Cutting-Edge Bladder Cancer Treatments at Bumrungrad Hospital

Bladder cancer is a serious and challenging condition, but advancements in medical technology and treatment techniques have transformed patient outcomes. Bumrungrad International Hospital, renowned for its state-of-the-art facilities and expertise, stands at the forefront of bladder cancer treatment in Thailand. This blog explores the innovative approaches and cutting-edge technologies used at Bumrungrad Hospital to provide exceptional care for bladder cancer patients.

Advanced Diagnostic Techniques

1. Cystoscopy with Enhanced Imaging :

Cystoscopy remains a fundamental procedure for bladder cancer diagnosis, allowing direct visualization of the bladder’s interior. At Bumrungrad Hospital, this procedure is performed using advanced flexible cystoscopes that are equipped with high-definition imaging capabilities.

A. High-Definition Imaging: The flexible cystoscopes used at Bumrungrad feature high-definition cameras that produce exceptionally clear and detailed images of the bladder’s lining. This clarity is crucial for identifying abnormal tissues and small tumors that could be missed with lower-resolution imaging. The high-definition view ensures that even the smallest abnormalities are captured, enabling precise diagnosis and targeted treatment.

B. Narrow-Band Imaging (NBI): An enhancement of traditional cystoscopy, Narrow-Band Imaging uses specific wavelengths of light to improve the contrast between cancerous and healthy tissues. NBI highlights changes in the bladder mucosa that are indicative of cancerous cells. This technique helps in distinguishing malignant tissues from benign ones and enhances the detection of early-stage tumors and subtle mucosal abnormalities, which are often challenging to detect with conventional white light cystoscopy.

Benefits: 

Enhanced imaging technologies at Bumrungrad Hospital improve diagnostic accuracy by providing a clearer view of the bladder’s surface. This allows for better detection of small or early-stage tumors and helps in planning the most effective treatment strategies. By ensuring that all potential areas of concern are identified, these advanced imaging techniques contribute to better treatment outcomes and reduced recurrence rates.

2. Urinary Biomarker Testing

Urinary biomarker testing is a non-invasive method that plays a crucial role in bladder cancer diagnosis and management. Bumrungrad Hospital employs state-of-the-art urinary biomarker tests, such as UroVysion™ and UroMark™, to analyze specific markers in the urine.

A. UroVysion™: This test detects genetic abnormalities associated with bladder cancer by analyzing cells in the urine. It identifies chromosomal alterations, such as changes in chromosome 9, which are linked to bladder cancer. UroVysion™ is particularly useful for detecting cancer cells that may not be visible during cystoscopy and for monitoring disease progression or recurrence.

B. UroMark™: This test measures protein markers that are associated with bladder cancer. It provides information on the risk of cancer recurrence and progression by assessing the presence and levels of specific proteins in the urine. UroMark™ helps in evaluating the effectiveness of treatment and guiding follow-up care based on the risk of relapse.

Benefits: 

Urinary biomarker testing at Bumrungrad provides an additional layer of diagnostic information that complements cystoscopy. These tests are valuable for early detection of cancer, monitoring for recurrence, and tailoring treatment plans based on individual risk factors. They offer a non-invasive way to gather critical information and enhance patient management.

3. Multiparametric MRI

Multiparametric MRI (mpMRI) is a sophisticated imaging technique that provides a detailed and comprehensive view of the bladder and surrounding tissues. Bumrungrad Hospital utilizes mpMRI to enhance the accuracy of bladder cancer diagnosis and treatment planning.

A. Comprehensive Imaging: MpMRI combines multiple MRI sequences, including T1-weighted, T2-weighted, and diffusion-weighted imaging, to produce detailed images of the bladder. This combination allows for a thorough evaluation of tumor characteristics, including size, location, and depth of invasion. MpMRI also helps in assessing the involvement of adjacent structures, which is crucial for staging the disease.

B. Tumor Evaluation: By providing a detailed map of the bladder and surrounding areas, mpMRI aids in determining the extent of tumor spread and guides surgical planning. It helps in identifying tumors that may have invaded nearby tissues or organs, which is essential for planning appropriate treatment strategies.

Benefits: 

The detailed imaging offered by mpMRI allows for more accurate staging and better-informed treatment decisions. It supports the development of individualized treatment plans and improves the effectiveness of interventions by providing a clear understanding of the tumor’s extent and characteristics.

