New Bladder Cancer Surgery May Lower Risk for Recurrence

Patients with earlier-stage bladder cancer have a new surgical option to remove tumors. The procedure may improve staging accuracy, lower the risk of recurrence and reduce the rate of complications, according to a leading Cedars-Sinai urologic oncologist.

Laser “en bloc resection,” or total tumor resection, enables surgeons to remove the bladder tumor in one piece. This novel procedure provides intact tissue for a pathologist to stage the cancer and reduces the risk of cancer remaining in the bladder, said Michael Ahdoot, MD, a Cedars-Sinai Cancer urologic oncologist and surgeon.

Laser Surgery

During laser en bloc resection, the surgeon looks inside the bladder with a camera, and then uses a laser to score, or “draw,” a margin around the tumor that includes healthy tissue. Next, the surgeon uses the laser to cut under the tumor and then remove it entirely. The tissue is sent to a pathologist who determines whether cancer is growing at the microscopic level in the bladder lining or deeper into the bladder. The cancer location determines whether additional surgery and other treatments are necessary, Ahdoot explained. A second surgery is not indicated if the margins around the tumor are cancer-free.

“With this procedure, we can avoid unnecessary additional surgeries and determine a patient’s recurrence risk much better,” Ahdoot said.

The most common procedure for bladder cancer diagnosis and staging—transurethral bladder tumor resection—involves the insertion of a cystoscope through the urethra into the bladder. The surgeon then removes the tumor by “cutting it into many pieces and then washing it out of the bladder,” Ahdoot explained. “That makes it hard for the pathologist to tell us if we got all of the cancer out. Using this procedure, 1 in 3 patients will still have tumor left behind.”

As a result, “the rate of recurrence is quite high—about 30% to 40% within one year,” Ahdoot added. “With the new technique, most of the time we don’t have to have a second surgery, unless the pathologist sees that the cancer is present beyond what we removed.”

Risk Factors 

Bladder cancer occurs when cells that make up the bladder start to grow out of control. The cells form a tumor, which over time, may spread to other parts of the body, according to the American Cancer Society. Urothelial carcinoma is the most common type of bladder cancer. It starts in the urothelial cells that line the inside of the bladder. About 83,730 new cases of bladder cancer are expected to be diagnosed in the U.S. in 2021. Men are at higher risk than women for the disease, and white people are more likely to be diagnosed with bladder cancer than Black or Hispanic Americans.

Additional risk factors include:

• Smoking: Smokers are at least three times more likely to get bladder cancer than non-smokers, according to the cancer society. Smoking causes about half of all bladder cancers in both men and women.
• Workplace exposure: Those who work with chemicals such as benzidine and beta-naphthylamine (dyes), rubber, leather, textiles, and paint products are at higher risk, as are hairdressers (dye exposure) and truck drivers (diesel fume exposure).
• Certain medicines and herbal supplements: The diabetes medicine pioglitazone (Actos) and the supplement aristolochic acid pose higher risks.

Bladder cancer typically is detected when blood is present in urine, Ahdoot said. When this occurs, a urologist inserts a tiny camera into the bladder to see if tumors are present. When they are detected, the masses usually are removed to confirm the diagnosis.

“There are many causes for having blood in the urine, though: It could, for example, be an infection, enlargement of the prostate or kidney stones,” Ahdoot said. “So, it’s valuable to interpret those results with the help of your doctor, to know whether or not it’s a concerning sign for bladder cancer, or it may be a sign of something else.”

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