Substantial Improvement In Survival
Dr. Powles and his colleagues enrolled 700 people with locally advanced or metastatic bladder cancer in the international JAVELIN Bladder 100 study, which was funded by Pfizer, the drug’s manufacturer.
All trial participants had already received chemotherapywith either cisplatin and gemcitabine or carboplatin and gemcitabine, if their health did not allow them to receive cisplatinand their disease had not worsened during chemotherapy.
Participants were then randomly assigned to receive either maintenance treatment with avelumab plus supportive care or supportive care alone. People in the maintenance group received infusions of avelumab every 2 weeks until their cancer started growing again or they left the study for other reasons. Supportive care for both groups included pain management, nutritional support, and treatment of infections.
People in the supportive care group whose cancer got worse did not receive avelumab as part of the trial. However, they could receive it or any other immunotherapy drug after leaving the study.
Maintenance treatment with avelumab after chemotherapy turned out to have substantial benefits. The median overall survival for people who received maintenance avelumab was more than 21 months, compared with about 14 months for people who received only supportive care until their cancer got worse.
Transurethral Resection Of The Bladder Cancer Tumor
This is when the tumor is removed from the urinary tract through the urethra using an electrical force. Transurethral resection is an endoscopic or scope procedure that does not involve making an incision in the body.
Drug therapy after TUR is commonly prescribed for patients with large, multiple or high-grade tumors.
Distribution Of Distant Metastatic Sites
The distribution of distant metastatic sites is summarized in , and we applied Venn diagram to further illustrate metastatic sites distribution. The Venn diagrams show the number of patients with different kinds of metastatic sites. It shows that 799 patients were diagnosed with bone metastases, 724 patients were with lung metastases, 637 patients were with distant lymph nodes metastases, 493 patients were with lung metastases and only 76 patients had brain metastases. A total of 1228 , 438 , 153 and 43 patients had one, two, three and four metastatic sites, respectively, and the overlapping area of the Venn diagram presents patients with multiple metastatic sites. No patient was found to have five metastatic sites in the cohort.
Venn diagram of the distribution of distant metastatic sites in the overall cohort.
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Should I Make Any Lifestyle Changes Including In My Diet Or Physical Activity
Achieving and maintaining a healthy weight by eating a balanced diet with plenty of fruits, vegetables, and whole grains, and staying physically active, can help your overall health. These lifestyle changes can also have a positive effect for men with bone metastases, Tagawa says. Both diet and exercise, he says, are things that are under a mans direct control.
A healthy lifestyle can help you better manage side effects from treatment as well. Try setting small but realistic goals for yourself when it comes to eating a healthy diet and getting plenty of exercise.
While no single food is likely to have a benefit for prostate cancer, smart food choices may help you feel better day to day. Start by cutting out foods high in sugar, saturated fat, and added flavorings and preservatives.
If youre not sure which healthy foods to choose, ask your doctor for a referral to a dietitian. This specialist can help you develop a meal plan that includes foods that offer the best chance of slowing the cancers growth and keeping you as healthy as possible.
As an oncologist, Tagawa says he concentrates on treating the cancer itself, but hes aware that many of the men he sees with advanced prostate cancer are older and more likely than younger men to have health problems that can benefit from diet and exercise.
And if youre on hormone therapy, talk to your doctor about investing in some weights or elastic resistance bands to support your bone strength too.
Liver And Gallbladder Cancer
Malignancies confined to the liver are one of the most common forms of cancer. There are two basic types of the disease:primary liver cancer originates in the tissues of the liver itself, while metastatic liver cancer occurs when cancer cells spread from other parts of the body, most commonly from the stomach, pancreas, breast or lung. Ultimately, about a thirdof all cancers will spread to the liver.
Surgery usually provides the best chance for a cure, and our surgicalspecialists are among the best in the country. In some cases, however, tumorsdevelop internally within the liver and complete surgical removal is not possible.
The University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center offers a comprehensive Liver-Directed Therapies Program, providingthe most advanced treatments available — from complete or partial surgicalremoval to systemic, combination therapies to regional, targeted treatment options– to provide the very best outcomes possible for patients with all forms ofliver cancer.
Our multidisciplinary Liver-Directed Therapies Program team consists of expertsin medical oncology, radiation oncology, surgical oncology,interventional radiology, nuclear medicine, gastroenterology, hepatology andpathology. These specialists meet and consult weekly to develop the bestplan of treatment for each individual patient.
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Subtleties And Future Questions
Several factors have to be carefully considered in interpreting the trial results, explained Dr. Apolo.
A major one is that the study did not directly compare survival between people who got avelumab immediately versus when their cancer progressed. Only about half of the participants who initially received supportive care alone went on to receive immunotherapy after their cancer got worse. There could be many reasons for this, including lack of access to these drugs in different countries, Dr. Apolo said.
But it also might be that, for some people, the cancer was progressing too rapidly, she added. When these tumors start growing, they start growing very quickly. So if you wait to start at the time of progression, maybe its too late, added Dr. Apolo.
