The diagnosis, the multi-team treatment and the innovations in the treatment
Bladder cancer is one of the most common cancers. Dr. Michal Tzarfati, a specialist in clinical oncology and director of the unit for urinary tract tumors at Sheba Medical Center, notes that this tumor is more common in men, usually over the age of 65 with a background of smoking, or exposure to various substances during their work.The symptoms

One of the most significant symptoms of the disease, according to Dr. French, is the appearance of blood in the urine. There may also be urgency to urinate or burning when urinating. Of the urinary tract, hence the great importance in diagnosis.

The diagnosis

Dr. Sarfati explains that in the first stage, people with one or more of the symptoms described are referred by the family doctor for a urine test and to perform a urinary imaging by CT or MRI.

Next, according to the findings, a urologist performs a cystoscopy, in which a tiny camera is inserted into the bladder, in order to notice what is happening in it. Dr. French explains that if a tumor is diagnosed, the treatment is done with TURBT surgery. In surgery, the bladder tumor is excised, during which the tumor is removed endoscopically and a sample of the tumor’s deep tissues, including the muscle layer, is collected to see if the tumor has penetrated it.

In case the tumor penetrates a muscle there is an increased risk of the tumor spreading to the blood vessels and lymphatic system and therefore in such a case, a PET CT scan is also performed to determine the stage of the disease. Stages of the disease include: Stage 1 – no muscle penetration; Stage 2 – penetrating; Stage 3 – Also involves lymph nodes, or adjacent organs; Stage 4 – a metastatic disease in which the cancer has spread to other organs.

The treatment

Dr. French notes that most people diagnosed with bladder cancer are located at a stage when the cancer has not penetrated the muscle. Their main treatment focuses on endoscopic resection, and in most cases local chemotherapy or biological treatment inside the bladder. However, if the pathology provides an answer that it is a muscle penetrating tumor, the treatment is more complex and therefore each patient is presented in a meeting of a multidisciplinary team of specialists, including: urologists, oncologists, radiotherapists, imaging people, nuclear medicine people and sometimes pathologists. “Discussing the patient, examining the test results, cross-referencing the information with data about the patient’s background diseases and formulating a treatment plan,” explains Dr. French.

Prof. Zohar Dotan, director of the urology department at Sheba, explains that “the main treatment for a muscle-penetrating tumor includes removal of the bladder, in an open or robotic approach.” He said, “In the last five years more and more departments have been performing robotic surgeries, and today about two-thirds of Sheba surgeries are performed using this approach, including bladder reconstruction.” Prof. Dotan explains that “this is an advantage that shortens the duration of hospitalization and shortens the recovery process.” “Providing chemotherapy before surgery reduces the tumor, treats microscopic metastatic disease and improves the long-term results of the surgery,” he said.

The therapeutic revolution that reduces the chance of disease recurrence

“When bladder cancer penetrates a muscle, microscopic cancer cells can enter the lymph or bloodstream and cause metastatic recurrence of the disease within a few years of surgery. Therefore, preoperative chemotherapy (neoadjuvant) is important to eliminate the cancer cells. “To prevent the recurrence of the disease,” explains Dr. Tzarfati.

“Once the bladder is removed, the tissue is processed in the pathology department so that information can be obtained about the response to neoadjuvant therapy. If the disease responds well to treatment, the chance of recurrence is very low. If the bladder remains invasive, Less good, “explains Dr. French.

Prof. Dotan notes that “until 2021 there was no complementary treatment given after chemotherapy, so patients had to live with the fear of recurrence of the disease. In the past year he has joined the war on growing innovative immunotherapy, which mobilizes the immune system to act against the tumor. “For recurrence of the disease, both for patients after prior chemo-adjuvant chemotherapy and for bladder cancer patients who did not receive preliminary chemotherapy. This treatment significantly reduces the chance of recurrence of the disease,” explains Prof. Dotan.

“This is a drug that has been used to treat patients with metastatic bladder cancer since 2016,” notes Dr. French. . Most of the patients suffered from mild side effects of fatigue, mild skin problems, diarrhea or disruption of thyroid activity, which can usually be treated. ”

The test that predicts the success rate of the innovative treatment

Dr. Sarfati explains that in order to assess the degree of success of the treatment, it is customary to perform a stain known as 1PDL. When the dye is positive, the effectiveness is estimated at 45%. “Both the test and the complementary immunotherapy are included and funded in the health basket.

Prof. Dotan believes that the last two years have been very significant in the field of integrating immunotherapy treatments in the field of bladder cancer. “We knew that immunotherapy was effective in metastatic disease. Several indications for the treatment of non-metastatic patients have recently been approved, including postoperative bladder resection, leading to significant long-term outcomes with a low toxicity profile. These are encouraging news for the many patients suffering from these tumors.”

“It is important to emphasize that early detection saves lives. Any condition of changes in the urinary system requires diagnosis, especially if there is blood in the urine,” concludes Dr. French. The treatment and use of immunotherapeutic drugs. The integration of the minds of a multidisciplinary team of experts makes it possible to make the best therapeutic decisions for the benefit of each patient. ”

By Editor

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