Two urologic surgeons at Vanderbilt-Ingram Cancer Center are among a leading group of cancer physicians using an innovative new imaging agent and blue light system to “light up” cancerous cells inside the bladder.
The combined system is used to confirm non-invasive papillary cancer inside the bladder and help surgeons detect and remove more of the cancerous tumors.
Sam Chang, M.D., and Michael Cookson, M.D., both professors of Urologic Surgery, participated in the pivotal clinical research trials for Cysview — an imaging agent that attaches to tumor cells and fluoresces a bright pink color when used with a special camera and lighting system. The new technology has been shown to enhance detection and treatment of bladder cancer.
In 2013, approximately 55,000 men and 18,000 women will be diagnosed with bladder cancer, making it one of the most common forms of cancer in the United States.
Early symptoms may include painful or more frequent urination or blood in the urine.
To diagnose bladder cancer, urologists insert a long, thin tube known as a cystoscope through the urethra to look inside the bladder.
“Most bladder cancers are papillary tumors that are small and noninvasive,” said Cookson, vice chair and Patricia and Rodes Hart Chair in Urologic Surgery. “Probably 70 percent are what we call “Ta”-low-grade papillary tumors. But about 5 to 10 percent are high-grade, flat lesions called carcinoma in situ (CIS). They can be elusive to traditional cystoscopic evaluation.”
In fact, “Urologists looking inside the bladder with traditional white light can’t always see both kinds of tumors.”
Using the new system, physicians insert the liquid Cysview optical agent into the bladder for 50-60 minutes prior to the surgery.
“It coats the inside of the bladder and both normal bladder cells and the cancer cells are exposed to the liquid,” said Chang who serves as chair of the American Urological Association’s Guidelines on Bladder Cancer. “The tumor or malignant cells preferentially absorb more of this agent and it fluoresces.”
When surgeons switch on a special blue light, the tumors light up pink. Cookson said the effect is like a “black light room inside the lumen of the bladder.”
The bright pink areas make it easier to confirm the presence of some tumors and physicians can switch back and forth between the white and blue lights during surgery to remove the cancerous cells.
“In white light you think you’ve removed all of the tumor but you turn on the blue light and you can still see outlines of pink so you go wider,” explained Chang.
Vanderbilt has been named one of 10 Centers of Excellence in the United States for the use of the new technology and patients with hard-to-detect forms of bladder cancer are now being referred to VICC.
“In the types of patients who are referred to us, the ones who are difficult to diagnose, that recur very frequently, this is a very nice option to have because you feel very confident that you’ve not only seen the tumors but you’ve been able to treat them,” said Chang.
While bladder cancer is often caught early before it metastasizes to other parts of the body, the cancer returns in nearly half of all cases.
The need for repeat testing and additional procedures to remove tumors leads to bladder cancer’s reputation as the most expensive form of cancer.
Cookson said clinical trials with the new system demonstrated its value.
“Tumor detection improved about 16 percent and then subsequent studies showed about the same reduction in recurrence rates. It is more than just helping them find the tumors; it can also lead to reduced need for subsequent surgeries.”
The Food and Drug Administration (FDA) has approved the use of the Cysview agent, licensed by Ipsen from Norwegian pharmaceutical company Photocure ASA, and the blue light imaging system known as the D-Light C Photodynamic Diagnostic System from KARL STORZ Endoscopy-America.
