Management Of Bladder Cancer Brain Metastases
Systemic chemotherapy forms the backbone of mUC treatment as established in several randomized Phase III trials, with combination gemcitabine/cisplatin non-inferior and less toxic compared to MVAC . The expected OS for unresectable mUC is poor, with median survival < 12 months . Of note, there is little information to guide optimal treatment of mUC patients with intracranial failure since they were typically excluded from randomized systemic therapy trials, likely due to poor performance status and concern regarding brain penetration by systemic therapy . ICB using pembrolizumab is now second-line therapy for mUC following first-line platinum-based regimens, yet the Phase II/III trials of ICB excluded active brain metastases so ICB efficacy for intracranial involvement is not defined . Patients who develop UC brain metastases typically have either already received cisplatin-based chemotherapy or cannot tolerate it only about 50% of mUC patients are eligible for cisplatin-based therapy . Thus, treatment of UC intracranial failure is extrapolated from management of brain metastases from more common histologies such as non-small cell lung cancer and melanoma.
Treatment Interventions And Outcomes
RC patients were classified into two groups according to initial treatment modality. The RT group was composed of RC patients who received surgery and adjuvant external-beam RT, and the no RT group was composed of patients who received surgery alone. To avoid bias caused by different modalities of RT, patients who received brachytherapy or combination RT were excluded from our analysis.
The primary outcome of the present study was to investigate the risk of development of a SBC more than one year after treatment of RC. The SEER program avoids the inclusion of recurrent disease of RC according to the ICD-O-3 guidelines. The follow-up for SBC started at 1 year after the initial treatment of RC and ended at the date of all-cause death, diagnosis of SBC, or reaching 30 years follow-up, whichever occurred first.
The secondary outcome was to evaluate the 10-year overall survival and 10-year cancer specific survival of SBC. The definition of OS was the time from SBC diagnosis to the date of all-cause death, and the definition of CSS was the time from SBC diagnosis to the date of SBC-cause death. The survival analysis was performed by using case-control design, in which each SBC patient who received RT was compared with each SBC patient who did not received RT or with five patients diagnosed with only primary BC . The definition of OPBC was the patient diagnosed with only BC, without any other malignancies diagnosed during their lifetime.
Potential Long Noncoding Rna Biomarkers In Cancer And Other Diseases
lncRNAs play important regulatory roles in transcription, translation, chromatin modification, and cellular organization. Misregulation of lncRNAs is found associated with various human diseases. Though lncRNAs are only recently discovered, at least 321 experimentally verified lncRNAs associated with 221 various types of diseases, which are most related to cancer . The lncRNAs represent another group of potential biomarkers for cancer diagnosis and prognosis.
Prostate cancer antigen 3 is a well-studied lncRNA and the most specific to prostate cancer as it is not expressed in other normal human tissues. PROGENSA PCA3 test is the first urine-based molecular diagnostic test approved by the Food and Drug Administration . The sensitivity and specificity of urine PCA3 expression for PCa diagnosis reach 62 and 75%, respectively, supporting PCA3 as a reasonable marker for prostate cancer diagnosis .
HOX transcript antisense RNA is another well-studied lncRNA. In cervical cancers, high serum levels of HOTAIR were significantly correlated with tumor recurrence and shorter overall survival .
Dong et al. found that the combination of CUDR, LSINCT-5, and PTENP1 provided the best diagnostic value in GC with an AUC of 0.92, a sensitivity of 74.1%, and a specificity of 100%. They were also sufficiently sensitive and specific for early GC detection and distinguishing benign peptic ulcers from GC .
For reference, more potential lncRNA biomarkers are listed in Table 18.3.
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How Do Healthcare Providers Treat Brain Metastases
Your healthcare provider may begin by treating your immediate symptoms. For example, if you have edema from your brain tumor, your healthcare provider might prescribe steroids. If youve had seizures, they might prescribe anticonvulsant medication.
The overarching treatment for metastatic brain tumors is to stop or slow the tumors growth in your brain and minimize your symptoms while treating the cancer thats spread to your brain.
Whats the treatment for breast cancer metastasis to my brain?
Healthcare providers may combine ongoing breast cancer treatment with the following treatments:
Whats the treatment for lung metastasis to my brain?
Healthcare providers use radiosurgery and/or brain surgery to treat lung metastasis to your brain. Recent research shows small cell lung cancer in the brain may be sensitive to targeted therapies and immunotherapy.
Whats the treatment for melanoma metastasis to my brain?
