Shining a New, Blue Light on Bladder Cancer
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 also one of the most treatable. The bad news is that it also 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 cancer cells that are confined to the surface layer of the bladder and have not yet developed into cancer). During the operation to remove the cancer, known as a resection, a blue light is used which causes those cells to fluoresce pink. “One of the reasons behind the high recurrence rate is that we have inadvertently been doing incomplete resections, leaving some difficult-to-see cancer behind,” says Dr. Jack Barkin, Urologic/Robotic Surgeon at Humber River Hospital and Clinical Professor at the University of Toronto. “This tool helps us accomplish a complete resection without leaving cancer behind and without missing carcinoma in situ.”
Dr. Barkin and his team at Humber River were the first to bring BLC technology to Canada, and the results of even the earliest trials were striking. “I was able to do a pilot study here at the Humber River Hospital where I compared my visualization under the white light versus the blue light,” says Dr. Barkin. “In 24 percent of patients, where I thought I was finished resecting, I saw more tumour when I flashed back onto the blue light. And the most sobering thing was that, in 42 percent of those patients, I saw carcinoma in situ under the blue light that was not even visible under the white light.”
The switch that makes the difference
In terms of patient outcomes, a more complete resection often means that even if the cancer does recur, it takes longer to do so. And that’s extremely valuable, especially considering that the average bladder cancer patient is around 70-years old. “From the patient’s standpoint, even if you 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. Bob 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,” says Bob. “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 patients 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 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, ON. 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 said. “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 is not planning to slow 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 has shown at Humber River and, more recently, other hospitals, there is a massive need for greater access across Canada. But that access will be much slower to arrive if patients don’t advocate for it.