Not all patients will be caught by the second-line safety net, agreed Dr. Plimack.
So, for now, said Dr. Balar, the takeaway message from the JAVELIN study is after chemotherapy, dont wait to give immunotherapy.
But more and more, studies are looking at whether some patients should receive immunotherapy as first-line treatment, he continued. Immunotherapy is one of the most important advances weve made in the last 30 years, Dr. Balar said.
The JAVELIN results cant provide any insight into which patients benefit from first-line treatment with a platinum-based chemotherapy, he added. This trial wasnt designed to ask: Is chemotherapy necessarily the best choice for every patient? he explained.
Surgery For Bladder Cancer
Surgery is done for most bladder cancers. The type you have depends on the stage of the cancer.
Removing the tumor from the inside bladder is the most common surgery for early bladder cancer. This can be done during a cystoscopy. A a cystoscope with a looped wire on the end is used to remove the tumor.
When the cancer is more invasive, the cancer is removed along with part of the bladder or the entire bladder.
If only part of the bladder is removed, you’ll still be able to hold and release urine as normal, though in smaller amounts. If the entire bladder is removed, you’ll need another way to store and pass urine. Your doctor can explain the options for this.
Side effects of surgery
Any type of surgery can have some risks and side effects. For instance, removing the bladder not only changes how your body passes urine, but it can also cause sexual side effects. If you have these or any other problems, let your doctors know. There are ways to help deal with many side effects.
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Catheterizable Continent Diversion Pouch
This is a reservoir of bowel with a stoma that is catheterizable for emptying the bladder. The urine is siphoned out of the urinary reservoir with a small catheter every four to six hours. The catheterizable pouch may require surgical repair at some point after surgery due to the wear and tear of frequent catheterization. This type of reconstruction is not performed on patients with a history of bowel disease.
Diagnosis Of Bladder Cancer
Cystoscopy can detect growths in the bladder and determine the need for a biopsy or surgery.
Biopsy, If abnormal tissue is found during a cystoscopy, a biopsy will be carried out
Transurethral resection of bladder tumor allows the removal of the tumor and a sample of the bladder muscle near the tumor. TURBT is used to diagnose bladder cancer and find out the type of tumor, how deeply it has grown into the layers of the bladder, and identify any additional microscopic cancerous changes, called carcinoma in situ.
Stage I
The cancer has grown through the inner lining of the bladder and only into the lamina propria.
Stage II
The cancer has spread into the thick muscle wall of the bladder. It is also called muscle-invasive cancer.
The cancer has spread through the muscle wall into the tissues around the bladder.
- Stage IIIA: The tumor has grown into the perivesical tissue or has spread into the prostate, uterus, or vagina.
- Stage IIIB: The cancer has spread into 2 or more regional lymph nodes.
Stage IV
The tumor has spread into the pelvic wall or abdominal wall, or to lymph nodes outside of the pelvis or to other parts of the body.
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Very Grateful For Comments Shared Here
At the first world class cancer centre, it was made very clear to us that there was really no choice but the chemo trial and surgery and the rad onc confirmed her view and concurred.
Because this treatment plan was viewed as suspicious and unusual, I wrote to a RO that is highly regarded at another facility. He responded that RT is definitely an option for my husbands case . Hes starting a stereotactic trial and is willing to see us in a couple of weeks.
Is it possible that a team would direct a man away from optimal care for him for the sake of a trial?
Thank you again.
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What Will Happen After Treatment
You’ll be glad when treatment is over. But its hard not to worry about cancer coming back. Even when cancer never comes back, people still worry about this. For years after treatment ends, you will see your cancer doctor. Be sure to go to all of your follow-up visits. People who have had bladder cancer are at high risk of having a second bladder cancer.
If you have no signs of cancer, most experts advise seeing with your doctor every 3 to 6 months. These visits might include urine tests, blood work, and other tests. If you still have your bladder, you will need regular exams of your bladder, too. The time between doctor visits may be longer after a few years if no new cancers are seen.
Having cancer and dealing with treatment can be hard, but it can also be a time to look at your life in new ways. You might be thinking about how to improve your health. Call us or talk to your doctor to find out what you can do to feel better.
You cant change the fact that you have cancer. What you can change is how you live the rest of your life making healthy choices and feeling as well as you can.
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Second Opinion For Peace Of Mind
Desperate for Hope,
I am very sorry for the situation. I can image the anguish you are having with the occurrence. Your bravery surprises me and I applaud you for the evident efforts you are doing to have the best diagnosis and treatment for your husband. He is very fortunate.I do not want my comments to distract you from your good work, however, I think you should get second opinions from an independent physician/radiologist, which opinion would provide you the deserved peace of mind.
The information you share above allows a newer perception of the diagnosis following your post of Oct 17. Things are moving fast and spinning around.The MRImp will add information for what has been found . Probably this MRI exam will conclude the process of staging and the story so far is not pleasant. Cancer spread into the bladder, if any, up to the ureters tubes are still classified localized but the probable T3 is now/becomes T4 disease. This may be the basis of the radiologist that follows the CAR guilines in radiotherapies.
