Future Directions And Research Priorities
Elderly adults with bladder cancer are faced with difficult choices with regard to the optimum management of their condition. Health-care providers need to consider the unique needs of older patients with bladder cancer. When facing any potentially catastrophic illness, issues related to functional independence and quality of life must be considered, as these factors may assume an importance equal to or even greater than that of survival. Many studies fail to include clinical outcome measures that are truly meaningful for older adults therefore, these studies are not able to appreciate the tremendous variability between individuals as they age. As the earlier discussion indicates, aging represents a very large risk factor for the development of bladder cancer, and may also increase the likelihood of muscle-invasive disease. Nevertheless, based on the available evidence, comorbidity, functional status and frailty may represent far better predictors of undesirable outcomes than chronological age alone. With these considerations in mind, future studies of elderly patients will need to incorporate these other dimensions of health status, as is normally done in the context of a geriatric assessment.37 Clinical domains that should be assessed include function, objective measures of physical performance, comorbidity, nutrition, social support, cognition and depression.
Blood In Urine May Be Interpreted Differently In Men Vs Women
While the symptoms may be similar for both genders, how they are interpreted can be different. In women, blood in the urine may be overlooked as a possible sign of bladder cancer, since it has a far less serious explanation for most people. Blood in the urine may be assumed to be a urinary tract infection or confused with postmenopausal uterine bleeding.
Symptoms of bladder cancer can be very similar to those of urinary tract infections, which are common in women, says Memorial Sloan Kettering Cancer Center medical oncologist and genitourinary cancer specialist Emily Feld. If blood in the urine is being attributed to a urinary tract infection, it is important to check a urine culture to confirm you actually have an infection. If the culture is negative and/or your symptoms persist despite treatment with antibiotics, you should have a urologist evaluate you. Hematuria, even when it is painless, is not something to ignore.
Symptoms Of Bladder Cancer In Women
i have been to the doctors 4 times in as many weeks with blood in my urine. The doctor prescribed a course of antibiotics which didnt work so prescribed another which also didnt work. Results from the urine samples stated no infection in any of the samples so took the antibiotics unnecessarily. So the doc sent me to radiology to see whether I had kidney stones. The result were I didnt have kidney stones either. Week 4 all samples of urine have blood in them no infection and no kidney stones. Now bladder cancer has been mentioned and Im back at hospital next week for further tests. Has anyone out there had similar or knows someone with similar results. Any feed back would be much appreciated. Thank you.
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Tests For Bladder Cancer
Your doctor may do some tests to check for bladder cancer:
- urine tests your urine will be checked for signs of bladder cancer
- blood tests to check your general health
- ultrasound a scan on the outside of your abdomen to check for cancer
- cystoscopy the doctor puts a small camera into your bladder to see inside
- biopsy the doctor takes a small sample of the cells from the bladder to check for signs of cancer.
Your doctor might ask you to have further tests. These can include:
- CT scan and x-rays scans that take pictures of the inside of the body, sometimes also called a CT-IVP or a triple phase abdominal-pelvic CT scan
- MRI scan a scan that uses magnetism and radio waves to take pictures of the inside of the body
- bone scan a scan that uses dye to show changes in your bones
- FDG-PET scan a scan that uses an injection of liquid to show cancer cells.
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Is Bladder Cancer A Fatal Illness
Left untreated, bladder cancer may spread to other parts of your body. Cancer thats metastasized, or spread, may affect how long youll live with bladder cancer. Like many types of cancer, early detection and treatment increase the chance of living longer with bladder cancer. According to the National Cancer Institute, 96% of people who received treatment for early-stage cancer were alive five years after diagnosis. Overall, 77% of people with bladder cancer were alive five years after diagnosis.
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How To Optimally Manage Elderly Bladder Cancer Patients
Francesco Soria1,2, Marco Moschini1,3, Stephan Korn1, Shahrokh F. Shariat1,4,5
1Department of Urology, Medical University of Vienna, Vienna, Austria 2Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, 10126 Turin, Italy 3Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy 4Department of Urology, University of Texas Southwestern Medical Center, Dallas, USA 5Department of Urology, Weill Cornell Medical College, New York, USA
Contributions: Conception and design: F Soria, SF Shariat Administrative support: None Provision of study materials or patients: All authors Collection and assembly of data: All authors Data analysis and interpretation: F Soria, SF Shariat Manuscript writing: All authors Final approval of manuscript: All authors.
