Monday, January 30, 2023

Bladder Cancer In The Muscle

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Treatmentof Patients With Bone Metastases

How Muscle Invasive Bladder Cancer Patients Managed their Initial Diagnosis and Decided on Treatment

The prevalence of metastatic bone disease in patients withadvanced/metastatic UC is 3040% . Skeletal complicationsdue to MBD have a detrimental effect on pain and QoL and are also associated with increasedmortality . Bisphosphonates such as zoledronic acid reduce anddelay skeletal-related events due to bone metastases by inhibiting bone resorption,as shown in a small pilot study . Denosumab, a fully humanmonoclonal antibody that binds to and neutralises RANKL , was shown to be non-inferior to zoledronic acid in preventing ordelaying SREs in patients with solid tumours and advanced MBD, including patients with UC. Patients with MBD, irrespective of the cancer type, should beconsidered for bone-targeted treatment .

Patients treated with zoledronic acid or denosumab should be informed aboutpossible side effects including osteonecrosis of the jaw and hypocalcaemia. Supplementationwith calcium and vitamin D is mandatory. Dosing regimens of zoledronic acid should followregulatory recommendations and have to be adjusted according to pre-existing medicalconditions, especially renal function . For denosumab, no doseadjustments are required for variations in renal function.

A Criteria For Inclusion/exclusion Of Studies In The Review

The criteria for inclusion and exclusion of studies will be based on the Key Questions and discussion with TEP members, and are described in the previous PICOTS section.

Below are additional details on the scope of this project:

Study Designs

We will include randomized controlled trials , and cohort studies with comparators when RCTs are not available, for all KQs. Additionally, we will exclude uncontrolled observational studies, case-control studies, case series, and case reports, as these studies are less informative than studies with a control group.

Systematic reviews will be used as primary sources of evidence if they address a key question and are assessed as being at low risk of bias, according to the AMSTAR quality assessment tool.14,15 If systematic reviews are included, we will update findings with any new primary studies identified in our searches, update meta-analyses if appropriate, and re-assess SOE based on the totality of evidence. If multiple systematic reviews are relevant and low risk of bias, we will focus on the findings from the most recent reviews and evaluate areas of consistency across the reviews.16,17

Non-English Language Studies

We will restrict to English-language articles, but will review English language abstracts of non-English language articles to identify studies that would otherwise meet inclusion criteria, in order to assess for the likelihood of language bias.

Treatment Of Bladder Cancer By Stage

Most of the time, treatment of bladder cancer is based on the tumors clinical stage when it’s first diagnosed. This includes how deep it’s thought to have grown into the bladder wall and whether it has spread beyond the bladder. Other factors, such as the size of the tumor, how fast the cancer cells are growing , and a persons overall health and preferences, also affect treatment options.

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Transurethral Resection Of Bladder Tumour

Transurethral resection of bladder tumour alone in MIBC patients is onlypossible as a therapeutic option if tumour growth is limited to the superficial muscle layerand if re-staging biopsies are negative for residual tumour . In general, approximately 50% of patients will still have toundergo RC for recurrent MIBC with a disease-specific mortality rate of up to 47% withinthis group . A disease-free status at re-staging TURB appearsto be crucial in making the decision not to perform RC . A prospective study by Solsona et al. including 133 patients with radical TURB andre-staging negative biopsies, reported a 15-year follow-up .Thirty per cent of patients had recurrent NMIBC and went on to intravesical therapy, and 30% progressed, of which 27 died of BC. After five, ten, and fifteen years, the resultsshowed CSS rates of 81.9%, 79.5%, and 76.7%, respectively and PFS rates with an intactbladder of 75.5%, 64.9%, and 57.8%, respectively.

In conclusion, TURB alone should only be considered as atherapeutic option for muscle-invasive disease after radical TURB, when the patient is unfitfor cystectomy, or refuses open surgery, or as part of a multimodality bladder-preservingapproach.

7.5.1.1.Guideline for transurethralresection of bladder tumour

Recommendation

Strength rating

Do not offer transurethral resection of bladdertumour alone as a curative treatment option as most patients will not benefit.

Strong

HCP = healthcare professional.

Bladder Cancer Has The Highest Lifetime Treatment Cost Of All Cancers With Substantial Economic Burden Throughout The Entire Disease Coursewith The Focus On Limiting Overuse Of Surveillance Testing And Treatment May Mitigate Associated Increasing Costs Of Care

ESU

The two articles linked and excerpted below offer up two opposing point illustrating the conventional and non-conventional sides of bladder control.

