Kristen Scarpato, M.D., Assistant Professor of Urological Surgery at Vanderbilt University in Nashville, Tennessee talks about a new procedure to help bladder cancer patients.
Interview conducted by Ivanhoe Broadcast News in April 2017.
We hear a lot about breast cancer, prostate cancer, they are in the news a lot, but we do not hear a lot about bladder cancer; how prevalent is it and who is most affected by it?
Dr. Scarpato: Bladder cancer tends to affect more men than women, and it tends to impact older folks compared to younger folks. Typically men age 65 and older, but bladder cancer is still the sixth most common cancer in the United States.
Because a lot of people have not heard of it, or know much about it, give us an idea of the symptoms?
Dr. Scarpato: Bladder cancer tends to be asymptomatic in many patients, but those who do have symptoms most commonly have blood in the urine,; either blood that you can see under the microscope or blood that the patient actually can see. Less commonly, there are symptoms of urinary urgency and frequency, bladder irritations symptoms, almost like a UTI.
Many times could a patient think they might have a UTI, some type of infection and not think of bladder cancer?
Dr. Scarpato: Sure, and I think that is one of the problems with bladder cancer. It is often a symptom that people can chalk up to something else, such as an infection and therefore not seek medical attention until it is persistent for several months.
Is it difficult to treat?
Dr. Scarpato: Bladder cancer can be difficult to treat. There are two different types; there is the more invasive bladder cancer, which requires major surgery and reconstruction typically; and then more commonly there is non-muscular invasive bladder cancer. While that is somewhat easier to treat it has a very high reoccurrence rate, and its labor-intensive for the patients who need close, follow-up, frequent looks in the bladder, frequent medicines in the bladder, and it is actually one of the most expensive cancers to treat because of that.
In Mary Beth case, she was only in her twenties. Is this rare, do you see it a lot?
Dr. Scarpato: Her case is very unusual and in fact she is one of the youngest patients we have ever treated here. She is young, she is a female, and she had no known risk factors. Typically it is older patients and patients with risk factors like smoking or a family history, and she didn’t have any risk factors that we were aware of.
So she sought out a second opinion and that is how she got to Vanderbilt. And she had already had surgery before, so at this point Dr. Scarpato what did the doctors here use and tell us a little about this new technology, how it is really helping?
Dr. Scarpato: Mary Beth before she came here had traditional, what is called white light cystoscopy, and that is the standard in the diagnosis of bladder cancer. When she came here we also looked in her bladder with that same endoscopic technology, but in addition to that, we used what is called blue light cystoscopy. This is a newer technology that allows us to see cancer more clearly using this special technology and medicine that we put in the bladder before surgery. The cancerous cells will pick up this medicine and process it, and then admit this florescent red color that makes tumors, which might not otherwise be seen because they are flat and inconspicuous, very obvious.
Did you say it was like a UV light?
Dr. Scarpato: Florescent.
This type of technology is critical because it really allows you to see the full scope of the bladder, so you can really see places that the traditional white light will not pick up?
Dr. Scarpato: It does not allow you to see the scope of the bladder any better, but it allows you to see lesions that are flat and not otherwise obvious more clearly.
Do you use this with every bladder cancer patient or someone you suspect of having bladder cancer?
Dr. Scarpato: We do not use it for every patient; we use it for patients who have had an initial diagnosis of bladder cancer that came back, high grade and non-invasive, or what is called CIS or Carcinoma-In-Situ. We take them back to the OR for a repeat look to make sure we have done a complete cancer removal, because often times we have not, and this technology is very useful in that setting.
In Mary Beth’s case there were more tumors there?
Dr. Scarpato: That is correct. In fact, when we took her back to the OR over fifty percent of her bladder had high grade non-invasive cancer.
Is bladder cancer very aggressive? Is it a more aggressive type of cancer, or is it more slow growing?
Dr. Scarpato: It depends on if it is low grade or high grade, and how invasive it is.
When Mary Beth’s was found, and then you guys did another surgery to remove the tumors, tell me most about the treatment she received after that?
Dr. Scarpato: After she had the tumors removed, she then had a medicine put in the bladder. In her case it was an immunotherapy, a BCG medicine.
Is that targeted therapy, or what does that mean?
Dr. Scarpato: BCG is a medicine that is actually derived from tuberculosis and it causes an immune reaction in the bladder, but fights of the cancer and prevents or limits occurrences and progression.
Do you feel that her treatment was successful?
Dr. Scarpato: I think her treatment was very successful. She is now over three years from her initial diagnosis and has no evidence of cancer.
Will a bladder cancer patient need to be closely monitored after?
Dr. Scarpato: These patients are closely monitored for many years afterwards; especially Mary Beth’s given her young presentation and aggressive non-invasive disease.
So, unfortunately it is or it can be a reoccurring cancer?
Dr. Scarpato: It can be recurring. There is a very high rate of reoccurrence with this type of cancer, anywhere from fifty to ninety percent of patients reoccur.
If it reoccurs, the patient will have to go through a similar process?
Dr. Scarpato: Correct.
Do you feel that enough people know about it? Is it getting enough awareness and education, or does more need to be done to get that information out there?
Dr. Scarpato: I think that we are doing a better job of making people aware of bladder cancer. There is increase general awareness, but still not where it needs to be. One great resource that is helping promote awareness is called The Bladder Cancer Advocacy Network. There is a website bcan.org and I actually refer all of my patients to this website because it has very useful information. There are patient stories, there are actually clinical resources available for physicians, and it is really a great place to go and gather more information.
What are the risk factors for bladder cancer and does family history play a big role?
Dr. Scarpato: The most common risk factors for bladder cancer are age and smoking. Approximately, fifty percent of bladder cancer can be attributed to smoking and chemical exposures.
Is there anything else doctor that we forgot or you would like people to know?
Dr. Scarpato: I just wanted to give one more anecdotal story of where this technology can be useful. I have one particular patient who has had several years of an abnormal urine test, it is called cytology, and we were doing that test because she had microscopic blood in her urine and that test was consistent coming back as suspicious. But every time we looked in her bladder traditional white light cystoscopy; we were unable to identify any particular cancerous lesion. And then we took her with the blue light cystoscopy and that allowed us to see actually several areas of her bladder that were abnormal and that biopsy came back positive for, of course, Carcinoma-In-Situ and so now she is receiving appropriate therapy. That is another patient instance of diagnosis that was made because of this technology.
So this technology is critical?
Dr. Scarpato: It is really good for identifying; it is also very good for accessing patient response to therapy after BCG, looking back in the bladder with blue light to see if the cancer is gone.
You go back after surgery to check?
Dr. Scarpato: Correct, after they receive the immunotherapy or the chemotherapy in the bladder.
There is no risk to the patient with this?
Dr. Scarpato: No, and it gives me confidence that I have done a complete bladder scrapping and that the patient has responded appropriately to therapy. I think in turn it gives patients increased piece of mind that their cancer is gone.
Do you know how often Mary Beth is being tracked? Would it be something like every six months or?
Dr. Scarpato: So initially, we look in the bladder every three months and then we spread it out to every six months, then after a period of time where there is no evidence of disease we space it out to every year. Everyone is a little bit different.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
If you would like more information, please contact:
Kristen Scarpato
Kristen.r.scarpato@vanderbilt.edu
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