Correspondence to:
Keywords: Bladder cancer old elderly geriatric patients radical cystectomy chemotherapy
Submitted Mar 04, 2016. Accepted for publication Mar 22, 2016.
doi: 10.21037/tau.2016.04.08
Optimizing Radical Cystectomy Outcomes In Elderly Patients
As previously mentioned, the morbidity associated with RC is high and potentially worse for elderly patients. A prolonged postoperative ileus is the most common complication following RC . Although, there is no standardized definition for PPOI and the pathophysiology contributing to this process is rather complex, several attempts have been made at decreasing the incidence of PPOI, ranging from pharmacologic agents to gum chewing . PPOI has previously been shown to be a common cause of a prolonged length of hospital stay following RC. When we evaluated our RC experience of 330 consecutive patients for perioperative risk factors associated with a prolonged LOS 12 days, only older age and female gender were statistical significant on multivariate analysis . Those with a prolonged LOS had significantly similar cancer specific outcomes but worse overall survival .
Another important consideration in the elderly is the rate of delirium following RC. It has recently been shown to be 29 % following RC in patients older than 65 years . Delirium is associated with an increased risk of morbidity and mortality after many surgical procedures . Unfortunately, it is often under detected by health care providers. Evidence suggests that the involvement of geriatricians with in-patient care after surgery may decrease the risk of postoperative delirium .
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Getting To The Root Cause
The first laboratory test you have is likely a dipstick on your urine to look for RBCs. It may need to be repeated if you are menstruating. Thats because menstrual blood in your urine sample could give a false-positive dipstick result. To check your kidney health, you may have a blood test.
If your dipstick results are a true positive, your urine is sent for a urinalysis. In a urinalysis, a technician looks for different kinds of cells that signal a health problem.
Your health care provider may want you to have a cystoscopy if theres blood in your urine and youre at risk of or have problems with your kidneys or urinary tract. In that procedure, a small tube with a camera in it is inserted into your urethra and up into your bladder.
Its important to undergo these tests when youre experiencing hematuria, because there is no widely used screening test for bladder cancer. Urinalysis is not used as a screening test because a lot of people have blood in their urine for reasons other than bladder cancer. There are some urinary biomarkers that show promise as a way to screen for bladder cancer, but these are not yet validated, says Dr. Tyson.
Treating Bladder Cancer That Progresses Or Recurs
If cancer continues to grow during treatment or comes back after treatment , treatment options will depend on where and how much the cancer has spread, what treatments have already been used, and the patient’s overall health and desire for more treatment. Its important to understand the goal of any further treatment if its to try to cure the cancer, to slow its growth, or to help relieve symptoms as well as the likely benefits and risks.
For instance, non-invasive bladder cancer often comes back in the bladder. The new cancer may be found either in the same place as the original cancer or in other parts of the bladder. These tumors are often treated the same way as the first tumor. But if the cancer keeps coming back, a cystectomy may be needed. For some non-invasive tumors that keep growing even with BCG treatment, and where a cystectomy is not an option, immunotherapy with pembrolizumab might be recommended.
Cancers that recur in distant parts of the body can be harder to remove with surgery, so other treatments, such as chemotherapy, immunotherapy, targeted therapy, or radiation therapy, might be needed. For more on dealing with a recurrence, see Understanding Recurrence.
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There Are Three Ways That Cancer Spreads In The Body
Cancer can spread through tissue, the lymph system, and the blood:
- Tissue. The cancer spreads from where it began by growing into nearby areas.
- Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
- Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.
Treatment Of Invasive Bladder Cancer In The Elderly And Frail Patient
I think this is a very contemporary topic because we are living in an aging society. If you look here, and you know if you really want to look at the life expectancy you should look at charts of the insurance company and governmental agencies rather than medical reports. And this is the life expectancy nowadays where in North America. So, you can see that if you are at the octogenarians, octogenarians for the sake of this talk is 80 years old, 80 to 90, and nonagenarians are 90 and plus. And you see so when you hit 80 you still have at least seven years as a male, and nine years or more as a female. So, we are actually talking about increased population that, and Ill show you data, has more bladder cancer, and theyre actually destined to live quite long if they are in the average risk. So, if you live for example to 90 years old youre expected to live about four years if youre a male and four and a half or five years if youre a female. So, we have to bear these figures in mind.
But once its diagnosed we have a very poor, we poorly address that. This is a paper by Gore et al, and it shows that only 21% of muscle invasive bladder cancer patients over the age of 65 here actually received radical cystectomy. He shows also that there was a better overall survival, but obviously this is biased by selection.
Partial cystectomy there is very few data, none in octogenarian. This is just a series from Wes Kassouf, so I will omit that because we really dont have enough data.
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Treating Stage Iv Bladder Cancer
These cancers have reached the pelvic or abdominal wall , may have spread to nearby lymph nodes , and/or have spread to distant parts of the body . Stage IV cancers are very hard to get rid of completely.
