Bladder Cancer

Bladder Cancer

Bladder cancer is one of the most common cancers in the United States, especially among people over age 70. Much is now known about its causes, offering the potential to reduce new cases in the years ahead.

Evidence-based surgical innovations and treatment refinements have led to steadily improved outcomes and quality of life for patients with the disease. Nevertheless, long-term survival rates have improved only slightly since the 1970s, in part due to bladder cancer receiving less research attention and resources than other common cancers. In fact, no new drugs have been approved specifically for bladder cancer in more than 20 years. Yet, researchers are hopeful that current clinical trials of targeted drugs will result in new, more effective treatment options for patients. 

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2016

First new treatment for bladder cancer in three decades

First new treatment for bladder cancer in three decades

The FDA approves atezolizumab (Tecentriq) for treatment of advanced urothelial carcinoma, the most common form of bladder cancer. With this approval, atezolizumab becomes the first new bladder cancer treatment in 30 years and the first PD-L1 immune checkpoint inhibitor approved for any use. The approval follows an early clinical trial in which atezolizumab rapidly shrank tumors in patients with previously treated advanced urothelial cancer, particularly those with high levels of PD-L1 in the tumor and immune cells.

2015

Immediate chemotherapy after surgery for advanced bladder cancer offers advantages

Immediate chemotherapy after surgery for advanced bladder cancer offers advantages

For the first time, a study shows that starting chemotherapy immediately following surgery is beneficial for patients with cancer that has spread beyond the bladder, compared to delaying chemotherapy until the cancer returns. While survival is similar with either approach, immediate chemotherapy was associated with longer time until the cancer worsens and fewer side effects.

Additional research will explore whether certain subgroups of patients may benefit more from each approach.

2008

Specialized CT scan improves bladder cancer detection

Specialized CT scan improves bladder cancer detection

The so-called CT urograph emerges as an effective, non-invasive strategy for detecting new and recurring cancers. The test, which is done externally, evaluates both the upper and lower tracts of the bladder and nearby lymph nodes. CT urography can help determine which patients need more invasive diagnostic procedures, sparing those who do not.

2003

Pre-surgical chemotherapy proven to extend survival

2000

New treatment alternative for advanced bladder cancer

New treatment alternative for advanced bladder cancer

While the MVAC chemotherapy regimen (methotrexate, vinblastine, doxorubicin, and cisplatin) remains the standard of care for patients with advanced bladder cancer, some patients, including those who are older and have other health problems, cannot tolerate its side effects. In 2000, researchers demonstrate that a new chemotherapy combination regimen using gemcitabine (Gemzar) together with cisplatin is comparably effective but has relatively fewer side effects than standard MVAC.

1997

New chemo-radiation therapy offers alternative to surgery for advanced disease

New chemo-radiation therapy offers alternative to surgery for advanced disease

The introduction of combination therapy - using both radiation and cisplatin chemotherapy together – offers an important new treatment alternative for patients with advanced bladder cancer who are older or otherwise unable to undergo bladder surgery. The strategy provides tumor shrinkage, limits nearby cancer growth, and enables many patients to retain normal bladder function – a key quality of life benefit.

In 2012, a Phase III study confirms the benefits of this approach, using the chemotherapy drugs fluorouracil and mitomycin. Researchers demonstrate this regimen improves survival, with no significant increase in side effects.

1987

New surgical technique helps more men with bladder cancer maintain sexual function

New surgical technique helps more men with bladder cancer maintain sexual function

Previously, nearly all men who underwent surgery to remove their bladder also lost sexual function. But in the late 1980s, researchers map out the nerves surrounding the bladder and prostate and develop a new surgical technique that spares key nerves involved in male sexual function. As this approach is refined, as many as 80 percent of properly selected young men who undergo bladder cancer surgery are able to maintain their potency.

1985

First successful combination chemotherapy for advanced bladder cancer

First successful combination chemotherapy for advanced bladder cancer

Researchers identify the first multi-drug chemotherapy regimen to extend survival for patients with advanced bladder cancer, offering cures in some cases. The regimen – called MVAC – involves a combination of the drugs methotrexate, vinblastine, doxorubicin, and cisplatin. Researchers later confirm that MVAC is superior to single-drug chemotherapy with cisplatin, although the combination regimen causes more side effects.

1984

Surgical advances improve bladder cancer survival

Surgical advances improve bladder cancer survival

Researchers identify the first multi-drug chemotherapy regimen to extend survival for patients with advanced bladder cancer, offering cures in some cases. The regimen – called MVAC – involves a combination of the drugs methotrexate, vinblastine, doxorubicin, and cisplatin. Researchers later confirm that MVAC is superior to single-drug chemotherapy with cisplatin, although the combination regimen causes more side effects.