4. Molecular Profiling and Genetic Testing

Understanding the genetic and molecular profile of bladder cancer is essential for personalized treatment. At Bumrungrad Hospital, molecular profiling and genetic testing are used to analyze the tumor’s genetic material.

A. Tumor DNA and RNA Analysis: The hospital examines tumor DNA and RNA to identify specific genetic mutations and alterations associated with bladder cancer. This analysis provides insights into the molecular characteristics of the tumor.

B. Targeted Therapies: The information gained from genetic testing helps in selecting targeted therapies that are tailored to the tumor’s genetic profile. This personalized approach can lead to more effective treatments and improved responses.

Benefits: 

Molecular profiling and genetic testing enable customized treatment plans, improve the precision of therapy, and help predict treatment outcomes based on the tumor’s unique characteristics.

5. Bladder Wash Cytology

Bladder wash cytology involves collecting cells from the bladder using a wash solution, which is then analyzed under a microscope. This technique is used at Bumrungrad Hospital to complement other diagnostic methods. During bladder wash cytology, a wash solution is introduced into the bladder to collect cells from the lining. These cells are then examined for the presence of cancerous changes or abnormal cells. This procedure provides additional diagnostic information to support findings from cystoscopy and other tests. Bladder wash cytology is particularly useful for confirming the diagnosis of bladder cancer and assessing the presence of malignant cells. It helps in monitoring for recurrence and provides an additional layer of verification for the diagnosis.

Benefits: 

This technique enhances the overall diagnostic accuracy by providing an extra method to detect cancerous cells. It is valuable for confirming the presence of cancer and for monitoring patients over time to ensure that any recurrence is promptly detected.

6. Photodynamic Diagnosis (PDD)

Photodynamic Diagnosis (PDD) is an advanced technique that improves tumor visualization during cystoscopy by using light and a photosensitizing agent.

A. Photosensitizing Agent: PDD involves administering a special photosensitizing agent that accumulates in cancerous tissues. When exposed to a specific wavelength of light, these tissues fluoresce, making them stand out from surrounding healthy tissue.

B. Improved Visualization: During cystoscopy, PDD enhances the visibility of tumors and abnormal tissues. This improved visualization allows for more accurate identification and removal of cancerous tissues, ensuring that no areas are missed during the procedure.

Benefits: 

PDD helps in achieving more precise tumor resections and reduces the risk of cancer recurrence. By highlighting cancerous areas more effectively, it allows for a more thorough treatment and improves the likelihood of successful outcomes.

Innovative Treatment Options

1. Intravesical Immunotherapy

Intravesical immunotherapy is a treatment method where medication is directly instilled into the bladder to stimulate the immune system to target cancer cells.

a. Bacillus Calmette-Guérin (BCG) Therapy: BCG is a live attenuated bacterium used as a vaccine. It is one of the most effective treatments for early-stage bladder cancer. At Bumrungrad Hospital, BCG therapy is administered directly into the bladder through a catheter. This therapy helps to activate the immune system to fight cancer cells and reduce the risk of recurrence.

b. Interferon Therapy: Interferon is another type of intravesical therapy used to boost the immune response against cancer cells. It can be used in combination with BCG or as an alternative when BCG is not suitable.

Benefits: 

Intravesical immunotherapy offers a targeted approach that focuses treatment directly on the bladder, minimizing systemic side effects. It is particularly effective in preventing the recurrence of superficial bladder tumors and improving overall survival rates.

2. Targeted Therapy

Targeted therapy involves using drugs that specifically target molecular markers associated with bladder cancer.

a. Erdafitinib: This drug is used to target specific genetic mutations in bladder cancer. It is particularly useful for patients with advanced bladder cancer who have certain genetic alterations. Erdafitinib inhibits tumor growth by blocking the signals that drive cancer cell proliferation.

b. Atezolizumab: Atezolizumab is an immune checkpoint inhibitor that helps the immune system recognize and attack cancer cells. It targets the PD-L1 protein on cancer cells, which helps the immune system to mount a more effective response against the tumor.

Benefits: 

Targeted therapies are designed to directly attack cancer cells based on their genetic and molecular characteristics, offering a more personalized treatment approach. They often come with fewer side effects compared to traditional chemotherapy and can be highly effective for patients with specific genetic profiles.

