Bladder Cancer Research Center
The Bladder Cancer Research Center works together with the Greenberg Bladder Cancer Institute to make discoveries that may save lives. Our investigators research all aspects of bladder cancer but are particularly interested in developing new ways to detect and treat the disease. Recent findings include a urine test that can accurately and easily flag bladder cancer — saving patients and doctors from invasive diagnostic procedures.
On This Page Our Areas of Investigation
Screening & Detection
In the area of screening and detection, the Bladder Cancer Research Center is investigating how urine testing may help with early detection of bladder cancer and screening for bladder cancer recurrence.
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Recent efforts in bladder cancer research have focused on finding the molecular origins of the disease. This important research conducted in the laboratory of Dr. David Sidransky, bladder cancer research member and university professor, has focused on understanding the relationship between genetic alterations in the bladder cancer cell and a tumor's ability to recur and progress.
Multiple publications have shown that alterations of specific genes on chromosome 9 probably contribute to the development of most bladder cancers. Detailed molecular maps of bladder cancers have been constructed in the laboratory and provide preliminary work for understanding how bladder tumors arise and recur.
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These observations have led Dr. Sidransky's group to explore the novel application of molecular analytic laboratory techniques to diagnose bladder cancers. Specific molecular abnormalities can be identified in the urine of bladder cancer patients utilizing a new diagnostic bladder cancer test developed in Dr. Sidransky's laboratory. This test, called microsatellite analysis of urinary sediment (MAUS), is a very sensitive and accurate identifier of bladder cancer cells in voided urine.
Pilot studies have already demonstrated that it can correctly diagnose bladder cancer in more than 90 percent of patients — six months earlier than conventional diagnostic testing. Ongoing studies will help define the clinical role of this new test for bladder cancer detection and prevention.
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The Johns Hopkins Bladder Cancer Research Center has established a surveillance program that provides periodic screening for individuals who have been occupationally exposed to chemicals linked to bladder cancer. The program uses microsatellite analysis and cytology of voided urine.
Exposure to chemical carcinogens significantly increases one’s risk for developing bladder cancer. Approximately one fourth to one third of all cases of bladder cancer are believed to be caused by occupational exposure (Catalona, 1991). Those individuals at greatest risk include textile workers, painters, leather and metal workers and workers in the rubber industries (Brettschneider and Orihuela, 1990). All these occupations carry a high risk of exposure to chemical carcinogens.
New Drug Development & Treatment
Superficial bladder cancer remains the most common form of bladder cancer in the United States. Over 75 percent of patients with bladder cancer have the superficial form of the disease and require long-term therapy and monitoring.
Scientists at the Bladder Cancer Research Center are investigating new drugs that may have the potential to treat superficial bladder cancer more effectively than standard treatments.
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One of the mainstays of therapy for patients with superficial bladder cancer who suffer multiple relapses, or who have high-grade tumors with or without invasion of the bladder lining or carcinoma in situ, is the use of intravesical drug therapy. During this treatment, immunotherapy or chemotherapy drugs are injected into the bladder through a catheter.
Since its introduction in the 1970s, a type of intravesical immunotherapy called the bacillus Calmette-Guerin (BCG) vaccine has consistently provided the best control of relapse — and some believe progression — in patients with high-risk bladder cancers. Intravesical chemotherapy agents with slightly less efficacy but substantially fewer side effects, such as mitomycin C, have also been used with good effect in many patients.
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New drugs are needed to treat patients with bladder cancer because even the best therapies available today only provide a 30 to 50 percent chance of long-term disease control. The Bladder Cancer Research Center has a strong investigational interest in new agents to treat superficial bladder cancer.
Surgical Innovation for Invasive Bladder Cancer Treatments
Physician scientists at the Bladder Cancer Research Center are interested in surgical techniques that improve outcomes and spare functioning in patients with bladder cancer.
Outcomes of Nerve-Sparing Cystoprostatectomy and Neobladder Bladder Reconstruction
Discoveries by Dr. Patrick C. Walsh defined the location of nerves that are responsible for potency in men. Years of surgical research and anatomic studies of the location of these nerves have allowed for the development of a highly emulated technique for nerve-sparing removal in men. Complete cystoprostatectomy preserves potency in patients undergoing major surgery for bladder cancer.