Healthcare providers may use radiosurgery and/or surgery and immunotherapy to treat melanoma metastasis to your brain.
Whats the treatment for prostate metastasis to my brain?
Metastatic brain tumors stemming from your prostate are very rare, accounting for about 1% of all metastatic brain cancers. Prostate cancer that has spread to your brain may be treated with radiosurgery and/or surgery.
Testicular Cancers: How They Spread
The majority of testicular cancers start in germ cells. Germ cells in your testicles make sperm. When these cells begin to grow out of control, they form two main types of tumors: seminomas and non-seminomas.
They grow and spread at different rates.
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Local Therapy For Bladder Cancer Brain Metastases
In general, management of brain metastases centers around treating or preventing neurological symptoms and achieving local control through multimodality treatment combining surgical resection and adjuvant RT for resectable patients and RT alone for those who are not good candidates for surgery . Stereotactic radiosurgery can be considered in lieu of surgery for patients with a lower burden of intracranial disease. Although rare, long-term survival with brain metastases following treatment is possible, with a 10-year OS rate of 1.3% , and most commonly observed in patients with solitary lesions, controlled primary disease, and excellent performance status . Treatment plans for local therapy are derived based on results observed for more common histologies.
Resources For More Information
Bladder Cancer Advocacy Network
Offers education and support services, advances research, and raises awareness about bladder cancer. Has an extensive online resource library for bladder cancer patients.
American Bladder Cancer Society
The site is intended to offer help, hope, and support to anyone affected by bladder cancer. Bladder cancer information, resources, and a support forum are offered.
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What Is The Metastatic Brain Tumor Prognosis
Your prognosis or expected outcome depends on several factors that are specific to you and your medical condition. Healthcare providers base prognoses on factors such as your age and your overall health. They also consider how your primary cancer responded to treatment, if you have more than one brain tumor and your brain tumors size. Your healthcare provider is your best resource for information about your personal prognosis.
What Are The Differences Between A Metastatic Brain Tumor And A Primary Brain Tumor
There are several differences between a metastatic or secondary brain tumor and a primary brain tumor. Some differences are:
- A primary brain cancer is a tumor that develops in your brain. A metastatic or secondary brain tumor happens when cancer spreads to your brain from another area of your body.
- A metastatic brain tumor is malignant, and most primary brain tumors are benign. However, benign brain tumors can affect how your brain functions if they grow large enough to press on nearby nerves, blood vessels and brain tissue.
- Metastatic brain tumors are more common than primary brain tumors.
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Who Gets Mental Confusion Or Delirium
Confusion is the most common sign that cancer or treatment is affecting the brain. It is a common problem for people with any advanced illness including advanced cancer or those at the end of life. A person with mental confusion will think and act very differently from normal. The condition can be difficult and stressful for the person affected as well as their loved ones. It may also make it harder for the health care team to care for other symptoms.
Database And Study Population
We identified patients diagnosed with histologically confirmed RC as their initial primary cancer from nine registries of the SEER program between January 1973 and December 2015. The RC and rectosigmoid cancer were included according to The 3rd Edition of International Classification of Diseases for Oncology . Localized and regional stage as defined by SEER was chosen for analysis. Exclusion criteria included patients where RC was not their first primary cancer, age younger than 20 years, survival less than 1 year after RC diagnosis, no rectal cancer surgery, distant metastases, and missing data on radiation, surgery, age, tumor stage, race and follow-up information. This study has been approved by the Ethics Committee of Cancer Hospital, Chinese Academy of Medical Sciences.
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Review: Brain Metastases In Bladder Cancer
Article type: Review Article
Authors: Brenneman, Randall J.a | Gay, Hiram A.a | Christodouleas, John P.b | Sargos, Paulc | Arora, Vivekd | Fischer-Valuck, Benjamine | Huang, Jiayia | Knoche, Ericd | Pachynski, Russelld | Picus, Joeld | Reimers, Melissad | Roth, Bruced | Michalski, Jeff M.a | Baumann, Brian C.a b *
Affiliations: Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA | Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA | Department of Radiation Oncology, Jewish General Hospital, Montreal, QC, Canada | Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO, USA | Department of Radiation Oncology, Emory University, Atlanta, GA, USA
Correspondence: Correspondence to: Dr. Brian Baumann, Assistant Professor, Chief of Genitourinary Radiation Oncology, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA. Tel.: +1 314 747 7236 Fax: +1 314 362 7769 E-mail: .
