the results of comprehensive (preliminary) examinations, the doctor makes a diagnosis and determines the appropriate treatment for the patient's individual bladder cancer. Depending on the stage of the disease, the following treatment options have been established as standard therapy for bladder cancer.

Surgical Removal of Tumors via Cystoscopy (TURBT)

Transurethral resection of bladder tissue (TURBT) is the standard treatment for non-muscle-invasive bladder cancer. During cystoscopy, an electric loop is inserted through the urethra (transurethrally), which the doctor uses to remove the tumor tissue, other suspicious tissue, and part of the bladder wall. If the risk of recurrence is low, a single TURBT operation is usually sufficient.

If the tumor tissue cannot be completely removed by TURBT or if there is a higher risk of recurrence, the TURBT is repeated in the area of the original tumor (re-resection).

Following surgery, medication is instilled into the bladder. In more severe cases, it may be necessary to perform a cystectomy after the second TURBT.

Instillation Therapy

Bladder instillation (bladder irrigation) is performed following transurethral resection of the bladder (TURBT). The bladder is irrigated with a special active ingredient using a catheter in order to reduce the risk of recurrence or inhibit the progression of bladder cancer.

Two types of active substances are suitable for bladder irrigation: cytostatic drugs (chemotherapeutic agents), which act locally in the bladder, and the attenuated live vaccine Bacillus Calmette-Guérin (BCG), which stimulates the immune system.

This therapy option is only used to treat non-muscle-invasive bladder cancer. If the risk of recurrence is low, a single early instillation immediately after TURBT may be sufficient. For medium or high risk, bladder irrigation is repeatedly performed over a period of 1 to 3 years.

Chemotherapy

In case of non-muscle-invasive bladder cancer, chemotherapy can be administered locally via bladder irrigation after tumor removal. In case of muscle-invasive bladder cancer, chemotherapy is administered before or after cystectomy as (neo)adjuvant therapy, i.e., as a complementary treatment measure.

Chemotherapy uses cytostatic drugs (cell-killing drugs) to consolidate the success of the treatment, destroy tiny, undetected metastases, or shrink the bladder cancer before surgery.

Chemotherapy can also be used as palliative therapy for advanced bladder cancer.

Radiotherapy (Radiation Therapy)

If removal of the bladder and possibly other organs is not an option because the patient's health does not allow it or because they refuse this type of bladder cancer treatment, radiotherapy may be used as a standalone treatment. Chemoradiotherapy (radiation therapy combined with chemotherapy) can be used as part of organ-preserving treatment for bladder cancer and after TURBT to ensure the success of the treatment or to avoid cystectomy.

If the bladder cancer is already very advanced and has formed metastases, radiotherapy can alleviate the symptoms.

Radical Cystectomy (Removal of the Bladder)

A radical cystectomy may be performed if the tumor has grown into the muscle layer of the bladder, if the bladder cancer is very aggressive, if there are many small cancerous lesions, or if there has been a recurrence. During radical cystectomy, the entire bladder and the pelvic lymph nodes are removed. If the urethra is affected by cancer, it is also removed. Adjacent organs are also removed during this procedure—in women, these are the uterus, ovaries, fallopian tubes, and part of the vagina; in men, this includes the prostate and seminal vesicles.

Following radical cystectomy, an artificial urinary diversion must be established, for which there are several options. Incontinence, sexual dysfunction, and hormonal imbalances are possible after the operation.

Immunotherapy

Immunotherapy can be administered after removal of the bladder if the patient's general state of health does not allow chemotherapy, if kidney function or urine flow is impaired, or if there is chronic inflammation of the upper urinary tract (kidneys and ureters). Immunotherapy may also be used to combat metastases.

This therapy can only be used in patients whose tumors have a specific biomarker on their surface.

Similar to chemotherapy, immunotherapy works throughout the patient's body, but may be associated with less severe side effects.

There are numerous guidelines for bladder cancer treatment, such as the EAU Guidelines for Non-muscle-invasive Bladder Cancer (Europe), the EAU Guidelines for Muscle-invasive and Metastatic Bladder Cancer (Europe), the NICE Guidelines for Bladder Cancer (UK), and the AUA Bladder Cancer Guidelines (US). These guidelines mention the so-called “trimodal therapy” for bladder cancer as an alternative to radical cystectomy (removal of the bladder). Trimodal therapy is is based on three pillars: local removal of the tumor using TURBT, followed by combined radiotherapy and chemotherapy. If the tumor cannot be completely removed or if recurrence occurs, surgical removal of the bladder is recommended instead of bladder-preserving therapy.

However, in addition to established treatment options, there are also new treatment methods for bladder cancer that aim to improve patient care. These new therapies can be used to complement the classic treatment of bladder cancer.

In recent years, immunotherapy for bladder cancer has been the subject of ongoing development. In clinical studies, new drugs have been approved that, for example, reduce the risk of recurrence after cystectomy without being as strenuous for the body as chemotherapy. Other therapeutic approaches, such as personalized therapy for bladder cancer, are also intended to help maximize therapeutic success while minimizing unwanted side effects for patients. These new approaches can complement and enhance traditional methods.

Personalized therapies are promising methods to treat bladder cancer because they are tailored to the individual cancer of each patient and to the specific genetic, molecular, and cellular characteristics of the tumor. The characteristics of bladder tumors are already well researched and can be identified using special tests. As a new treatment method for bladder cancer, personalized therapy allows for tailored treatment and opens up new possibilities in cancer therapy.

RGCC’s Personalized Bladder Cancer Therapies

The teams at RGCC International consist of scientists specializing in various disciplines who are working in an international network of laboratories. Our experts combine cutting-edge research with state-of-the-art technology to develop targeted cancer therapies. It is our daily mission to improve outcomes for patients and reduce the number of ineffective treatments.