The disease-specific survival of men undergoing this type of surgery as well as data on potency after the operation appear below:
Postoperative potency status of 78 evaluable patients listed by pathological stage and age group at time of surgery (No. potent/No. evaluable) | |||||||
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| Stage | 20-29 years | 30-39 | 40-49 | 50-59 | 60-69 | 70-79 | Totals |
| PO | - | - | 2/2 | 5/7 | 2/5 | - | 9/14 64% |
| PA | - | - | 1/3 | - | - | 1/3 | 2/6 33% |
| PIS | - | - | 0/1 | 2/5 | 3/10 | 0/1 | 5/17 22% |
| P1 | - | - | 2/3 | 1/4 | 2/6 | - | 5/13 30% |
| P2 | - | - | 2/2 | 1/2 | 1/1 | - | 4/5 80% |
| P3A | 1/1 | - | 1/2 | 1/1 | 0/1 | 0/1 | 2/5 40% |
| P3B | - | - | 0/3 | 1/4 | 2/5 | 1/4 | 5/17 29% |
| P4 | - | - | - | 1/1 | - | - | 1/1 100% |
| Totals | 1/1 100% | - | 8/16 50% | 12/14 50% | 11/31 35% | 1/6 17% | |
Innovative Surgical Techniques are Routine at Johns Hopkins
The surgical intervention for invasive bladder cancer is routine and well organized at the Johns Hopkins Brady Urological Institute. Faculty and staff complete preoperative consultation, imaging, endoscopic evaluation and expert review of biopsy material, laboratory and X-ray data. Our surgeons routinely perform all forms of urinary tract reconstruction, including ileal conduit, catheterizable continent diversion pouch and orthotopic neobladder reconstruction.
Bladder-Preserving Therapies
Combination Radiation and Chemotherapy
Investigators at the Bladder Cancer Research Center are studying bladder cancer treatment approaches that preserve bladder function.
Organ-preserving approaches to managing advanced tumors combine less aggressive surgical procedures with radiation and chemotherapy. In the past, radiation alone has been shown to effectively shrink bladder tumors. Yet recent studies have indicated a better response with a combined approach in the treatment of muscle-invasive bladder cancer using local resection of the tumor, radiation and chemotherapy.
Radiation and chemotherapy used together as a bladder-preserving technique are proving to be much more effective than either radiation or chemotherapy alone, although some tumors respond more favorably than others. Factors that can influence the success of bladder-preserving therapies are the completeness of the transurethral resection of the tumor, the tumor location and the tumor stage.;
Although bladder removal (cystectomy) remains the standard therapy for muscle-invasive bladder cancer, new advances in conformal radiation therapy and more active chemotherapeutic agents available at The Johns Hopkins Kimmel Cancer Center will continue to make the option of bladder-preserving therapy available.
Symptom Management
Researchers at the Bladder Cancer Research Center are interested in studying how bladder cancer symptoms affect a patient’s physical and psychological well-being, and how offering various types of support can improve quality of life and treatment outcomes.
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Patients with bladder cancer frequently experience depression. Psychological distress expressed as depression or excessive anxiety has been identified in patients with advanced cancer (Cella, Jacobsen and Lesko, 1990). The frequency of psychological distress in patients with cancer at various disease stages ranges from 30 to 47 percent. Spiegel (1994) and Kaasa et al. (1993) reported that 70 percent of patients with advanced cancer and high levels of distress had poor performance and more pain.
A study is currently underway to determine if psychological screening and intervention at the time of diagnosis for cancer can improve the patient's well-being. This study uses the Brief Symptom Inventory (BSI) to identify individuals that need psychological intervention.
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Enterostomal therapy services are provided by a certified wound, ostomy and continence nurse (CWOCN). These services include:
- Preoperative counseling and stoma site marking
- Inpatient self-care teaching and assistance with physical, psychological and social adaptation
- Community referrals for support and appliances (as needed)
- Lifelong follow-up for maintenance issues
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Expert nursing care received by patients at the Brady Urological Institute makes a difference in the quality of patient care. Postoperatively, patients at the Brady Institute are cared for by the nursing staff on the Marburg 2 Nursing Unit who routinely work with individuals treated surgically for urological conditions.
Nurses not only provide clinical and psychological care for patients, but also educate patients in preparation for discharge. Medical oncology nurses are involved in administration of chemotherapy, patient assessment, symptom management, planning of patient care and patient involvement in research protocols.