Bladder Reconstructions And Stomas
If you have had your bladder removed, the way you pass urine will change. There are several options that your treatment team will talk to you about:
- Urostomy is where doctors create a new hole in your abdomen called a stoma. Urine drains from the stoma to the outside of your abdomen into a special bag.
- Neobladder is where a new bladder made from your small bowel forms a pouch inside your body to store urine. You will pass urine by squeezing your abdominal muscles. You will also pass a small tube into the neobladder each day to help drain the urine.
- Continent urinary diversion is a pouch made from your small bowel inside your body to store urine. The urine empties through a hole called a stoma to the outside of your abdomen into a special bag.
A bladder reconstruction is a big change in your life. You can speak with a continence or stomal therapy nurse for help, support and information. You can also call Cancer Council (. You may be able to speak with a trained Cancer Council volunteer who has had cancer for tips and support. If you find it difficult to adjust after your bladder reconstruction, it may help to be referred to a psychologist or counsellor.
Note: If you have a stoma, you can join a stoma association for support and free supplies. For more information about stoma associations, visit the Australian Council of Stoma Associations.
Molecular Biomarkers In Bladder Preservation Therapy
Clinicopathological factors play an important role in predicting better therapeutic outcomes post CRT-based BPT. However, these clinicopathological factors are insufficient to predict CRT response and outcomes after bladder preservation. Therefore, molecular biomarkers that can predict precise therapeutic outcomes are strongly warranted. Recent understanding of the molecular and genomic characteristics of bladder cancer has led to the identification of different molecular biomarkers of MIBC. In this chapter, we will discuss the possible prognostic or predictive biomarkers of BPT in MIBC patients.
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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Side Effects Of Chemotherapy
Chemo drugs attack cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body, such as those in the bone marrow , the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells are also likely to be affected by chemo, which can lead to side effects.
The side effects of chemo depend on the type and dose of drugs given and how long they are taken. When chemo and radiation are given at the same time, side effects tend to be worse. Common side effects of chemo include:
- Nausea and vomiting
- Increased risk of infections
- Easy bleeding or bruising, even after minor cuts or injuries
These side effects usually go away over time after treatment ends. There are often ways to lessen these side effects, some can even be prevented. For instance, drugs can be used to help prevent or reduce nausea and vomiting. Ask your health care team about the side effects your chemo drugs may cause and what can be done to prevent and/or treat them.
Some chemo drugs can cause other, less common side effects. For example, drugs like cisplatin, docetaxel, and paclitaxel can damage nerves. This can sometimes lead to symptoms such as pain, burning or tingling, sensitivity to cold or heat, or weakness. This is called peripheral neuropathy.
Chemotherapy In Palliative Care
Many patients with bladder cancer present with distant metastases at diagnosis or develop metastatic disease during the course of their illness. The survival time for patients with untreated metastatic bladder cancer is usually less than 6 months, and a variety of disabling symptoms can develop during this interval that disrupt quality of life.180,181 Chemotherapy may be effective in ameliorating these symptoms.
Other regimens comprising active agents with nonoverlapping toxic effects are being investigated with the aim of enhancing the therapeutic ratio. They include combinations of cisplatin with gemcitabine or paclitaxel.181 An update of a large international randomized study that compared M-VAC with gemcitabine plus cisplatin for patients with metastatic bladder cancer186,187 revealed no differences in response rate, survival rate, or quality of life between the treatment groups. However, gemcitabine plus cisplatin was significantly less toxic more patients completed the full course of treatment, fewer had significant neutropenia or sepsis, and the rate of death from side effects was lower. These findings have led to gemcitabine plus cisplatin becoming the standard of care for patients with metastatic bladder cancer.181
Bin S. Teh MD, … Arnold C. Paulino MD, in, 2008
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What Impacts The Bladder Cancer Survival Rate
Survival rates depend on many factors, including the type and stage of bladder cancer that is diagnosed. According to the ACS, the five-year survival rate of people with bladder cancer that has not spread beyond the inner layer of the bladder wall is 96%. This is called non-muscle invasive bladder cancer . More than half of people are diagnosed at this stage.
If a tumor is invasive but has not yet spread outside the bladder, the five-year survival rate is 69%. Approximately 33% of bladders cancers are diagnosed at this stage. If the cancer extends through the bladder to the surrounding tissue or has spread to nearby lymph nodes or organs, the five-year survival rate is 37%. If the cancer has spread to distant parts of the body, the five-year survival rate is 6%. About 4% of people are diagnosed at this stage.
It is important to remember that statistics about the five-year survival rates for people with bladder cancer are estimates only and come from annual data based on the number of people with this cancer. A number of new and promising bladder cancer treatments that have been approved by the Food and Drug Administration in the last five years might not be reflected in a five-year survival rate statistic.
Just like no single treatment is appropriate for all bladder cancer patients, there is not one statistic that applies to everyone either. Talk with your doctor about your own individual situation to gain the best understanding you can.
What Can I Expect Following Treatment
You may be advised to drink plenty of fluid to flush the rest of the medication from your bladder.
