Monday, January 23, 2023

Bladder Cancer In Lymph Nodes Prognosis

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How Is Bladder Cancer Treated

Lymph Node Dissections in Bladder Cancer

Treatment for bladder cancer will depend on the stage and type of cancer you have. Your provider will talk to you about treatment options and which plan of care is best for you.

Superficial Bladder Cancer

Superficial bladder cancer is bladder cancer that has not invaded into the muscle. It is often treated with surgery and intravesicular therapy.

Surgery

A TURBT is a surgical treatment in which a surgeon removes the bladder tumor using a tool placed into the body through the urethra. The extent of the disease is based mainly on findings during this test. TURBT is the main treatment for superficial disease since all of the tumor is often able to be removed. After a TURBT, you may have intravesicular therapy to prevent the cancer from coming back.

Intravesicular Therapy

Intravesicular therapy is when chemotherapy or immune therapy is injected directly into the bladder. This treatment destroys any remaining cancer cells. Both immunotherapy and chemotherapy medications can be used in intravesicular therapy.

Bacillus Calmette-Guerin is an immunotherapy medication that is used. BCG is a type of virus that works to stimulate the immune system to destroy any cancer cells in the area. You will likely be given this medication multiple times. After treatment, you will have regular cystoscopies to monitor for any reoccurrence or new tumor development.

Muscle Invading Bladder Cancer

Immunotherapy

What Is The Five Year Survival Rate For Bladder Cancer

A five-year survival rate is the percentage of people in a study or treatment group who are alive five years after they were diagnosed with or started treatment for a disease such as bladder cancer. Their disease may or may not have recurred during that time.

The American Cancer Society periodically reports on the five-year survival rate for bladder cancer. The most recently period studied was from 2010 to 2016 and that rate was 77%. This means that from the time of diagnosis, 77 out of 100 people diagnosed with bladder cancer were alive in five years. From 1987 1989 , the five-year survival rate was 79% and from 1975 1977, it was 72%. The survival rates are not the same for everyone, however.

What Are The Signs Of Bladder Cancer

The most common sign of bladder cancer is blood in the urine, called hematuria. Gross hematuria is blood that can be seen in the urine. Your urine can be pink, red, or dark red. In some cases, urine can only be seen with a microscope, called microscopic hematuria. Other signs of bladder cancer include increased frequency of urination, a feeling of urgency to urinate, nocturia , pain with urination, and feeling like your bladder is not empty. These can all be caused by irritation of the bladder wall by the tumor, but can also be signs of infection or other bladder problems.

In advanced cases of bladder cancer, the tumor can stop urine from entering the bladder, or from exiting the bladder. This may cause severe flank pain, infection, and damage to the kidneys. Other signs of advanced bladder cancer are loss of appetite, weight loss, feeling tired, bone pain, and swelling in the feet.

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Survival Analyses Based On The Kaplan

The survival curves for the groups of patients with positive and negative lymph nodes were plotted using the Kaplan-Meier method. Survival analysis indicated a significant difference between the training and verification sets. In addition, death from other causes was regarded as a competing risk event. We used the Fine and Gray competitive risk analysis in both the training and verification sets to further analyze the effect of lymph node status on BCA prognosis. The result showed that LNM was significantly associated with cancer-specific death.

Figure 4 Survival analysis: Kaplan-Meier survival curves grouped according to lymph node status in the training set. Competitive risk curve: death from non-bladder cancer in the training set was regarded as a competitive risk event.

Figure 5 Survival analysis: Kaplan-Meier survival curves grouped according to the lymph node status in the verification set. Competitive risk curve: death from a non-bladder cancer cause in the verification set was regarded as a competitive risk event.

Mechanisms Of Lymph Node Metastasis

Lymphatic Metastases from Pelvic Tumors: Anatomic Classification ...

Tumor-associated lymphatic vessels serve as a route for lymph node metastasis

Lymph node. Metastases of tumor cells through lymphatic vessels to lymph nodes.

Local extension of tumor cells from the primary tumor into the surrounding lymphatics through a process called permeation is one means through which tumor cells can enter into the lymphatic vessels . In addition, tumor cells can be stimulated by cytokines produced by the lymphatic vessels, which promote chemotactic diffusion of tumor cells into the lymphatics . Finally, many tumors have the ability to secrete growth factors that induce the growth of new lymphatic vessels from a precursor, a process called lymphangiogenesis .

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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.

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.

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Cancer Spreading To The Lymph Nodes

Cancer appearing in the lymph nodes is an indicator of how the cancer is spreading. If cancer cells are only found in the lymph nodes near the original tumor, it may indicate the cancer is in an earlier stage and has not spread far beyond its primary area.