3. Robotic-Assisted Surgery

Robotic-assisted surgery represents a significant advancement in surgical techniques, providing greater precision and control.

a. Da Vinci® Surgical System: Bumrungrad Hospital utilizes the Da Vinci® Surgical System for bladder cancer surgeries. This robotic system allows surgeons to perform complex procedures with enhanced accuracy through small incisions. The robotic arms provide a 3D view of the surgical field and allow for precise manipulation of surgical instruments.

b. Advantages: Robotic-assisted surgery offers several benefits, including reduced postoperative pain, shorter recovery times, and minimal scarring. The enhanced precision of the robotic system improves the likelihood of successful outcomes and helps in preserving bladder function.

c. Applications: Robotic-assisted surgery can be used for a variety of bladder cancer procedures, including tumor resection and radical cystectomy. The approach is particularly beneficial for patients who require complex surgical interventions.

4. Photodynamic Therapy (PDT)

Photodynamic Therapy (PDT) is a treatment that uses a photosensitizing agent and light to destroy cancer cells.

A. Photosensitizer Administration: A photosensitizing drug is administered and accumulates in cancerous tissues. When exposed to a specific wavelength of light, the drug activates and produces a form of oxygen that kills the cancer cells.

B. Application: PDT is used for treating superficial bladder tumors and can be combined with other treatments to improve efficacy. It helps to target cancer cells while minimizing damage to surrounding healthy tissue.

Benefits: 

PDT is a minimally invasive treatment that provides a targeted approach to destroy cancer cells. It is particularly useful for patients with superficial tumors or those who have not responded well to other therapies.

5. Neoadjuvant Chemotherapy

Neoadjuvant chemotherapy is administered before surgical intervention to shrink tumors and improve surgical outcomes.

A. Treatment Protocols: At Bumrungrad Hospital, neoadjuvant chemotherapy is used to treat patients with muscle-invasive bladder cancer. The chemotherapy regimen is tailored to each patient based on their specific tumor characteristics and overall health.

B. Goals: The primary goal of neoadjuvant chemotherapy is to reduce the size of the tumor, making it easier to remove surgically. This approach also aims to eliminate micrometastatic disease, potentially improving long-term survival rates.

Benefits: 

By shrinking the tumor prior to surgery, neoadjuvant chemotherapy can increase the likelihood of successful surgical outcomes and reduce the risk of cancer recurrence. It also allows for a more conservative surgical approach, preserving bladder function where possible.

6. Bladder Reconstruction Surgery

Bladder reconstruction surgery is a critical option for patients who have undergone radical cystectomy (removal of the bladder).

A. Orthotopic Neobladder: This procedure involves creating a new bladder from a segment of the intestine. The neobladder is implanted in the pelvic region and connected to the urethra, allowing the patient to urinate normally.

B. Continent Cutaneous Reservoir: Alternatively, a continent cutaneous reservoir is created, which involves constructing a pouch from a segment of the intestine. This pouch is connected to the skin through a stoma, and patients use a catheter to drain urine from the pouch.

Benefits: 

Bladder reconstruction surgery helps to restore urinary function and improve the quality of life for patients who have had their bladder removed. The choice between different reconstruction options is based on individual patient needs and preferences.

Supportive Care and Rehabilitation

Bladder cancer treatment at Bumrungrad Hospital extends beyond the medical interventions. The hospital provides:

• Personalized Rehabilitation Programs: Designed to help patients recover quickly and return to their daily lives with optimal functionality.
• Psychological Support: Counseling and support services to assist patients and their families in coping with the emotional and psychological aspects of cancer treatment.
• Nutritional Guidance: Expert advice on diet and nutrition to support overall health and improve treatment outcomes.

• Access to top doctors in 38+ countries and the largest health travel platform.
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• Post-treatment care and assistance.
• Teleconsultations with leading doctors at $1/minute.
• Over 61K patients served.
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• 24/7 unwavering support, from hospital formalities to travel arrangements or emergencies.

Hear from our satisfied patients

Bumrungrad International Hospital’s commitment to innovation and excellence in bladder cancer treatment is evident through its use of cutting-edge technologies and comprehensive care approaches. By combining advanced diagnostic techniques, innovative treatments, and a multidisciplinary care team, Bumrungrad Hospital provides patients with the highest standard of care and a hopeful path forward in their battle against bladder cancer.