New technology improves surgery for bladder cancer

Matt Rutherford has always been interested in new and upcoming technology, so when given the option of having Cysview® blue-light cystoscopy used in a surgery to remove a tumour in the lining of his bladder, he didn’t hesitate.

“I really want to extend my life as long as I can, and so if there is an extra technology out there, I’m all for it,” says Matt, 56.

Cysview® blue-light cystoscopy is an innovative procedure designed to help surgical teams in transurethral resections (removal) of bladder tumours. For this procedure, a special imaging solution or liquid — Cysview® — is instilled into the bladder and absorbed by any abnormal growths in the surface layers. The surgeon examines the bladder tissue using both white and blue light. Working with the Cysview® solution, the blue light illuminates tumours in pink, making them easier for the surgeon to identify and remove.

Matt had previously undergone three surgeries for bladder tumours under white light before undergoing surgery using the Cysview® technology at the Misericordia Community Hospital earlier this year. While the tumour removed in his first surgery was benign, the recurring tumours were cancerous.

The usual process is to perform the surgery using only white light, which can mean missing some of the cancer, says Dr. Adrian Fairey, the urologist at the Misericordia who used the Cysview® system in Matt’s recent surgery.

Using blue light leads to a “more complete resection,” Adrian says. “It (allows) visualization of cancers that would otherwise not be visible with the older white light technology.”

While the Cysview® blue-light technology has been available elsewhere in Canada and in other countries for several years, the Misericordia is the first hospital in Alberta to use it. Thanks to more than $62,000 provided by the Covenant Foundation, the hospital’s urology department was able to purchase the equipment for the system.

“We’re tremendously grateful to our donors, whose generosity is enabling us to advance cancer treatment ― and ultimately improve outcomes ― for patients at the Misericordia,” says Lisa Munro, president and chief executive officer of the Covenant Foundation. “Funds for this leading-edge technology came from ticket sales for our Covenant Foundation Lottery, which gives ticket buyers a chance to win big for themselves and their hospitals.”

Adrian and his colleagues began integrating the new Cysview® technology into their program for bladder cancer patients in the summer of 2022. The program currently includes three surgeons using the technology in surgeries for four patients a day, six days a month. To be eligible for the procedure, the patients must have high-risk non-muscle invasive bladder cancer, meaning their cancer hasn’t spread deep into the muscle wall of the bladder but remains on the surface layers.

Implementing the new system has required some changes to processes, says Annette Fayant, a registered nurse who prepares patients for surgery in the day ward. For one, it has meant adjusting the timing for presurgery care. Patients come into the day ward earlier to allow time for instillation of the Cysview® solution, which it is recommended they hold in their bladder for at least one hour before surgery. “We have to make sure patients get the medication on time so they get the maximum outcomes,” says Annette.

The outcomes of using this innovative procedure can give patients peace of mind about their condition, says Munira Visram, charge nurse for the urology department. Because the technology can help reveal better margins (the healthy areas around a tumour), the surgeon can take more tissue to ensure that none of the cancer is left behind.

“Knowing that this system was used in their surgery can give patients the peace of mind that we got everything. And getting everything is our goal in medicine,” says Munira.

In Matt’s case, Adrian and the surgical team were able to see and remove a tumour that tested positive for cancer. Matt is now receiving follow-up treatment at the Cross Cancer Institute. He is hopeful that use of the Cysview® blue-light technology in his most recent surgery will lead to better outcomes for his treatment. “If they were able to see everywhere it was happening, that would have given them a better handle on it,” he says.

Research has shown that controlling cancer recurrence is another potential benefit of using the technology. “The data from big clinical trials suggests that this (technology) can help reduce recurrence risk because we’re more thoroughly resecting all the tumours and we’re not missing some of the ones that we can’t otherwise see with the normal white light,” says Adrian.

Along with reducing the chances of cancer returning, the procedure may also benefit patients by reducing the number of surgeries needed to manage their disease, says Adrian. “If we’re doing a more complete resection and getting more of the tumours out, there’s going to be less of a need for repeated surgeries.”

And considering the long waiting lists for cancer surgery in Alberta, a decreased need for surgeries also benefits the healthcare system, says Adrian.

Looking ahead, the Misericordia urology department hopes to expand the Cysview® blue-light cystoscopy program to include more patients. “We’re looking into the future … striving to achieve excellence for patients,” says Munira. “Ultimately, it comes down to patient care.”

For his part, Matt would encourage other patients to take advantage of the Cysview® blue-light system.

“Don’t be scared of the new technology,” he says. “It’s better to embrace it than to shy away from it.”