The first article about bladder cancer talks about how expensive observation is after an early stage bladder cancer diagnosis. The article assumes all conventional, FDA approved therapies. To be sure, conventional therapies, conventional diagnostic testing, conventional everything is expensive.

But what about evidence-based non-conventional therapies shown to reduce the risk of bladder cancer?

To be clear, I am not an oncologist. I am a long-term survivor of a very different cancer called multiple myeloma. Im simply saying that I have learned to think outside the conventional standard-of-care therapy box.

Scroll down the page, post a question or comment and I will reply to you ASAP.

Thank you,

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What Are The Stages Of Bladder Cancer

Bladder cancer can be either early stage or invasive .

The stages range from TA to IV . In the earliest stages , the cancer is confined to the lining of the bladder or in the connective tissue just below the lining, but has not invaded into the main muscle wall of the bladder.

Stages II to IV denote invasive cancer:

  • In Stage II, cancer has spread to the muscle wall of the bladder.
  • In Stage III, the cancer has spread to the fatty tissue outside the bladder muscle.
  • In Stage IV, the cancer has metastasized from the bladder to the lymph nodes or to other organs or bones.

A more sophisticated and preferred staging system is known as TNM, which stands for tumor, node involvement and metastases. In this system:

  • Invasive bladder tumors can range from T2 all the way to T4 .
  • Lymph node involvement ranges from N0 to N3 .
  • M0 means that there is no metastasis outside of the pelvis. M1 means that it has metastasized outside of the pelvis.

Understanding The Statistics: Cancer Survival

It is important to remember that all cancer survival numbers are based on averages across huge numbers of people. These numbers cannot predict what will happen in your individual case.

Survival rates will not tell you how long you will live after you have been diagnosed with bladder cancer. But, these numbers can give you an idea of how likely your treatment will be successful. Also, survival rates take into account your age at diagnosis but not whether you have other health conditions too.

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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.

Role Of Cystectomy In Nmibc

Understanding Muscle Invasive Bladder Cancer | Indications for Cystectomy

Guideline Statement 27

27. In a patient with Ta low- or intermediate-risk disease, a clinician should not perform radical cystectomy until bladder-sparing modalities have failed.

Discussion

Low-grade, noninvasive tumors very rarely metastasize, and even large-volume, multifocal cancers can usually be managed with techniques, such as staged resection. Patients with low-grade recurrences can be successfully managed with intravesical chemotherapy 225 or BCG. 177,226,227 In addition, small, multifocal recurrences despite intravesical therapy can usually be treated effectively with office fulguration, repeat TURBT or even surveillance, in select cases. 64-67

Guideline Statement 28

28. In a high-risk patient who is fit for surgery with persistent high-grade T1 disease on repeat resection, or T1 tumors with associated CIS, LVI, or variant histologies, a clinician should consider offering initial radical cystectomy.

Discussion

Guideline Statement 29

29. In a high-risk patient with persistent or recurrent disease within one year following treatment with two induction cycles of BCG or BCG maintenance, a clinician should offer radical cystectomy.

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Causes Of Bladder Cancer

Most cases of bladder cancer appear to be caused by exposure to harmful substances, which lead to abnormal changes in the bladder’s cells over many years.

Tobacco smoke is a common cause and it’s estimated that more than 1 in 3 cases of bladder cancer are caused by smoking.

Contact with certain chemicals previously used in manufacturing is also known to cause bladder cancer. However, these substances have since been banned.

Read more about the causes of bladder cancer.

Curcumin Inhibits Bladder Cancer Progression Via Regulation Of

Bladder cancer has a considerable morbidity and mortality impact with particularly poor prognosis. Curcumin has been recently noticed as a polyphenolic compound separated from turmeric to regulate tumor progression. However, the precise molecular mechanism by which curcumin inhibits the invasion and metastasis of bladder cancer cells is not fully elucidated.

In this study, we investigate the effect of curcumin on the bladder cancer as well as possible mechanisms of curcumin

In addition, bladder cancer cell lines T24 and 5637 cells were treated with different concentrations of curcumin. The cytotoxic effect of curcumin on cell proliferation of T24 and 5637 cells was measured by 3–2,5-diphenyltetrazolium bromide assay.

Furthermore, curcumin inhibited the cell proliferation of T24 and 5637 cells, and curcumin reduced the migration and invasive ability of T24 and 5637 cells via regulating -catenin expression and reversing epithelialmesenchymal transition. Curcumin may be a new drug for bladder cancer.