For six hours after each treatment, youll have to be very careful when you urinate to avoid transmitting BCG to others. Men should urinate while seated to avoid splashing.
Disinfect the urine by adding 2 cups of bleach into the toilet. Let it stand for about 20 minutes before flushing. You should also wash your genital area very carefully after you urinate, so your skin doesnt become irritated from the BCG. Wash your hands thoroughly, too.
Men can pass BCG to their partner during sex. For that reason, you should avoid sex for 48 hours after each treatment. Use a condom between treatments and for six weeks following your final treatment.
Women should avoid getting pregnant or breastfeeding while on BCG therapy.
Treatment is usually given every week for six weeks. After that, you might need to do it once a month for six months to a year.
One benefit of BCG is that while it affects the cells in your bladder, it doesnt have a major effect on any other part of your body. But there can be a few side effects such as:
When comparing BCG to other bladder cancer treatments, its important to remember that treatment isnt the same for everybody. Some of the factors that determine your options are:
- type of bladder cancer
- your age and general health
- how well you tolerate certain treatments
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What Are The 5
In 2020, approximately 17,980 deaths in the United States are predicted to be attributed to bladder cancer1. This represents the eighth most common cause of cancer deaths in men.
The general 5-year survival rate for people with bladder cancer is 77%, while the 10-year survival rate is 70% and the 15-year survival rate is 65%1. Notably, as each patient and cancer are different, it is not possible to definitely know the disease course for an individual patient.
Survival Rates For Bladder Cancer
Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain amount of time after they were diagnosed. They cant tell you how long you will live, but they may help give you a better understanding of how likely it is that your treatment will be successful.
Keep in mind that survival rates are estimates and are often based on previous outcomes of large numbers of people who had a specific cancer, but they cant predict what will happen in any particular persons case. These statistics can be confusing and may lead you to have more questions. Your doctor is familiar with your situation ask how these numbers may apply to you.
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Stage Information For Bladder Cancer
The clinical staging of carcinoma of the bladder is determined by the depth of invasion of the bladder wall by the tumor. This determination requires a cystoscopic examination that includes a biopsy and examination under anesthesia to assess the following:
- Size and mobility of palpable masses.
- Degree of induration of the bladder wall.
- Presence of extravesical extension or invasion of adjacent organs.
Clinical staging, even when computed tomographic and/or magnetic resonance imaging scans and other imaging modalities are used, often underestimates the extent of tumor, particularly in cancers that are less differentiated and more deeply invasive. CT imaging is the standard staging modality. A clinical benefit from obtaining MRI or positron emission tomography scans instead of CT imaging has not been demonstrated.
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How Do You Prevent Bladder Cancer
Unfortunately, there is no one way to prevent bladder cancer. Some things like age, race, gender and genetics or family history cant be controlled. However, people can take steps to reduce their risk.
Tips for bladder cancer prevention include:
- Quit or dont start smoking
- Limit chemical exposure on the job
- Drink plenty of fluids, especially water
- Eat a diet high in fruits and vegetables
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How Is Bladder Cancer Diagnosed
Several different diagnostic tests and procedures may be used to detect bladder cancer, often in combination. They are selected based on a patients symptoms and risk factors and may include:
- Urinalysis: a quick test used to detect blood and other substances in urine.
- Urine cytology: urine is examined microscopically to see if cancer cells are present.
- Genomic urine tests: non-invasive molecular tests, such as Cxbladder, which measure gene expression to detect or rule out bladder cancer.
- Cystoscopy: a thin, flexible tube with a light and camera is inserted into the bladder through the urethra. If an abnormal area is seen, a small sample of tissue is usually collected for laboratory examination.
- Imaging: several types of imaging test can be used to visualize the inside of the body, such as ultrasound, CT scan, MRI scan, and x-ray.
Chemotherapy For Metastatic Disease
Historically, MVAC had been considered the standard therapy for treating advanced bladder-cancer patients. The efficacy of MVAC was first reported in 1989 when Sternberg and colleagues treated 121 patients with advanced urothelial tract cancers and demonstrated a 72% response rate.232 MVAC was subsequently compared with single-agent cisplatin and shown to be superior in terms of response rate and overall survival in patients with advanced bladder cancer.233 MVAC has also been compared with the previously used multiagent regimen CISCA: 110 patients were randomized to either MVAC or CISCA. MVAC was found to have both a higher objective response rate and a longer median survival.234 Despite superior outcome with MVAC, significant limitations include its severe toxicity . In addition, despite high objective response rates, only a very small percentage of patients with metastatic bladder cancer have long-term disease-free survival .233
Taxanes have significant activity in advanced transitional carcinoma. Paclitaxel has been tested in combination with gemcitabine and cisplatin and demonstrated significant activity in phase II testing.236 Phase III evaluation of the triplet regimen compared with GC alone has been reported in abstract form, and suggests that there is no significant improvement with the addition of a third agent to GC chemotherapy.237
Andrew V. Schally, … Norman L. Block, in, 2013
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When Do Doctors Use Bcg
Doctors most commonly use BCG to treat superficial bladder cancer. The vaccine stimulates the immune system to attack cancer cells in the bladder. It can be used with intravesical chemotherapy for advanced stages of bladder cancer.
