Revolutionizing Urinary Bladder Cancer Treatment Through Advanced Medical Device Technology

Upon hearing the word ‘cancer’, we immediately associate it with lung cancer, breast cancer, cervical cancer, leukemia and skin cancer. However, cancerous tumors in the genitourinary system are amongst the most common type occurring amongst patients who are diagnosed with the life-threatening disease. Moreover, this type of cancer is also known to significantly shorten the life span of patients, as compared to other diseases of a similar degree.

Tumors in the genitourinary system vary across demographic factors and clinical outcomes. As per studies in recent years, genitourinary cancers are very common amongst Indian males and females, accounting for nearly 21 per cent of all cases. Moreover, in males, 30.4 per cent of genitourinary system malignancies (17.50 per cent) consisted of urinary bladder malignancies. On a global scale, of 356,000 new cases of urinary bladder cancer diagnosed annually, the disease results in the death of 145,000 patients.

A number of advancements in the field and new technologies over the years have helped to improve processes and equipment for diagnosis, surgery, and treatment of urinary bladder cancer. Let us look into some of these.

What causes urinary bladder cancer?

Urinary bladder cancer originates in the urothelial cells (also called transitional cells) within the bladder. The menace of smoking, in particular, is a leading cause of the disease. As per the above-mentioned study, in the US alone, 48% of men and 32 per cent of women have urinary bladder cancer as a result of smoking. In India, the situation is worse, given the widespread tobacco consumption. The incidence rate amongst men and women in India are more than their western counterparts, at 74 per cent and 22 per cent respectively, with the rate of smoking amongst Indian males being even higher than western males.

While smoking is a major factor, other forms of tobacco consumption, chronic irritation of the bladder lining, exposure to chemicals and radiation, and parasitic infections are also some of the common causes for the disease.

Symptoms and diagnosis:

The most common symptom of urinary bladder cancer is blood in the urine (hematuria). Other symptoms include dark urine, frequent/reduced urination, painful urination or burning sensation while urinating. Those with bladder cancer may also experience pelvic/lower back pain, loss of appetite, sudden weight loss, fatigue/weakness, bone pain, or swelling in the feet.

An indicator of blood in the urine is that it turns bright red or brownish. However, sometimes the color may not be significantly different but blood may be detected with a microscopic examination. One should immediately consult a urologist if they experience any of these unusual symptoms, who may further direct them to an oncologist for further evaluation. Some common processes for diagnosing the disease are via imaging tests, biopsy, urine cytology, and cystoscopy. Once diagnosed, the treatment will ensue.

Current procedures for the treatment of urinary bladder cancer:

As with a majority of diseases, there are a number of procedures for treating urinary bladder cancer. The most prevalent of these is Bacillus Calmette-Guerin (BCG) intravesical immunotherapy, which is also comparatively less expensive. The procedure involves the use of a liquid drug that is given

directly inside the bladder instead of injecting it into the blood or through the mouth. It is the same BCG vaccine that is administered during childbirth to prevent the development of tuberculosis in infants. The drug is then kept in the bladder for two days in order for it to act on the cancer cells inside it.

While this method is effective in some cases, studies have revealed that the likeliness of the disease recurring is high after BCG treatment in non-muscle invasive bladder cancer (NMIBC) patients. If cancer comes back, the process can be repeated for a period of about one year. But, when this fails and cancer continues to grow or spread, doctors usually recommend a radical cystectomy (removal of the bladder).

However, the quality of a patient’s life is drastically affected after their bladder is removed. It can lead to social and psychological problems such as depression, anxiety, shame, tension, loss of interest in hobbies, irritability, and loneliness. It can also cause erectile dysfunction in males and significantly affect one’s sex life. These side effects are present amongst 40-60 per cent of patients who undergo the procedure.

This is where solutions driven by new-age technology are proving to be extremely effective in the treatment of bladder cancer. One example of this is Combat Medical’s Bladder Recirculation System (BRS) which uses its proprietary HIVEC (Hyperthermic Intra-Vesical Chemotherapy). Through technology, the device provides heated chemotherapy to treat (NMIBC) patients. Additionally, it uses clinical hyperthermia, which keeps the temperature between 41-43 degrees, as per therapeutic requirements.

