mCancerPartner sat down recently with Cheryl Lee, M.D., a surgeon and professor of urology, to discuss blue light cystoscopy, a technology that significantly improves the detection of non-muscle invasive (early stage) cancer of the bladder during surgery. Dr. Lee’s research focuses on improving quality of life and surgical outcomes for bladder cancer patients. She is active with the Bladder Cancer Advocacy Network, where she has served as president of its Scientific Advisory Board and is currently a member of the Board of Directors. She is Past-Chairman of the Bladder Cancer Think Tank.
mCancerPartner: Can you talk about bladder cancer tumors and the challenges they present in regard to removing all the cancer.
Dr. Lee: Most people with bladder cancer (around 70%) are initially diagnosed with early stage disease, meaning that their tumor is not growing deeply into the wall of the bladder. We can use endoscopic, or minimally invasive surgery to scrape the tumor or tumors off the inner bladder layer. One of the tools is a long thin surgical device with a light and video camera that allows us to see images of the patient’s bladder on a screen. Unfortunately there is a 40-70% risk of a bladder cancer returning (recurring) depending on the features of the tumor.
Previous research has shown that a significant number of these cancer ‘recurrences’ are actually persistent tumors that were missed during the first surgical procedure. These bladder cancers can be missed when the surgeon can’t see clearly due to bloody urine or when tumors are small or in hard-to-see areas of the bladder. Our bladders aren’t always smooth and there can be many nooks and crannies that hide tumors. As a result, patients may require multiple procedures before their bladder is fully rid of bladder cancer.
mCancerPartner: You and your surgical colleagues here at the Cancer Center are using a new method for more effectively seeing tumors on the bladder. How does it work, and what does it offer to the patient that’s an improvement on traditional methods?
Dr. Lee: As you can imagine, there’s been lots of research over the years to improve tumor detection for bladder cancer. An important advance in bladder tumor detection involves the use of a special chemical (Cysview®) that can be taken up by tumors. Then, with the use of special equipment, the tumor cells will fluoresce or appear as bright blue tissue in the bladder. This can take a small tumor that is difficult to see and make it much more obvious. This ‘blue light’ technique has been used and studied in Europe for some time, and has only recently been approved for use in the United States. So it’s already a proven technique that is now gaining use in the United States. The U-M Comprehensive Cancer Center is the only hospital in Michigan that is able to provide this technology.
There are several strong benefits for our patients. By using the blue light technique, the rates of bladder tumor recurrence are lower, allowing patients to avoid invasive procedures and potentially reduce the frequency of their bladder checks. We hope this will reduce physical discomfort and anxiety for our patients. A recent study of the old white light technique versus the newer blue light technique found the average time to a bladder tumor recurrence was seven months longer with the blue light.
Another advantage for patients is that the blue light technology is able to identify high risk tumors in addition to low risk tumors. High-risk non-invasive cancer such as carcinoma-in-situ is important since it can progress over time and invade the bladder wall. However, it isn’t always easy to see or to distinguish from other non-cancerous conditions of the bladder. Early detection of this type of tumor means that we can begin treatment quicker, when there’s the greatest chance for a cure.
mCancerPartner: Can you speak to the promise of new surgical technologies like blue light cystoscopy?
Dr. Lee: Blue light cystoscopy is the only new technology in recent years that has proven to make a difference for our patients:
- We see the tumors better which makes the surgical procedure more effective.
- The blue light can detect both high risk and low risk tumors.
- Research shows that, for people at risk of recurrence, there is a longer period of time before the tumor recurs.
- Patients at risk for recurring tumors have fewer surveillance procedures, so patients may experience less anxiety.
The benefits of blue light cystoscopy are clear and, in Europe, its use is considered standard. As a result, European guidelines for the management of bladder cancer have recommended that urologists use it to ensure that their patients have optimal care. The FDA has approved the use of this technology in the U.S. noting its safety and ability to improve outcomes for patients with early stage bladder cancer. As its use increases in the U.S., we will undoubtedly find additional benefits for patients based on continuing research studies.
Take the next step:
- Learn more about Blue Light Cystoscopy at the U-M Comprehensive Cancer Center.
- Find out how bladder cancer is diagnosed and treated.
- Learn about the risks for developing bladder cancer.
- Bookmark these resources for bladder cancer patients and families.
At the U-M Multidisciplinary Urologic Oncology Clinic our patients are cared for by nationally recognized experts – urologists, medical oncologists, radiation oncologists and pathologists – as well as nurse practitioners and physician assistants who specialize in the treatment of bladder cancer. Each member of our team is committed to the best possible treatment for our patients.
The University of Michigan Comprehensive Cancer Center’s 1,000 doctors, nurses, care givers and researchers are united by one thought: to deliver the highest quality, compassionate care while working to conquer cancer through innovation and collaboration. The center is among the top-ranked national cancer programs, and #1 in Michigan according to U.S. News & World Report. Our multidisciplinary clinics offer one-stop access to teams of specialists for personalized treatment plans, part of the ideal patient care experience. Patients also benefit through access to promising new cancer therapies.