Patients, experts shed light on bladder cancer in Canada

TORONTO – Jim Van Horne is still fighting the cancer that he was diagnosed with five years ago.

It was in 2008 when the popular former TSN sports anchor was diagnosed. Since then it’s been a vicious cycle of removing tumours, having them return and fighting the cancer again with treatment.

Van Horne worked with TSN for 17 years. He’s turned to multiple rounds of a treatment called BCG, which instills a specific dose of the tuberculosis vaccine into the bladder to reduce recurrence and advancement of tumours.

It hasn’t completely removed the cancer for good, though.

“It’s been hard on me. It’s been hard on my family. I wouldn’t wish this on anybody,” Van Horne told Global News.

“The doctors can’t get rid of it and it makes me angry. I’m not angry at anybody, I’m just angry at the situation. I wish I could get a break,” he said.

Living with and surviving through bladder cancer is a family ordeal that includes patients, their loved ones looking after them, along with doctors.

On Saturday, Canadian families afflicted by the disease, along with experts in the field, are coming together at the annual Toronto Bladder Cancer Patient Conference.

The full-day event only occurs once every two years – it’s meant to provide an opportunity for patients to connect with survivors, their family members and doctors treating the condition.

Prevalence of bladder cancer in Canada

The event is also helping to raise awareness about the lesser-known cancer. But it’s more common than Canadians realize, Dr. Alexandre Zlotta says. Zlotta is director of uro-oncology at Mount Sinai Hospital.

Bladder cancer is the sixth most common cancer among patients in Canada. It’s also the fourth most common among men, although it’s less prevalent in women, according to Bladder Cancer Canada.

Like Van Horne’s predicament, bladder cancer has a recurrence rate of nearly 80 per cent. This is why the disease is the most expensive cancer to treat.

“It accounts, believe it or not, in the U.S., for $4 billion a year. And with the equivalent in Canada, it’s around $400 million, which is enormous,” Zlotta said.

The Canadian Cancer Society’s latest statistics estimate that 7,800 people are diagnosed with the condition each year. Men have a one-in-28 chance of developing the disease; meanwhile women have a one-in-83 probability.

The cancer starts in the cells of the bladder, which is in the lower part of the abdomen.

Zlotta says the cancer is divided into two major categories. The first is when the tumour is limited to superficial layers of the bladder and remains in the organ’s lining. Once the cancer spreads into the muscle walls or even over to other organs, it’s called invasive bladder cancer.

Challenges in detection compared to other cancers

Unlike mammograms, prostate exams, colorectal scans or Pap tests to catch other cancers, major advances haven’t shed light on easier diagnosis and identification for bladder cancer patients.

“With bladder cancer, there hasn’t been anything where a simple test, like a urine test, will be sensitive and specific enough to detect even people who are at high risk early on,” Zlotta said.

Instead, patients may present with symptoms – most commonly bleeding.

The highest risk factor for bladder cancer is smoking – Zlotta said this may be why rates are higher in men than in women.

“I always tell patients it’s a silent killer because they don’t realize that smoking causes bladder cancer. Everyone thinks that smoking causes lung cancer but what they don’t realize is that it can also cause bladder cancer,” Dr. Robert Nam, a surgical oncologist at Sunnybrook Health Centre, said.

Those who have been exposed to chemicals in the workplace, such as dyes or fumes are also more at risk, the CCS says. As life expectancy in Canada also increases, cases of bladder cancer are also steadily climbing, Zlotta said.

New treatments to combat bladder on the rise

Right now, treatment options are limited for bladder cancer patients. There’s surgery to remove the tumour, chemotherapy in which drugs are instilled in the bladder and radiation, for starters.

BCG – or Bacille Calmette-Guerin – helps to downsize the cancer, but it doesn’t necessarily remove it completely.

“Now, new treatments have been on the horizon simply because BCG is not the ultimate weapon. People still recur just by this treatment and there are still a fairly significant number of patients who will have a tumour that will progress despite BCG,” Zlotta said.

The doctors point to EMDA – or electromotive drug administration – as a potential treatment waiting in the wings. In this case, the drug makes its way into the bladder through electronic transfer into the cells and through the bladder wall.

“Theoretically, that would cause more penetration of the drug into the bladder and actually into the tumour cells where it’s most effective,” Nam said.

The method has been used in Europe, but it’s still relatively new to Canada.

It’s intended only for the treatment of superficial tumours or tumours that are on the bladder surface. Deeper tumours that have invaded the bladder wall require surgery.

“It has been demonstrated to be more efficacious than BCG alone, at preventing tumours from coming back and progressing into the bladder wall,” Zlotta explained.

Van Horne is looking into EMDA treatment, but it comes at a hefty $20,000 price tag coming out of his own pocket.

“It’s going to be tight, but I have to do it,” he told Global News.

“I refuse to quit. There is no way I am going to fold my tent and say take me. I’ll take whatever comes.”

carmen.chai@globalnews.ca
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