The following personalized cancer therapies from RGCC are generally suitable for use in cancer treatment. However, only a cancer test in conjunction with further diagnostics by specialized physicians can determine whether and which of these methods can be used in individual cases.

Q-REstrain

Q-REstrain consists of microRNA molecules with the ability to regulate the gene expression of a specific target. The short dsRNAs (double-stranded RNAs) are derived by cleavage of long dsRNA from Dicer and can be microRNAs (miRNAs). miRNAs then assemble with RNA-induced silencing complex (RISC) and cause gene silencing. RNAi has been used in the therapy of different diseases including cancer, viral infections, respiratory diseases, etc. Targeting of specific proteins, through degradation of their mRNA, is very common in cancer treatment of different types of cancer or other infections. Q-REstrain contains microRNAs isolated by the patient’s sample, leading to the degradation of specific mRNA molecules, which are overexpressed in this specific sample, thus regulating the expression. Q-REstrain is for autologous use only and is provided through the RGCC network.

Clavic-Q-RE

Clavic-Q-RE is an adoptive cell therapy aiming to generate a robust anti-tumor immune response. Clavi-Q-RE contains different cell populations, isolated by the patient’s sample.

They include monocytes, natural killer cells, as well as dendritic cells that are already activated in vivo against tumor antigens, which are expressed on cancer samples, cytotoxic T lymphocytes, and plasma cells that have been already differentiated in vivo against tumor antigens.

Clavic-Q-RE is for autologous use only and is provided through the RGCC network.

Vaccine Prep (ATA)

Vaccine Prep (ATA) is a new type of immunotherapy that activates or strengthens specific immune cells. The body's own cells are specifically designed to recognize and destroy cancer cells. We use the cellular fragments of dying tumor cells (CTCs). These include organelles, mitochondria, cell membranes, cellular RNA and DNA and tumor protein fragments.

Dentric Cell Therapy

The aim of dendritic cell therapy is to activate or strengthen the immune system. In immunotherapy, specific immune cells are used to target cancer cells. The therapy method uses so-called dendritic cells, which can recognize specific antigens on the surface of cancer cells. Thanks to improved tumor defense and a reduction in systemic side effects, the therapy is considered a promising treatment approach.

The first step toward personalized treatment for bladder cancer is a cancer blood test by RGCC. The sample is examined by specialists to identify the tumor's specific characteristics. The test results are then sent to the treating physicians. Based on the results and further diagnostics, the doctors can then determine the best combination of treatment methods for their bladder cancer patients.

The following tests can be used to diagnose bladder cancer, identify specific tumor biomarkers, and personalize bladder cancer treatment:

Oncotrace

establishes baseline values for CTC count, phenotype markers, and stemness markers in the bloodstream. These parameters provide a…

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Oncocount

detects the presence of CTCs and quantifies their concentration in the bloodstream. A higher number of CTCs might…

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Oncotrail RGCC

is designed for specific cancers. It benchmarks the aggressiveness of the tumor and is used to track…

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Metastat

investigates the proteins that are related to the distant spread of cancer and the potential metastatic properties of…

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Onconomics

provides highly detailed and accurate information about how effective specific anti-cancer drugs and targeted therapies are in treating…

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Onconomics Plus

provides information about the effect of specific anti-cancer drugs, targeted therapies and natural treatments on the cancer…

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Onconomics Extracts

is a unique and highly detailed test that provides information on how effective natural substances and plant…

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Onconomics Extracts +

Onconomics Extracts+ provides highly detailed and accurate information about how effective specific natural substances and plant extracts are. Furthermore,…

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ChemoSNiP

analyzes how each body reacts to a chemotherapy agent. It helps clinicians make superior decisions on which medication(s)…

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Immune-Frame

provides insights into the current state of a patient’s immune system. It is used to guide treatment and…

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ArrayCGH RGCC

helps identify chromosomal abnormalities and genetic disorders.

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CAMBISeq

is used to predict cancer treatment response. The test analyzes 500+ genes, which are used as biomarkers to…

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Onco-D-Clare

Early detection can make all the difference. Onco-D-Clare can help identify cancer risk even before symptoms appear.

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InVyomma Plus

focuses on gut microbiome profiling, including analysis of short-chain fatty acids, and their association with cancer.

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Unfortunately, recurrence is common in bladder cancer, even after successful treatment. Between 50 and 70 percent of patients with non-muscle-invasive bladder cancer experience a recurrence after the initial treatment. Follow-up therapy then depends on factors such as the previous treatment and the individual risk of further recurrence or progression of the cancer. Subsequent treatment for bladder cancer is then based on the specific findings. Either the classic transurethral resection of bladder tissue (TURBT) can be repeated, followed by bladder instillation, or the bladder and other organs in the urogenital tract must be completely removed. A combination of TURBT and radiation chemotherapy is also possible. Of course, the new treatment methods for bladder cancer described above can also be used here. A cancer blood test can provide additional information about specific tumor characteristics and the individual risk of recurrence.

Our researchers at RGCC work every day to meet unmet medical needs and contribute to more targeted cancer therapy. We want to support doctors and patients with our tests and therapies so that cancer in the bladder and other organs can be treated even more effectively.

Would you like to have a blood test for early cancer diagnosis, disease analysis, or therapy monitoring? Feel free to contact us! Our state-of-the-art tests and therapies are available exclusively to doctors in the RGCC network. In addition to bladder cancer treatment, our procedures can also be used for other types of cancer such as prostate cancer, colon cancer, lung cancer, and breast cancer, among others.

Do you have any questions? Contact the team of experts at our help desk! We are happy to assist you.