On the other hand, if your doctor finds the cancer cells have traveled to lymph nodes far from the initial tumor, the cancer may be spreading at a faster rate and could be in a later stage.

Additionally, its important to know how many cancer cells have traveled to the respective lymph node. If theres visible or palpable cancer in lymph nodes, or the cancer has grown outside the lymph node walls, the cancer may have progressed further and may require a different treatment plan.

If cancer cells have spread to your lymph nodes , symptoms may include:

  • lump or swelling in your neck, under your arm, or in your groin
  • shortness of breath

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What Is The First Sign Of Bladder Cancer

Updates in Muscle Invasive Bladder Cancer

Blood in the urine, referred to as hematuria, is usually the first sign of bladder cancer. This is because early bladder cancer commonly causes bleeding without associated pain or other symptoms.

  • Depending on the amount of blood present, urine may appear pink, red, or brownish in color.
  • Blood may not be present all the time – there may be relatively long periods of clear urine .

If you have noticed blood in your urine it is important to speak to your doctor as soon as possible.

Other early symptoms of bladder cancer that may be experienced are urinary irritation or changes in bladder habits, such as increased urination frequency and/or urgency, pain or a burning sensation during urination, or difficulty passing urine.

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Prognosis And Survival For Bladder Cancer

If you have bladder cancer, you may have questions about your prognosis. A prognosis is the doctors best estimate of how cancer will affect someone and how it will respond to treatment. Prognosis and survival depend on many factors. Only a doctor familiar with your medical history, the type and stage and other features of the cancer, the treatments chosen and the response to treatment can put all of this information together with survival statistics to arrive at a prognosis.

A prognostic factor is an aspect of the cancer or a characteristic of the person that the doctor will consider when making a prognosis. A predictive factor influences how a cancer will respond to a certain treatment. Prognostic and predictive factors are often discussed together. They both play a part in deciding on a treatment plan and a prognosis.

The following are prognostic and predictive factors for bladder cancer.

N Categories For Bladder Cancer

The N category describes spread only to the lymph nodes near the bladder and those along the blood vessel called the common iliac artery. These lymph nodes are called regional lymph nodes. Any other lymph nodes are considered distant lymph nodes. Spread to distant nodes is considered metastasis . Surgery is usually needed to find cancer spread to lymph nodes, since this is seldom seen on imaging tests.

The N categories are described in the table above, except for:

NX: Regional lymph nodes cannot be assessed due to lack of information.

N0: There’s no regional lymph node spread.

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Whats The Treatment For Stage 3 Bladder Cancer

The standard treatment for stage 3 bladder cancer is surgery, usually in combination with other therapies.

Be sure to discuss your treatment goals with your doctor. Assess all the potential benefits and risks of each therapy. Some treatments aim for a cure. Others work to slow progression or relieve symptoms. The recommended treatment may depend on your overall health.

If cancer continues to progress or comes back during treatment, you may have to reconsider your options.

Monitoring For Bladder Cancer Recurrence

Lymphatic Metastases from Pelvic Tumors: Anatomic Classification ...

Those who have already been treated for bladder cancer have unique monitoring needs to protect against the threat of recurrence. Generally doctors recommend a cystoscopy to examine the inside of the bladder and urethra every 3 to 12 months, depending on your risk of recurrence, for several years after bladder cancer treatment. If several years of surveillance have gone by and no cancer recurrence has been detected, a cystoscopy once a year may be enough, though the final decision rests with the doctor and additional testing may be required depending on the nature and severity of the original cancer.

If you’re recovering from treatment, ask your doctor about Cxbladder. Cxbladder is an accurate and non-invasive surveillance alternative designed to detect or rule out the return of bladder cancer. The test provides reliable results with a single urine sample, reducing the need for frequent cystoscopies in some patients, which can be both uncomfortable and inconvenient.Learn more about Cxbladder

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Intravenous Or Retrograde Pyelograms

For example, intravenous or retrograde pyelograms are types of x-rays that use a special dye to highlight the organs of the urinary tract. This can make it possible to detect cancer that has spread to the kidneys, ureters, or other parts of the urinary tract. If healthcare providers suspect that the bladder cancer may have spread to the patients lungs, then a chest x-ray may be used.

Bladder Cancer Is A Disease In Which Malignant Cells Form In The Tissues Of The Bladder

The bladder is a hollow organ in the lower part of the abdomen. It is shaped like a small balloon and has a muscular wall that allows it to get larger or smaller to store urine made by the kidneys. There are two kidneys, one on each side of the backbone, above the waist. Tiny tubules in the kidneys filter and clean the blood. They take out waste products and make urine. The urine passes from each kidney through a long tube called a ureter into the bladder. The bladder holds the urine until it passes through the urethra and leaves the body.

