What Are The Treatment Options For Bladder Cancer
There are four types of treatment for patients with bladder cancer. These include:
Sometimes, combinations of these treatments will be used.
Surgery is a common treatment option for bladder cancer. The type of surgery chosen will depend on the stage of the cancer.
- Transurethral resection of the bladder is used most often for early stage disease . It is done under general or spinal anesthesia. In this procedure, a special telescope called a resectoscope is inserted through the urethra into the bladder. The tumor is then trimmed away with the resectoscope, using a wire loop, and the raw surface of the bladder is then fulgurated .
- Partial cystectomy is the removal of a section of the bladder. At times, it is used for a single tumor that invades the bladder wall in only one region of the bladder. This type of surgery retains most of the bladder. Chemotherapy or radiation therapy is often used in combination. Only a minority of patients will qualify for this bladder-sparing procedure.
- Radical cystectomy is complete removal of the bladder. It is used for more extensive cancers and those that have spread beyond the bladder .
This surgery is often done using a robot, which removes the bladder and any other surrounding organs. In men, this is the prostate and seminal vesicles. In women, the ovaries, uterus and a portion of the vagina may be removed along with the bladder.
Symptoms In Men And Women
Women are more likely to mistake bladder cancer symptoms for urinary tract infections or menstruation.
Rarely, bladder cancer may also be misdiagnosed as interstitial cystitis in women. IC is a painful, inflammatory bladder condition that affects more women than men.
In one study, doctors found bladder cancer in about one percent out of 600 patients referred to them for IC treatment, according to an article in Urology Times.
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Trimodal Therapy For Stage Ii Or Iii
A select group of people with Stage II or III bladder cancer may be able to be treated with trimodal therapy. This involves 3 modes of treatment:
- TURBT Your doctor will insert a scope into your bladder and use a wire loop to remove the tumor.
- Radiation Given after surgery, daily, for 4 to 6 weeks. Some patients may receive a radiosensitizer. This is a chemotherapy drug that helps make the radiation more effective.
- Systemic Chemotherapy May be given before the TURBT to shrink the tumor.
Trimodal therapy may cause common chemo and radiation side effects. Patients may also have problems with bladder, bowel, and sexual function.
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When Metastatic Cancer Can No Longer Be Controlled
If you have been told your cancer can no longer be controlled, you and your loved ones may want to discuss end-of-life care. Whether or not you choose to continue treatment to shrink the cancer or control its growth, you can always receive palliative care to control the symptoms of cancer and the side effects of treatment. Information on coping with and planning for end-of-life care is available in the Advanced Cancer section of this site.
Prognosis Of Patients With Muscle Invasive Bladder Cancer Who Are Intolerable To Receive Any Anti
Muscle invasive bladder tumor has a high propensity for rapid growth and distant metastasis.
The aim of this retrospective study was to evaluate the prognosis of patients who had been diagnosed with muscle invasive bladder cancer and did not receive anti-cancer treatment because of their physical characteristics.
We evaluated 26 patients. Median overall survival was 12 months.
These results may assist in counseling older patients with MIBC if the disease is left untreated.
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Immunotherapy In The Neoadjuvant Setting
A phase II trial of neoadjuvant atezolizumab administration based on 1,200 mg for one, two, and three doses before cystectomy will give significant information regarding the effects of and requirement for multiple CPI applications . In this multi-dose portion trial, patients with adverse pathology at the time of cystectomy and no metastatic disease will be permitted to receive adjuvant atezolizumab for up to 16 cumulative doses. For NACT-ineligible patients, but fit to undergo surgical resection of their cancer by cystectomy, a combination phase II trial is underway comprising two nivolumab cycles, an antibody targeting PD-1 to reactivate T cells, plus urelumab, an CD137-agonistic antibody with additional activating properties, will be compared to two cycles of nivolumab alone . In addition, a pilot presurgical study will evaluate durvalumab and tremelimumab safety for this, 28 patients are enrolled. This will determine if this is an effective and safe neoadjuvant therapy for MIBC patients who are not eligible for cisplatin-based therapy .
Treatment Options For Recurrent Bladder Cancer
Treatment options for patients with recurrent bladder cancer include the following:
Palliative radiation therapy should be considered for patients with symptomatic tumors.
Recurrent or progressive disease in distant sites or after definitive local therapy has an extremely poor prognosis, and clinical trials should be considered whenever possible.
