Shining a New, Blue Light on Bladder Cancer
Research and Innovations Blue light cystoscopy is helping identify and treat bladder cancer more effectively.
Bladder cancer is one of the most common cancers in Canada, with roughly 9,000 Canadians being newly diagnosed every year. The good news is that it is one of the most treatable cancers. The bad news is that it has a very high rate of recurrence, up to 80 percent after 5 years.
New developments, however, are beginning to provide tools to help reduce the rate of recurrence. Blue light cystoscopy (BLC) is a technology in which the patient’s bladder is flooded with a diagnostic agent that is selectively absorbed by fast-growing cancer cells and carcinoma in situ (abnormal cells that have not yet developed into cancer). During the operation to remove the cancer, known as a resection, a blue light is used, causing those cancerous or abnormal cells to fluoresce pink. “One of the reasons behind the high recurrence rate is because we have been inadvertently doing incomplete resections, leaving some difficult-to-see cancer behind,” says Dr. Jack Barkin, urologist and the past Chief of Staff at Humber River Regional Hospital. “This tool helps us accomplish a complete resection without leaving cancer behind and missing carcinoma in situ.”
^ Photo: (Left) Bladder image seen using white light. / (Right) Same bladder image seen using blue light (cancerous tissues fluoresces pink).
The switch that makes the difference
A more complete resection often means a longer time between recurrences. And that’s extremely valuable, especially considering that the average bladder cancer patient is around 70 years old. “From the patient’s standpoint, if you can increase the interval between recurrences, that’s a big benefit,” says Dr. Barkin. “There’s a big difference between going in for a resection every few years versus every six months.”
Bob, a patient of Dr. Barkin’s, was 64 years old when he was first diagnosed and treated for bladder cancer in 2009. He ended up having several recurrences and resections before BLC became available. The very first time Bob was resected with BLC, Dr. Barkin was able to find and resect a small tumour that had been invisible under the white light. “It’s revolutionary,” he says. “The only additional inconvenience is that you have an extra hour in the hospital while they fill you up with the agent before the procedure.”
Today, at 73, Bob is happy and strong at home with his wife in Toronto, and he credits a lot of that to Dr. Barkin and BLC. He does, however, believe that it’s patients who must drive the push for greater access. “The patient has to be a serious advocate for himself or herself, ” he says.
Patients must drive change
BLC was approved by Health Canada in 2015, and yet uptake by Canadian hospitals has been slow because funding has not been provided despite the proven benefits and years of successful use of the procedure around the world. “This isn’t an experimental technology,” says Dr. Girish Kulkarni of the University Health Network in Toronto, home of Canada’s newest BLC unit. “It’s just been slow to come to Canada. But now that it’s here, it requires additional funding. Patient advocacy groups like Bladder Cancer Canada are aware of this technology, but it’s going to be the patients themselves who help drive this. If there was more awareness among patients, they would be asking for BLC.”
Enter Ryan Lougheed of Sudbury, Ontario. He was diagnosed with bladder cancer last year after noticing blood in his urine and immediately began to educate himself. “I read this article that showed the difference that BLC can make compared to the white light,” Lougheed says. “I decided immediately that I wanted to bring this technology to Sudbury.”
In less than a year, Lougheed’s fundraising efforts are already at the $70,000 mark and his group has zero plans to slow their efforts down. “Our timeline is, the sooner the better,” Lougheed says. “Sudbury is a regional hospital for all of northeastern Ontario.”
If you ask Dr. Kulkarni, Lougheed’s efforts may actually end up saving other patients and supporting an overtaxed health care system. “We did a study that showed a decrease in the number of hospital beds required for these patients. It also helps lessen the strain on the health care system by freeing up operating room slots for other people,” he says.
With all the benefits that BLC can bring to patients and the system itself, there is a massive need for greater access in hospitals across Canada. But that access will be much slower to arrive if patients don’t advocate for it. One way to get involved is to visit www.DetectBladderCancer.ca to easily send an email to your local government-elected official regarding access to BLC for your community.
< (Photo) Ryan at the hospital with his wife, Jessie Plummer and mother, Corinne Newman, following his first resection.