James Researchers Turn to Tech to Improve Bladder Cancer Identification

OSUCCC  James Dr Cheryl Lee

Accurately calculating the extent – or stage – of bladder cancer in a patient is vital in determining the treatment options.

If the cancer has spread deep into the four layers of the bladder, then a radical cystectomy (the removal of the bladder) may be the best option. If it is still in the early stages, a less invasive treatment with fewer long-term side effects could be utilized.

“However, we’ve been suffering for decades with inadequate staging of bladder cancer,” said Cheryl Lee, MD, Chair, Department of Urology at The Ohio State University and bladder cancer expert at Ohio State’s Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute (OSUCCC – James).

While current imaging techniques, such as a CAT scan, can determine if bladder cancer is present and the size of the tumor, they can’t “show if the cancer is invading just the superficial muscle, or the deep muscle of the bladder,” Dr. Lee said.

Now, with the help of a Pelotonia Idea Grant, Dr. Lee and her team in the Department of Urology and members of The Ohio State University Department of Biomedical Informatics will utilize digital pathology and advanced computer analytics to better analyze tissue samples from a patient’s bladder cancer to better determine the stage of the cancer.

This is important Dr. Lee said, because a cystectomy can eliminate bladder cancer and save lives, “but, it can also have serious quality of life implications for patients in terms of their urinary, bowel and sexual function.”

Even when Dr. Lee removes a tissue sample from a bladder cancer tumor, it is hard for pathologists to gauge the exact stage of the cancer. “They may not have all the tissue samples they may need,” Dr. Lee said. “And even when they do, it’s still very subjective.”

There will be an estimated 79,030 people in the United States diagnosed with bladder cancer this year, and 16,870 deaths, according to the National Cancer Institute. Patients tend to be older (in their 70s and 80s) Dr. Lee said, and “tend to have other medical issues because of the risk factors for bladder cancer: smoking and chemical exposure – a large number worked in industrial plants and in farming.”

There are three components of bladder cancer staging: T stage, which is the growth of the tumor within the layers of the bladder and nearby tissue or other organs; the N stage, which indicates if the cancer has spread to the lymph nodes near the bladder; and the M stage, which indicates the cancer has metastasized and spread to other lymph nodes and organs further from the bladder, according to the American Cancer Society.

A T1 bladder cancer is the least invasive stage and the stage in which doctors and their patients must decide between a more conservative type of treatment or a radical cystectomy.

“But, if I see 10 patients who are diagnosed with T1 bladder cancer, four or five would actually have cancer deeper in their bladder (or beyond the bladder) and be at a higher and more dangerous stage,” Dr. Lee said. “Conservative treatment won’t work well for more advanced stages. We don’t want to lose an opportunity to cure a patient because we didn’t use the right treatment. That’s why it’s so important to improve our staging of bladder cancer.”

In the Pelotonia Idea Grant research, Dr. Lee; Dr. Metin Gurcan, PhD, Director, Division of Clinical and Translational Informatics; and Dr. Anil Parwani, MD, PhD, MBA, Vice Chair and Director of Anatomic Pathology will utilize the latest advances in digital pathology and computer analytics that use sophisticated algorithms to analyze bladder cancer tissue samples.

“We will begin to recognize and appreciate patterns and redefine the structures we are looking at,” Dr. Lee said. “We’ll create a more expansive definition of stage and attempt to predict who the four or five patients are that we currently diagnose with T1 bladder cancer when they are actually a higher stage.”

Improving diagnostic tools could lead to fewer cystectomies, “because if you can accurately predict those patients with less-aggressive bladder cancer, you’d be more willing to explore less-aggressive treatment options with those patients,” Dr. Lee said. “We want to use the right treatment for the right patient at the right time.”

Working with her patients and their families to make the treatment decisions that lead to the best outcomes is what drives Dr. Lee.

“It’s a privilege to care for a patient,” she said. “If you can make a difference in their lives, and in the lives of their families, well, that’s the driving force for me.”