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How Does Recurrence Of Bladder Cancer Affect Survival Rate
Recurrent bladder cancer is cancer that has returned after initial treatment. Recurrence rates for bladder cancer depend on the stage of the original tumor, with 5-year recurrence rates of approximately 65% in patients with non-invasive or in situ tumors and 73% in patients with slightly more advanced disease at first diagnosis.16
Many patients with non-invasive bladder cancer have recurrences that are typically not life threatening however, the prognosis is generally worse if the disease has spread into deeper layers of the bladder wall or beyond to the lymph nodes or other organs.
What Are The Risk Factors For Bladder Cancer
Some factors increase the risk of bladder cancer:
- Cigarette smoking is the biggest risk factor it more than doubles the risk. Pipe and cigar smoking and exposure to second-hand smoking may also increase one’s risk.
- Prior radiation exposure is the next most common risk factor .
- Certain chemotherapy drugs also increase the risk of bladder cancer.
- Environmental exposures increase the risk of bladder cancer. People who work with chemicals, such as aromatic amines are at risk. Extensive exposure to rubber, leather, some textiles, paint, and hairdressing supplies, typically related to occupational exposure, also appears to increase the risk.
- Infection with a parasite known as Schistosoma haematobium, which is more common in developing countries and the Middle East.
- People who have frequent infections of the bladder, bladder stones, or other diseases of the urinary tract, or who have chronic need for a catheter in the bladder, may be at higher risk of squamous cell carcinoma.
- Patients with a previous bladder cancer are at increased risk to form new or recurrent bladder tumors.
Other risk factors include diets high in fried meats and animal fats, and older age. In addition, men have a three-fold higher risk than women.
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Relationship Between Basal Type And Prognosis
In the case of CK5/6+ and GATA3- samples, more than 1% CK5/6 expression and GATA3- expression was significantly negatively correlated with OS . In the case of CK5/6+ and FOXA1- samples, more than 1% CK5/6+ expression and FOXA1 expression was significantly negatively correlated with OS and CSS . In the case of CK14+ and GATA3-samples and CK14+ and FOXA1- samples were not significantly correlated with OS, CSS and RFS.
Oncologic outcomes according to ck5/6 and gata3 and ck5/6 and foxa1 in immunochemical staining. a Overall survival, b Cancer specific survival, c Recurrence free survival
Causes And Risk Factors
Researchers dont know exactly what causes bladder cancer, but they do know what increases the risk of getting it. These risk factors range from family history to certain types of medication.
Data published in 2021 on MedRxiv by researchers from the online pharmacy Valisure and Memorial Sloan Kettering Cancer Center showed patients who took Zantac had elevated diagnosis rates of bladder, breast, prostate and thyroid cancer.
Patients should keep in mind that this data suggests a link between ranitidine and increased risk, but it doesnt prove that all people who take ranitidine will get bladder cancer.
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Comorbidity Scales Anaesthetic Risk Classification Andgeriatric Assessment
A range of comorbidity scales has been developed , seven of which have been validated . The Charlson Comorbidity Index ranges from 0 to30 according to the importance of comorbidity described at four levels and is calculated byhealthcare practitioners based on patients medical records. The score has been widelystudied in patients with BC and found to be an independent prognostic factor forperi-operative mortality , overallmortality , and CSM . Only the age-adjusted version of the CCI wascorrelated with both cancer-specific and other-cause mortality . The age-adjusted CCI is the most widely usedcomorbidity index in cancer for estimating long-term survival and is easily calculated .
Health assessment of oncology patients must be supplemented by measuringtheir activity level. Extermann et al. have shown thatthere is no correlation between morbidity and competitive activity level . The Eastern Cooperative Oncology Group performancestatus scores and Karnofsky index have been validated to measure patient activity . Performance score is correlated with patient OS after RC and palliative chemotherapy .
Table 5.2: Calculation of the Charlson Comorbidity Index
Number of points
Both patient and tumour characteristics guide treatment decisions andprognosis of patients with MIBC.
Appendix A: Search Strategy
Primary Search Strategy for Emerging Approaches to Diagnosis and Treatment of Non-Muscle-Invasive Bladder Cancer and Treatment of Non-metastatic Muscle-invasive Bladder Cancer
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Prognosis And Survival Rates For Bladder Cancer
When someone is diagnosed with bladder cancer, their doctor will give them a prognosis. A prognosis is the doctors opinion of how likely the cancer will spread and the chances of getting better. A prognosis depends on the type and stage of cancer, as well as the persons age and general health.
Bladder cancer can usually be effectively treated if it is found before it spreads outside the bladder.