Max above is also suspicious of the affair. The clinical trial of your link is sponsored by the University Health Network, Toronto, Canada, now recruiting patients. Logically a number of hospitals/clinics and physicians are in charge of supplying patients. I believe your urologist to make part of their list for his proposal to you.
I would appreciate if you can post the images taken in the cystoscopy.
Best of lucks,
Effect Of Surgeries To The Primary Sites And Metastatic Sites On Survival Outcomes
For all patients included in this study, patients who received RC were associated with better OS and CSS , regardless of the specific metastatic sites . This phenomenon remained true with regard to patients with a single-site metastasis . In patients with multisite metastases, however, the survival outcomes of patients who received RC did not differ from that of patients with no RC , as shown in . The effect of RC on survival outcomes of patients stratified by their metastatic sites was further analyzed and the results revealed that for patients with bone-only , lung-only and distant node-only metastases , RC could significantly improve the OS and CSS outcomes, while patients with liver metastases seemed not to benefit from this surgery in terms of OS and CSS . Multivariate analysis revealed that RC was a strong prognostic indicator in the overall cohort and in patients with single metastatic site .
KaplanMeier curves of overall survival and cancer-specific survival according to whether or not radical cystectomy has been done for the overall cohort , in patients with single metastatic site and in patients with multiple metastatic sites .
KaplanMeier curves of overall survival and cancer-specific survival according to whether or not radical cystectomy has been done for patients with bone-only , liver-only , lung-only and distant node-only metastases.
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Transurethral Resection Of A Bladder Tumor
A procedure called transurethral resection is commonly used to learn more about the bladder cancer. This procedure is often also part of treatment for early-stage or non-muscle invasive bladder cancer. During this procedure, a telescope is inserted into your bladder, and the tumor is then removed by scraping it from the bladder wall. Other tests may include a CT scan of the abdomen and pelvis, MRI scans, X-rays, and bone scans.3
How Is Bladder Cancer Treated
Treatment for bladder cancer depends on
- The stage of cancer.
- If cancer has spread beyond the lining of the bladder.
- The extent of cancer spread.
Treatment options based on tumor grade
- High-grade bladder cancer: High-grade cancers that are life-threatening and spread quickly need to be treated with chemotherapy, radiation or surgery.
- Low-grade cancers: Less aggressive cancers have a low chance of becoming high grade and do not require aggressive treatments, such as radiation or bladder removal.
Treatment options may vary depending on the tumor stage.
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When Bladder Cancer Spreads To Other Parts Of The Body
When cancer cells break away from where they started to grow and start spreading to other parts of the body, it is called metastasis. Metastatic bladder cancer is the name for bladder cancer that has spread to other parts of the body, such as the lungs, the liver, or the bones. Even if the cancer cells are first discovered in the bones, for example, if they first started growing in the bladder it is still called metastatic bladder cancer.1
Tests That May Be Done
Physical exam: The doctor will check you for signs of bladder cancer and other health problems. This might include a rectal exam, during which a gloved finger is put into your rectum. If you are a woman, a pelvic exam might also be done. During these exams, the doctor can sometimes feel a bladder tumor.
Urine tests: For these tests, you’ll be asked to pee in a cup. Your urine is then tested for cancer cells, blood, or certain proteins .
Cystoscopy: For this exam, a doctor called a urologist looks at the inside of your bladder using a tool called a cystoscope. This is a thin tube with a tiny light and camera on its end. It’s put through the opening of your urethra and moved up into your bladder.
Blue light cystoscopy: Sometimes, special drugs are put into the bladder during the exam. Cancer cells soak up these drugs and then glow when the doctor shines a blue light through the scope. This can help the doctor see cancer cells that might have been missed with the normal light.
Bladder biopsy: This is needed to know for sure if you have bladder cancer. For this test, a cystoscope is used it to take a tiny piece of the bladder . More than one sample may be taken because sometimes cancer starts in more than one part of the bladder. Salt water washings of the inside of your bladder may also be collected to look for cancer cells. Any samples are sent to a lab and tested to see if there are cancer cells in them.
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What Affects Survival
Your outlook depends on the stage of the cancer when it is diagnosed. This means whether the cancer is just in the bladder lining or whether it has spread into the muscle wall of the bladder or beyond.
The type of bladder cancer can affect your likely survival. And the grade of the cancer may also be important. Grade means how abnormal the cells look under the microscope.
Most bladder cancers are diagnosed when they are still only in the bladder lining. These are called early bladder cancers. The outlook for early bladder cancers depend on several factors, including:
- exactly how far the cancer cells have gone into the bladder lining
- the number of tumours
- how wide the tumours are
- how abnormal the cancer cells look under the microscope
- whether CIS is present
- whether this a recurrence and how often a tumour has recurred
Your doctor looks at all these factors. They use them to decide whether there is a low, medium or high risk of the cancer coming back or spreading into the muscle of the bladder. Your doctor will be able to tell you about your risk group and how this affects your outcome.