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Surgery For Stage Ii Or Iii

Most patients with stage II or stage III bladder cancer will have part or all of their bladder removed. This is called a cystectomy. A partial cystectomy is when only a part of the bladder is removed. A radical cystectomy is a surgery to remove all of the bladder:

  • In men, the surgery removes the entire bladder as well as the prostate and seminal vesicles.
  • In women, the bladder is removed along with the uterus, ovaries, and part of the vagina.
  • Some stage IV patients may be offered surgery.

Your surgeon will reconstruct your urinary tract if your bladder is removed.

Before you have bladder removal and reconstruction:

  • Find a surgeon who performs the surgeries often.
  • Ask questions like: How will your reconstruction work? How long will you be in the hospital? What complications may you experience? How long will it take to recover? How may the surgery affect your sexual functioning?
  • Talk to your doctor about the lifelong follow-up you will need. Your health care team will check your reconstruction and address bladder stones or other health problems.
  • Be aware that you may experience incontinence or urine leakage, no matter what reconstruction you choose.
  • Get support as you learn to use your new bladder. Specialized urology nurses and wound/ostomy nurses can help you in recovery.
  • Join an in-person or online support group to connect with other bladder cancer patients.

Bladderschistosomiasis And Chronic Urinary Tract Infection

Is Surgery Needed for Muscle

Bladder schistosomiasis is the second most common parasiticinfection after malaria, with about 600 million people exposed to infection in Africa, Asia,South America, and the Caribbean . There is a well-establishedrelationship between schistosomiasis and urothelial carcinoma of the bladder, which canprogress to squamous cell carcinoma , however, better control of the disease isdecreasing the incidence of SCC of the bladder in endemic zones such as Egypt .

Similarly, invasive SCC has been linked to the presenceof chronic urinary tract infection distinct from schistosomiasis. A direct associationbetween BC and UTIs has been observed in several case-control studies, which have reported atwo-fold increased risk of BC in patients with recurrent UTIs in some series . However, a recent meta-analysis found no statisticalassociation when pooling data from the most recent and highest quality studies whichhighlights the need for higher quality data to be able to draw conclusions .

Similarly, urinary calculi and chronic irritation orinflammation of the urothelium have been described as possible risk factors for BC. Ameta-analysis of case-control and cohort studies suggests a positive association betweenhistory of urinary calculi and BC .

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Treatment Options For Metastatic Bladder Cancer

Cancer that returns to the other organs or lymph nodes outside of the groin is called metastatic cancer. At this stage, the treatment no longer aims to cure you but can alleviate the symptoms . This treatment aims to halt the cancer and keep the symptoms under control. Which palliative treatment is right for you, depends on your symptoms and wishes. We have multiple palliative treatments available. Chemotherapy and radiotherapy are commonly used, as is a combination of the two . In the case of pain, we can offer a radical cystectomy as part of palliative care.

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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Stage 3 Bladder Cancer

Stage 3 bladder cancer means that the cancer cells have spread beyond the bladder muscle.1,2,3 Stage 3 bladder cancer includes the following combined TNM stages:

In all three types of stage 3 bladder cancer, the cancer cells have not spread to the lymph nodes near the bladder and they have not spread to other parts of the body.

In a bladder tumor that is stage T3a or stage T3b, the bladder cancer cells have grown into the layer of fatty tissue that surrounds the outside of the bladder. This layer of fatty tissue is called perivesical tissue.

In a stage T3a bladder tumor, the bladder cancer cells in the perivesical tissue are only visible through a microscope. In a stage T3b bladder tumor, the bladder cancer cells have grown into the perivesical tissue and are large enough that they are visible using an imaging test or they can be felt by a healthcare professional. A stage T4a bladder tumor is different in women and men. In women, the stage T4a tumor has grown through the perivesical tissue and into the uterus and/or vagina. In men, the stage T4a tumor has grown through the perivesical tissue and into the prostate. However, in both women and men, a stage T4a tumor has not grown into the pelvic wall or the abdominal wall.

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What Are The Treatment Options For Bladder Cancer

Understanding Muscle Invasive Bladder Cancer | Preparing for Surgery

There are four types of treatment for patients with bladder cancer. These include:

  • Surgery

Sometimes, combinations of these treatments will be used.

Surgical options

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.

Chemotherapy

  • Methotrexate

Intravesical therapy

Radiation therapy

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