Keywords: Urothelial carcinoma, urinary bladder neoplasms, radiotherapy, neoplasm metastasis, immune checkpoint blockade
Journal: Bladder Cancer, vol. 6, no. 3, pp. 237-248, 2020
Some Colorectal Tumors Are Born To Be Bad
To get a better handle on the timing of metastasis, the team developed a computer model to simulate the evolution of millions of virtual tumors under different conditions.
We could then compare the simulated data with the observed patient data using various statistical techniques, Dr. Curtis explained.
The modeling data indicated that metastasis begins very early during tumor developmentwhen the primary tumor is smaller than the tip of a sharpened pencil.
In other words, Dr. Curtis said, some tumors may be “born to be bad.
The team next investigated whether the results from their small set of paired samples of primary and metastatic tumors from patients could be extended to a larger number of patients.
They analyzed publicly available data from 938 people with metastatic colorectal cancer and 1,813 people with early-stage, nonmetastatic colorectal cancer whose medical histories were known. The primary tumors of these patients had been profiled to identify genetic changes in known cancer-associated genes.
This analysis showed that certain genetic changes tend to occur together, and that specific combinations of three to five mutations were more common in patients with metastatic cancer than in those with nonmetastatic disease, suggesting that specific combinations of early genetic changes confer the potential for tumor cells to spread.
If confirmed in future studies, this information could potentially be used to guide treatment decisions, she said.
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Taking Care Of Yourself
You go through a lot when you have cancer. Rest, exercise, and managing stress can help. Its also important to eat well during your treatment. It may be harder now for your body to absorb nutrients from food. Work with a dietitian to make sure you get enough calories and nutrition. Ask your doctor for a referral.
Make sure you get the emotional support you need during this time, too. Friends, family members, social workers, and therapists can all be a big help. They may not be sure what to offer, so let them know what would be helpful. Ask them to listen when youâve had a tough day or to do something fun with you when you have the energy for it.
What Kind Of Treatment Will I Need
There are many ways to treat bladder cancer. You might want to get a second opinion about the best treatment plan for you.
Bladder cancer is most often treated with:
Sometimes more than one type is used. The treatment plan thats best for you depends on:
- The stage and grade of the cancer
- Whether the cancer has spread into the bladder wall
- The chance that a type of treatment will cure the cancer or help in some way
- Other health problems you have
- Your feelings about the treatment and the side effects that come with it
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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.
Risks For Bladder Cancer
Certain behaviours, substances or conditions can affect your risk, orchance, of developing cancer. Some things increase your risk and some thingsdecrease it. Most cancers are the result of many risks. But sometimes cancer develops in peoplewho dont have any risks.
Smoking tobacco is the main risk for bladder cancer.
The risk of developing bladder cancer increases with age. Itusually occurs in people older than 65 years of age. Bladder cancer is mostcommon in Caucasians, and men develop this disease more often than women.
The following can increase or decrease your risk for bladdercancer. There are things you can do to lower your risk and help protect yourselffrom developing cancer.
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I Have Brain Metastases How Do I Take Care Of Myself
Brain metastases can create a new set of medical conditions and issues when youre already dealing with cancer treatment:
- Depending on your brain tumors location, you may be at increased risk for seizures, which may affect your ability to work or drive. Your healthcare provider may prescribe medication to reduce your risk.
- You may need surgery to remove your brain tumor. If so, youll need support while you recover.
- You may need help managing side effects from different or additional cancer treatments. You may want to consider palliative care to help you manage your symptoms and treatment side effects.
- Your brain metastases diagnosis is another step in your cancer journey. Metastatic brain cancer treatment focuses on slowing cancers spread and helping you maintain your quality of life. This may be time for you to talk to your healthcare provider about next steps if your cancer cant be cured.
Treatment By Cancer Type
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Where Can I Find A Support Group
To find a local group, talk to your healthcare provider. Local and Zoom meeting lists are also available through organizations such as CancerCare.
Joining a support group of people dealing with advanced cancer may help provide camaraderie and knowledge. You can connect with people who understand what you’re going through.
Treating cancer means looking after your whole self. This includes keeping an active lifestyle, eating healthy, practicing mindfulness, and socializing with family and friends to improve your mood and overall health. If you smoke cigarettes or use nicotine products, this is a good time to try to quit or cut down.
It’s also important to look after your mental health. Meeting with a therapist can help you navigate intense emotions and provide you with tools to feel more in control of your daily life.
Palliative care may also be beneficial. Your palliative care provider can help you learn about pain management options. Palliative care providers can also assist with finding mental health services, such as counseling.