According to the American Cancer Society, statistics showed that bladder cancer took almost 18,000 lives in 2017. Another estimated 80,000 people were awaiting their fate from this disease.
However, if their urine was tested soon enough and the cancer is detected right away in the urinary tract, treatment may work. The cystoscopy procedure is the current gold standard in detection and is pretty much expensive, invasive, iterative, and is not comprehensive to include detection of low-grade bladder cancer or the upper urothelial cancer.
Researchers at John Hopkins University estimated that about 3 billion dollars per year are spent in managing patients with bladder cancers. According to Dr. George J. Netto, senior author and former researcher at The Johns Hopkins University and current chair at the University of Alabama Department of Pathology in Birmingham, "Because urine cytology is relatively insensitive for the detection of recurrence, cystoscopies are performed as often as every three months in such patients in the United States."
The Urinary Tract
Kidneys, the ureters, the bladder, and the urethra are found in the urinary tract. Kidneys are found below the ribs and near the middle back. They look like a pair of beans. The significant roles of the kidneys are the removal of wastes from the blood, production of the erythropoietin hormone (responsible for red blood cells in bone marrow) and balance of the electrolytes in the body.
The urinary bladder is located behind the pubic bone within the pelvis. It is a hollow muscular organ for storage of urine.
Meanwhile, ureters are fibromuscular tubes that are about 16 inches long. The ureter leading to the left kidney is longer than the one leading to the right kidney. They are responsible for transporting urine from the renal pelvis to the bladder. They look like mucosal, fibrous, and muscular layers.
Effective DNA Test
But things may change with UroSEEK, a revolutionary method which is not invasive, cheaper, and efficient in detecting cancer much sooner. John Hopkins University in Baltimore worked on a smart approach — maximize the DNA recovered from the cells found in urine to look for cancers in urinary tracts. The test conducted and published in 3Life revealed that UroSEEK found mutations in 11 genes which could lead to cancer in the bladder and upper urothelial.
UroSEEK is designed to identify cancer cells in at-risk patients and included urine with the blood of smokers. Those who have undergone treatment of bladder cancer were also included in the test. Presence of abnormal chromosomes indicates cancer-associated cancer present in the system.
Today, about one-third of the patients with bladder cancer were detected late with the cancer cells spreading to the surrounding muscles. Even in cases where the detection was made early, tumors did recur. "Bladder cancer has a high rate of recurrence," said David McConkey, Ph.D, director of the Johns Hopkins Greenberg Bladder Cancer Institute. Lifelong examination of the cancer through invasive cytology procedure and biopsy are taking a financial toll to patients.
The cytology procedure involves inserting a cystoscope (hollow tube) equipped with a lens in the urethra and proceeding carefully to the bladder. Better results are achieved when this procedure is combined with UroSEEK for early detection.
The Experiment
The research described the process of experimentation involved. Taiwan was selected as a source of participants because of high urinary-cancer related cases in the country. This was believed to have been caused by medicinal herbs which have high concentrates of aristolochic acids. The acids were proven to be associated with urinary tract and kidney cancers.
About 570 Taiwanese patients at risk of bladder cancer were enrolled. Using UroSEEK method alone, about 83 percent were positive to develop cancer. However, when paired with the cytology procedure, 95 percent of the patients showed positive signs of developing the disease. This combination with UroSEEK proved the increased sensitivity in detection.
"When you combine them, you get better results," said Dr. Nickolas Papadopoulos, a researcher at the Ludwig Center at Johns Hopkins. "Side by side, UroSEEK has better sensitivity. There are some cases when cytology detects when UroSEEK doesn't. Combining them produces the best results."
The research also showed that 75 percent of the 56 patients tested in the upper tract urothelial were positive in the UroSEEK test. This included about 79 percent of patients with noninvasive tumors. When compared to cytology alone, this procedure only revealed 10 percent of patients detected with cancer cells.
Using the UroSEEK increased the sensitivity cytology and when paired, they boosted the detection and management of patients with cancer without the invasive cystoscopy, an endoscopy of the urinary bladder via the urethra. Also, UroSEEK is cost effective for hematuria (blood in the urine) patients which usually tested negative using cytology alone.
Near Future
In the course of the research, possibilities became apparent and resulted in other cancer-gene screen tests for a number of diseases.
Researchers developed and announced PapSEEK, a screening test for endometrial and ovarian cancers. Cervical fluid samples are collected during the routine Pap test. Meanwhile, CancerSEEK is another screen test developed which involve a single blood test to screen eight types of cancer in the body. Today's medical discoveries should be able to detect cancers which are mostly curable. Thus, UroSEEK is a step forward towards that expectation. Researchers are now looking at the possibility of using the cancer-gene approach to cancer screening tests aimed at improving cancer survival.
[researchpaper 리서치페이퍼= Kay Yeban 기자]