Treating and Diagnosing Bladder Cancer

Diagnosis

Dr. Lamm uses Bostwick Laboratories for cytology and biopsy interpretation, as well as special tests such as FISH (fluorescent in situ hybridization) and DNA ploidy to aid in the diagnosis and management of bladder cancer.

Biopsy is important because it helps determine the best treatment. Special analysis of the biopsy specimen including chemosensitivity testing, DNA microarray and immunohistology, tests that provide new information on treatments that may be effective, are available in cooperation with Oncotech and Tgen.

Office flexible cystoscopy is done using the newest Olympus scope, which unlike other scopes is contoured and gently curved to increase comfort. Local anesthesia and electrocautery are available so biopsy and removal of small tumors can be done in the office. Vital staining is used when necessary to visualize tumors that are otherwise invisible.

Prevention

Dr. Lamm has developed and tested in a randomized, double blind controlled clinical trial (the most rigorous of scientific medical studies) a high-dose vitamin combination (Oncovite, by Mission Pharmacal). In a dose of two tablets twice a day, Oncovite reduced tumor recurrence by 40%. We have studied chemoprevention in animals with garlic, which reduced bladder tumor growth and prolonged survival. More about prevention

Treatment

Intravesical BCG Therapy

BCG, the treatment that the FDA first approved based on Dr. Lamm's studies, is now recognized as the best treatment for superficial bladder cancer. Dr. Lamm has published the results of his BCG treatment on over a thousand patients. These studies have set the current standard for the management of bladder cancer. Does Dr. Lamm have better ways to give BCG? The answer is: Medicine is an art as well as a science - both improve with experience. New treatments using new immunotherapies, improved ways to deliver chemotherapy, and new chemotherapies are also available and under further development.
--More about BCG

Surgery

Bladder Tumor Resection: Bladder cancer often can be treated in the office or same day surgery. Experience, of course, is critical to optimal bladder tumor resection. Operating from the inside of the bladder, the goal is to remove all of the tumor without perforating (scraping all the way through) the bladder. Dr. Lamm has trained dozens of urologists in this surgery. What to Expect: Bladder Tumor Resection

Laser surgery is also available, but Dr. Lamm generally prefers electrosurgery because it provides a better specimen for microscopic examination by the pathologist.

Cysectomy: The goal of intravesical therapy is to prevent tumor recurrence and invasion into the muscle of the bladder. Some patients have muscle invasion when first seen, and at times intravesical therapy fails. Once the tumor invades muscle, removal of the bladder provides the best chance of cure. Dr. Lamm has long emphasized the importance of a thorough lymph node dissection when bladder removal (cystectomy) is done. Recent studies have now demonstrated that this technique significantly improves survival.

Survival can also be improved in some patients by adding chemotherapy to cystectomy, and Dr. Lamm will provide counsel and advice on when to add chemotherapy. Dr. Lamm has also written a study to improve survival by adding immunotherapy, which is much better tolerated than chemotherapy, to cystectomy.

Artifical Bladder: For fit patients who do not wish to have an external appliance (bag), Dr. Lamm creates "artificial" bladders to replace the removed bladder using the Studer neobladder, created from the small bowel, or the Indiana bladder, created from the large bowel. With the Studer bladder, urination is through the normal urethra, the normal channel. Sometimes the urethra also has cancer and has to be removed. In these cases the internal re-constructed bladder (Indiana pouch) is drained by a catheter (rubber tube) the patient inserts through the umbilicus (belly button).

Created: 8/2/2005