Cedars-Sinai is attacking bladder cancer through innovations in both the operating room and the laboratory.

Patients with early-stage disease now have the option of a procedure called en bloc resection, which allows surgeons to remove the tumor in one piece. The technique involves looking inside the bladder with a tiny camera and then removing the tumor by encircling it with a thin laser. The intact tissue makes it easier for pathologists to check whether the cancer is confined to the bladder lining or has invaded deeper into the organ, and it allows surgeons to determine whether any cancer has been left behind.

Meanwhile, for the 25% of patients whose malignancies invade bladder-wall muscle—increasing the danger of metastasis—Cedars-Sinai investigators have developed a means of predicting how bladder cancers respond to certain therapies.

"My hypothesis was that if we looked at the expression of individual cells within the bladder tumor, we could develop more effective tools to guide treatment and perhaps even find novel targets for future therapies," says Dr. Dan Theodorescu, the PHASE ONE Foundation Distinguished Chair and director at the Samuel Oschin Comprehensive Cancer Institute and Cedars-Sinai Cancer.

His team used single-nucleus RNA sequencing—which relies on isolated cell nuclei instead of whole tissue—to profile the genes expressed by each individual cell in aggressive muscle-invasive bladder cancers in 25 patients, map each cell’s position and study the cells' interactions.

RNA sequencing also enabled the study team to discover a previously unclassified type of cell in the bladder lining that expresses high levels of a protein associated with poor surgical outcomes.