If you have bladder cancer, your doctor will talk to you about your individual situation when working out your prognosis. Every persons experience is different, and there is support available to you.
What To Do Before And After Treatment
Talk with your doctors about whether you need to do anything to prepare for treatment and help your recovery. Some things they may suggest are:
Stop smoking If you smoke, aim to quit before starting treatment. If you keep smoking, you may not respond as well to treatment and you may have more treatment-related side effects. Continuing to smoke also increases your risk of cancer returning. For support, see your doctor, call Quitline 13 7848 or visit iCanQuit.
Begin or continue an exercise program Exercise will help build up your strength for treatment and recovery. It can also help you deal with side effects of treatment. Talk to your doctor, exercise physiologist or physiotherapist about the right type of exercise for you.
Improve your diet Aim to eat a balanced diet with a variety of fruit, vegetables, wholegrains and protein. Eating well can improve your strength and you may respond better to treatment.
See a physiotherapist They can teach you exercises to strengthen your pelvic floor muscles, which help control how your bladder and bowel work. These exercises are useful if you have a neobladder, a partial cystectomy or radiation therapy.
When deciding on treatment for muscle-invasive bladder cancer, you may want to discuss your options with a urologist, radiation oncologist and medical oncologist. Ask your GP for referrals.
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How Does Bladder Cancer Develop And Spread
The bladder wall has many layers, made up of different types of cells. Most bladder cancers start in the urothelium or transitional epithelium. This is the inside lining of the bladder. Transitional cell carcinoma is cancer that forms in the cells of the urothelium.
Bladder cancer gets worse when it grows into or through other layers of the bladder wall. Over time, the cancer may grow outside the bladder into tissues close by. Bladder cancer may spread to lymph nodes nearby and others farther away. The cancer may reach the bones, the lungs, or the liver and other parts of the body.
Small Cell Carcinoma Of The Bladder
This aggressive form of the disease begins in small nerve-like cells in the bladder called neuroendocrine cells. Small cell carcinoma makes up about 1 percent of bladder cancers. It is often detected at an advanced stage, after it has spread to other parts of the body. It usually requires a combination of treatments, including chemotherapy, surgery, and radiation therapy.
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Cellular Classification Of Bladder Cancer
More than 90% of bladder cancers are transitional cell carcinomas derived from the uroepithelium. About 2% to 7% are squamous cell carcinomas, and 2% are adenocarcinomas. Adenocarcinomas may be of urachal origin or nonurachal origin the latter type is generally thought to arise from metaplasia of chronically irritated transitional epithelium. Small cell carcinomas also may develop in the bladder. Sarcomas of the bladder are very rare.
Pathologic grade of transitional cell carcinomas, which is based on cellular atypia, nuclear abnormalities, and the number of mitotic figures, is of great prognostic importance.
Design Setting And Participants
LncRNAs were quantified from RNA-seq data from a HGT1 bladder cancer cohort that was enriched for primary micropapillary cases . Unsupervised consensus clustering of variant lncRNAs identified a three-cluster solution, which was further characterised using a panel of micropapillary-associated biomarkers, molecular subtypes, gene signatures, and survival analysis. A single-sample genomic signature was trained using lasso-penalized logistic regression to classify micropapillary-like gene-expression, as characterised by lncRNA clustering. The genomic classifier was tested on luminal tumors derived from the TCGA cohort .
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Factors Influencing Survival Rates
The variability in survival rates highlights one key reality about stage 4 lung cancer: no two people have the same disease. Arguably more than any other stage of the disease, stage 4 lung cancer survival is influenced by multiple factors, some of which are fixed and others of which can be changed .
There are seven factors known to influence survival times in people with stage 4 NSCLC.
Stage 2 Bladder Cancer
A diagnosis of stage 2 bladder cancer means that the bladder cancer cells have grown into the muscle layer of the bladder wall.1,2 This is also called muscle-invasive bladder cancer. Stage 2 bladder cancer includes the following combined TNM stages:
In both of those types of stage 2 bladder cancer, the cancer cells have not grown into the nearby lymph nodes and they have not spread to other parts of the body. The muscle portion of the bladder wall has two layers. The inner half, closest to the bladder lining, is called the superficial muscle. The outer half is also called the deep muscle of the bladder. If the tumor is type T2a, it means that the cancer cells have spread into the superficial muscle, but not into the deep muscle. If the tumor is type T2b, the bladder cancer cells have grown through the superficial muscle and into the deep muscle of the bladder. However, the cancer cells have not yet spread into the layer of fatty tissue that surrounds the outer part of the bladder muscle.
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