Chemotherapy is usually the first treatment if the cancer has not spread to distant parts of the body . The tumor is then rechecked. If it appears to be gone, chemo with or without radiation or cystectomy are options. If there are still signs of cancer in the bladder, chemo with or without radiation, changing to another kind of chemo, trying an immunotherapy drug, or cystectomy may be recommended.
Chemo is typically the first treatment when bladder cancer has spread to distant parts of the body . After this treatment the cancer is rechecked. If it looks like it’s gone, a boost of radiation to the bladder may be given or cystectomy might be done. If there are still signs of cancer, options might include chemo, radiation, both at the same time, or immunotherapy.
In most cases surgery cant remove all of the cancer, so treatment is usually aimed at slowing the cancers growth and spread to help people live longer and feel better. If surgery is a treatment option, it’s important to understand the goal of the operation whether it’s to try to cure the cancer, to help a person live longer, or to help prevent or relieve symptoms from the cancer.
Because treatment is unlikely to cure these cancers, many experts recommend taking part in a clinical trial.
Changes In Bladder Habits Or Symptoms Of Irritation
Bladder cancer can sometimes cause changes in urination, such as:
- Having to urinate more often than usual
- Pain or burning during urination
- Feeling as if you need to go right away, even when your bladder isn’t full
- Having trouble urinating or having a weak urine stream
- Having to get up to urinate many times during the night
These symptoms are more likely to be caused by a urinary tract infection , bladder stones, an overactive bladder, or an enlarged prostate . Still, its important to have them checked by a doctor so that the cause can be found and treated, if needed.
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Bladder Cancer Treatment In Men Vs Women
As with most cancers, there are more treatment options for bladder cancer when it is detected early. Most people require a combination of therapies to treat bladder cancer successfully.
At MSK, we have the benefit of a multidisciplinary team of experts who are highly specialized in urology, radiation oncology, medical oncology, radiology, and pathology, Dr. Feld says. We all work very closely together to deliver the highest quality care to our patients.
Men and women with very early-stage bladder cancer can be cured with a combination of surgery and treatments delivered directly into the bladder, known as intravesical therapy.
For men and women with disease that is more advanced but still confined to the bladder, a common treatment is removal of the bladder in a surgical procedure known as a radical cystectomy. The urologic surgeon will likely also remove lymph nodes and/or some of the organs near the bladder. This may include the prostate in men and the uterus and ovaries in women.
Its important to know that expert bladder cancer care means not only lifesaving treatments but also preserving quality of life. A recent study showed that people who had their bladder removed at MSK recover well from the surgery and have a good quality of life.
How Can I Prevent Bladder Cancer
You may not be able to prevent bladder cancer, but it may be helpful to know the risk factors that may increase the chance youll develop bladder cancer. Bladder cancer risk factors may include:
- Smoking cigarettes: Cigarette smoking more than doubles the risk of developing bladder cancer. Smoking pipes and cigars or being exposed to second-hand smoke also increases that risk.
- Cancer treatments: Radiation therapy is the second-most common risk factor. People who have certain chemotherapy drugs may also develop an increased risk of bladder cancer.
- Exposure to certain chemicals: People who work with chemicals, such as aromatic amines , are at an increased risk. Extensive exposure to rubber, leather, some textiles, paint and hairdressing supplies, typically related to occupational exposure, also appears to increase the risk.
- Infections: People who have frequent bladder infections, bladder stones or other urinary tract diseases may have an increased risk of developing bladder cancer.
- Past bladder cancer: People with a previous bladder cancer are at increased risk to form new or recurrent bladder tumors.
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Survival For All Stages Of Bladder Cancer
Generally, for people diagnosed with bladder cancer in England:
- around 75 out of every 100 survive their cancer for 1 year or more after diagnosis
- almost 55 out of every 100 survive their cancer for 5 years or more after they are diagnosed
- around 45 out of every 100 survive their cancer for 10 years or more after diagnosis
Cancer survival by stage at diagnosis for England, 2019Office for National Statistics
These statistics are for net survival. Net survival estimates the number of people who survive their cancer rather than calculating the number of people diagnosed with cancer who are still alive. In other words, it is the survival of cancer patients after taking into account that some people would have died from other causes if they had not had cancer.
What Are The Symptoms Of Bladder Cancer
The most common symptom of bladder cancer is visible blood in the urine.1 Other common symptoms are frequent, urgent, or painful urination. These symptoms are not always caused by bladder cancer, but it is important to speak with your healthcare provider if you experience them. Treatment is typically more effective for bladder cancer when its in its earliest stages.
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