The HIVEC-driven BRS device equally distributes the Mitomycin C (MMC) drug through a catheter. Though it is known that MMC remains stable at temperatures up to 50°C, research has shown that the drug is more effective, and reaches an optimum level at 43°C. At this temperature, the cytotoxicity level of the MMC, i.e. its effectiveness in killing cancer cells, goes up by 10x, without having a negative impact on the body. The resulting benefit is lower time to drug exposure, with fewer side effects. Additionally, the thermotherapy triggers the Natural Killer Cells (NKC) of the body’s immunization system, which leads to the elimination of the cancer cells.

According to clinical evidence in a 2019 study conducted amongst select NMIBC patient groups, those who underwent BCG procedure had 5 recurrences of the disease, while 4 of the cases further deteriorated and progressed to the next stage. Conversely, zero recurrences were observed amongst the patient group administered with HIVEC, thus proving its effectiveness. Moreover, these patients recorded “higher therapeutic adherence” compared to their BCG counterparts. Several prominent doctors across the country have reported making the switch to the BRS-HIVEC device to efficiently prevent recurrences in superficial bladder cancer.

Dr Raghunath.S.K, Senior Consultant Urooncologist and Robotic Surgeon, TRUSTWELL and HCG Hospitals, Bengaluru says, “We can see an increasing number of urinary bladder cancer patients. This is due to exposure to risk factors like smoking, exposure to chemicals, usage of hair dye and environmental pollution. Giving BCG into the bladder is one of the common and effective modalities of treating early-stage bladder cancers. However, BCG has its own adverse effects and many patients may not tolerate it. To overcome this, we have a new technology called HIVEC, wherein we give heated Mitomycin into the bladder instead of BCG to prevent the adverse effects. The effect of HIVEC is the same as giving BCG into the bladder. I strongly feel HIVEC technology would help many early-stage bladder cancer patients to prevent a recurrence.”

Commenting on HIVEC’s potential to solve critical cases of bladder cancer, Dr. Mohan Keshavamurthy, Director, Urology/Andrology, Fortis Hospital, Bengaluru, states, “HIVEC Mitomycin administration is a novel therapy for patients of bladder cancer. It is an excellent option for patients suffering from high-grade superficial bladder who have recurrence despite intravesical BCG therapy. It is also useful for patients with muscle-invasive bladder cancer who want to preserve their bladder and avoid radical surgery. However, the greatest promise is in de novo treatment of newly diagnosed bladder to prevent recurrences. Overall it is offering a new ray of hope for bladder cancer patients.”

Dr Yuraraja T.B., Head of Robotic Surgery, and Consultant of Surgical Oncology (uro-oncology) at Kokilaben Hospital, Mumbai further added, “I have been using Combat BRS’s HIVEC for some time now, and it is giving really effective results. HIVEC is surely the next best step for an efficient treatment to prevent recurrence in superficial bladder cancer.”

From a functional point of view, the BRS-HIVEC requires only 5 minutes more than BCG to set up and can easily be integrated into existing systems. It works independently for the most part, given its patient-monitoring and safety features like automated alerts, but can be overseen even by a trained nurse when required. Given that such devices don’t require constant monitoring, doctors and operation theatre staff can focus on other patients and pressing medical duties within the duration of the procedure.

With such technological advances in the medical space, in addition to the treatment procedure being carried out successfully, the need for extra staff or allocation of additional logistical resources is significantly reduced. It helps to cut down the costs of the overall treatment as well as peripherals, while greatly optimizing patient outcomes. The continuous research, development, and implementation of such systems and devices will result in better accessibility and affordability for providers, enabling them to do the same for patients on a large scale.

Dr Yuvaraja T.B.

Guest Author The author is Head of robotic surgery, consultant of surgical oncology (uro-oncology) at Kokilaben Hospital, Mumbai.