It is not recommended for those who have weakened immune systems. While BCG treatment for bladder cancer can be effective, it is not a cure. It can help prevent cancer from recurring.
Can Cystectomy Be Avoided In Muscle
The answer is yes for many patients. Radical cystectomy is a major operation and requires diversion of the urinary stream, which has life-altering implications. Identification of patients that can have their cancer eradicated with transurethral resection plus systemic therapy alone and avoid cystectomy is a priority. Transurethral resection of bladder tumor plus systemic therapy has been known for decades to achieve durable bladder-intact survival in a subset of patients. Research presented at the 2021 America Society of Clinical Oncology Annual Meeting defined an approach using Gemzar , cisplatin chemotherapy combined with Opdivo immunotherapy designed to preserve the bladder in as many patients as possible.
Researchers initially treated patients with with 4 cycles of Gemzar, cisplatin, plus Opdivo immunotherapy followed by clinical re-staging to determine next steps. Re-staging was comprehensive and included urine cytology, MRI/CT of the bladder, cystoscopy, and bladder/prostatic urethral biopsies. Patients achieving a clinical complete response were eligible to proceed without cystectomy and receive Opdivo every 2 weeks and close surveillance otherwise, patients underwent cystectomy. If local recurrence occurred patients proceeded to cystectomy. This approach allowed a majority of patients with MIBC to avoid cystectomy.10
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Cystoscopy With Cautery Destruction Of The Bladder Tumor
Cystoscopy is an outpatient procedure during which a thin, lighted tube with a camera is passed through the urethra into the bladder, allowing your doctor to see the inside of the bladder.
Most modern cystoscopes are also equipped with channels that permit small instruments to be passed into the bladder. During a cystoscopy, your doctor may use these instruments to remove tissue, stop bleeding with a special electrical device called an electrocautery or even perform laser treatment. If the bladder cancer tumor is small enough, this cautery may be used to remove the cancer.
Dna Repair Gene Alteration
MIBCs are characterized by a complex genomic landscape, such as high mutation burden, frequent copy number alteration, and chromosomal translocations . These genomic instabilities are caused in part by alterations in the DNA repair pathway, which could also affect patients sensitivity to CRT-based treatments . Therefore, factors or genes involved in the DNA repair pathway have been investigated as potential biomarkers to predict outcomes in MIBC patients.
Ionizing radiation causes DNA double-strand breaks and consequently induces cell death. Double-strand break is detected by meiotic recombination 11 -RAD50-NBS1 complex which activate the DNA double-strand break repair pathway . Additionally, platinum agents produce DNA intrastrand adducts, which could be repaired by the nucleotide excision repair pathway, a highly conserved DNA repair mechanism. Excision repair cross-complementing group 1 is one of the key players in the nucleotide excision repair pathway .
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Is Combination Chemotherapy And Radiation Used For Bladder Cancer Treatment
In recent years, chemotherapy and radiation have been combined to provide a bladder preservation therapy for higher risk cases. In the past radiation therapy alone was used because it effectively shrunk tumors. Bladder cancer tumor cells are chemosensitive, susceptible to the cell-killing effects of anticancer drugs. Adding combined chemotherapy to radiation has improved results. To ensure the success of bladder preservation therapy, there are at least three requirements which should be met: 1) complete resection of the tumor by TURBT 2) no obstruction of 1 or both kidneys as a result of the bladder tumor and 3) no T4 bladder tumors.
If the tumors do not respond to an initial course of chemotherapy and radiation, it may be reasonable to perform, if medically possible, a cystectomy.
Information and services provided by the Bladder Cancer Advocacy Network are for informational purposes only. The information and services are not intended to be substitutes for professional medical advice, diagnosis, or treatment. If you are ill or suspect that you are ill, seek professional medical attention immediately! BCAN does not recommend or endorse any specific physicians, treatments, procedures, or products even though they may be mentioned on this site.
Risk Factors For Bladder Cancer
There are some things that can make you more likely to develop bladder cancer. These are called risk factors and they include:
- smoking chemicals in cigarettes can cause bladder cancer, so if you smoke, your risk is up to 3 times that of a non-smoker
- age most people with bladder cancer are over 60 years of age
- being male men are around 3 times more likely than women to develop bladder cancer
- chemicals being in contact with certain chemicals for a long period of time, like aromatic amines, benzene products and aniline dyes, which have been linked to bladder cancer
- chronic infections frequent infections of the bladder over a long period of time
- previous cancer treatments some types of radiation therapy around the pelvis, and the chemotherapy drug cyclophosphamide
- family history a first degree relative with bladder cancer increases risk up to nearly 2 times higher than the general population.
Having these risk factors doesnt mean you will develop bladder cancer. Often there is no clear reason for getting bladder cancer. If you are worried about your risk factors, ask your doctor for advice.
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