1980

Reconstructive bladder surgery offers improved quality of life

Reconstructive bladder surgery offers improved quality of life

Based on pioneering preliminary studies conducted as far back as the 1950s, surgeons begin to offer a “neobladder” to select patients needing surgery (cystectomy) for bladder cancer. This procedure provides a functional replacement for the bladder using tissue fashioned from the small bowel that allows the passage of urine through the urethra. This procedure is further refined over the next decade. Prior to the introduction of this procedure, patients who underwent cystectomy needed an external device to collect urine.

Mitomyacin chemotherapy reduces risk of bladder cancer's return

Mitomyacin chemotherapy reduces risk of bladder cancer's return

This treatment is proven to lower the risk of recurrence following surgery for certain early-stage bladder cancers. To maximize its effectiveness, mitomycin is administered directly to the bladder using a tiny catheter (intravesical chemotherapy). Over time, researchers identify new strategies to increase the dose and potency of mitomycin treatment while limiting patients’ side effects.

1978

FDA approves the first chemotherapy drug for bladder cancer

FDA approves the first chemotherapy drug for bladder cancer

Cisplatin emerges as a standard chemotherapy drug for patients with bladder cancer, following results of several studies showing that the drug shrinks many bladder cancer tumors and, in some cases, induces cancer remissions. Later, combination chemotherapy using cisplatin together with other chemotherapy drugs becomes the cornerstone of bladder cancer treatment.

1976

New treatment activates immune system against aggressive bladder cancers

New treatment activates immune system against aggressive bladder cancers

From the mid-1970s through the 1980s, evidence grows on the benefits of an immunotherapy called Bacille Calmette–Guérin (BCG) for an often aggressive form of early-stage bladder cancer called carcinoma in situ (CIS). BCG is a weakened bacterium that is administered directly into the bladder through a catheter (a technique called "intravesical administration"), which boosts the body’s immune response to the cancer. Several trials demonstrate that endoscopic removal of CIS, followed by BCG treatment, lowers the risk of tumor recurrence, compared to surgery alone.

Later studies show longer-term BCG treatment, called “maintenance” therapy, also reduces the risk of cancer recurrences and prolongs survival for patients with CIS who have already undergone surgery.

1974

Cigarette smoking linked to bladder cancer risk

Cigarette smoking linked to bladder cancer risk

Researchers tie sharp increases in bladder cancer deaths among British men to the rapid rise in cigarette smoking during prior decades. Because smoking gained popularity more slowly among women, comparable increases in bladder cancer deaths take longer to emerge.

Years later, in 2011, researchers from the U.S. National Cancer Institute report that cigarette smokers have four times the risk of bladder cancer as non-smokers. Overall, the study attributes about half of U.S. bladder cancer cases to smoking.

Warning labels first appear on cigarette packs

Warning labels first appear on cigarette packs

Researchers tie sharp increases in bladder cancer deaths among British men to the rapid rise in cigarette smoking during prior decades.  Because smoking gained popularity more slowly among women, comparable increases in bladder cancer deaths take longer to emerge.

Years later, in 2011, researchers from the U.S. National Cancer Institute report that cigarette smokers have four times the risk of bladder cancer as non-smokers.  Overall, the study attributes about half of U.S. bladder cancer cases to smoking.

1960

High-risk but curable form of early-stage bladder cancer identified

High-risk but curable form of early-stage bladder cancer identified

Researchers first establish that a specific form of early-stage bladder cancer, called carcinoma in situ (CIS) or noninvasive flat urothelial carcinoma, is a precursor to invasive bladder cancer. These early cancers grow in the layer of cells closest to the inside of the bladder and appear as flat lesions on its inside surface. When diagnosed early, doctors now know to treat CIS aggressively with surgery and other drug therapies. Left untreated, nearly a quarter of these early cancers will spread to the surrounding muscle and become far more difficult to cure.

1956

Early bladder removal surgery introduced

Early bladder removal surgery introduced

Surgeons report one of the first effective techniques for surgically removing the bladder (cystectomy) and surrounding tissue where cancer is most likely to spread. While this early approach carries many risks and results in month-long hospitalizations, it lays the groundwork for many surgical advances in bladder cancer surgery.

1940

Diagnostic tool detects bladder cancer in urine

Diagnostic tool detects bladder cancer in urine

A new test called urine cytology emerges as a tool to detect recurrent bladder and urinary tract cancers.  The test involves examing urine samples under a microscope to look for abnormal cells.  Over time, researchers find the test is most effective for detecting more aggressive cancers, versus those that are slow-growing.

1879

Tool offers view inside bladder for first time