There are three types of bladder cancer that begin in cells in the lining of the bladder. These cancers are named for the type of cells that become malignant :

  • Transitional cell carcinoma: Cancer that begins in cells in the innermost tissue layer of the bladder. These cells are able to stretch when the bladder is full and shrink when it is emptied. Most bladder cancers begin in the transitional cells. Transitional cell carcinoma can be low-grade or high-grade:
  • Low-grade transitional cell carcinoma often recurs after treatment, but rarely spreads into the muscle layer of the bladder or to other parts of the body.
  • High-grade transitional cell carcinoma often recurs after treatment and often spreads into the muscle layer of the bladder, to other parts of the body, and to lymph nodes. Almost all deaths from bladder cancer are due to high-grade disease.

See the following PDQ summaries for more information:

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Medical Fitness For Chemotherapy

Before considering palliative chemotherapy for metastatic bladder cancer, all patients should be evaluated for medical fitness for chemotherapy. The assessment should incorporate medical and physiologic considerations and include evaluation of renal and cardiac function, as well as performance status. A medical fitness assessment stratifies patients into medically fit or unfit patients, and this classification is used to determine treatment options.

Table 1. Eastern Cooperative Oncology Group Performance Status Definitions

Performance Status

Michael J. Zelefsky MD, … Jonathan E. Rosenberg MD, in, 2010

How Is Metastatic Bladder Cancer Treated

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The way that metastatic bladder cancer is treated depends primarily on where the cancer has spread and the type of cells that make up the primary tumor. Its important to remember that when bladder cancer spreads, the secondary tumors are still considered to be bladder cancer not lung cancer, liver cancer or any other type of malignancy. Potential treatment options may include chemotherapy, radiation therapy and clinical trials.

At Moffitt Cancer Center, weve treated many patients with metastatic bladder cancer, creating tailored treatment plans for every single one. To help ease the burdens of treatment, we also offer comprehensive supportive care services for patients and their caregivers.

If youd like to request an appointment with one of our experienced oncologists, you can do so by calling or submitting a new patient registration form. Referrals are welcome, but never required.

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Patients Can Enter Clinical Trials Before During Or After Starting Their Cancer Treatment

Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring or reduce the side effects of cancer treatment.

Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCIs clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.

If Youre Concerned About Bladder Cancer Talk To Your Doctor About Cxbladder

Cxbladder is a cutting-edge genomic urine test that quickly and accurately detects or rules out bladder cancer. The test combines clinical risk factor markers with genetic information, measuring five biomarker genes to detect the presence or absence of bladder cancer in hematuria patients and those being monitored for recurrence.

Cxbladder comes as a suite of tests, each optimised for a different point in the patient journey:

  • Cxbladder Triage: Incorporates known bladder cancer risk factors to help quickly rule out the disease.
  • Cxbladder Detect: Designed to work alongside other tests to improve overall detection accuracy.
  • Cxbladder Monitor: A non-invasive surveillance alternative that can reduce the need for frequent cystoscopies.

Cxbladder gives you peace of mind and will help your physician make informed treatment decisions.

Speak to your doctor or urologist to learn more about Cxbladder and which test might be right for you. You can also contact our Customer Service Team directly.Learn more about Cxbladder Contact us for more information

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Response Of Bladder Cancer To Nac

In metastatic breast and colon cancers, chemotherapy provides response rates of 35%60% and 17%36% , respectively. Bladder cancer is also sensitive to chemotherapy, and treatment for metastatic bladder cancer using methotrexate, vinblastine, doxorubicin, and cisplatin provides a response rate of 50%70% and complete remission in 12%40% of cases . Thus, it is possible that NAC using MVAC may be useful for treating bladder cancer. Many studies have explored the role of NAC in MIBC although most studies were underpowered to detect a significant difference in the survival rate and the surgical techniques were an important confounding factor.

Table 22.1. Randomized Clinical Trials of NAC in MIBC

Study

Differences In Nusap1 Expression Between Bladder Urothelial Carcinoma Positive Lymph Nodes And Normal Bladder Tissues

Lymphatic Metastases from Pelvic Tumors: Anatomic Classification ...

Primarily, NUSAP1 was localized to the cytoplasm of the positive cells. Immunohistochemistry was performed for 47 pathological lymph node samples and the corresponding adjacent normal bladder tissue samples and compared with the correspondingly matched BUC primary foci tissues. 91.49%, 17.02%, and 82.98% of positive lymph nodes, normal bladder tissues, and BUC tissues, respectively, were positive for NUSAP1 expression the difference between these two was statistically significant .

Table 2 NUSAP1 expression in BUC and normal bladder tissues.

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