Monday, January 23, 2023

Carcinoma In Situ Bladder Cancer Prognosis

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Treatment For Bladder Cancer

Understanding Bladder Cancer Carcinoma In-Situ (CIS)

Treatment for bladder cancer depends on how quickly the cancer is growing. Treatment is different for non-muscle invasive bladder cancer and muscle-invasive bladder cancer.

You might feel confused or unsure about your treatment options and decisions. Its okay to ask your treatment team to explain the information to you more than once. Its often okay to take some time to think about your decisions.

When deciding on treatment for bladder cancer, you may want to discuss your options with a urologist, radiation oncologist and medical oncologist. Ask your GP for referrals.

What Are The Risk Factors For Bladder Cancer

Some factors increase the risk of bladder cancer:

  • Cigarette smoking is the biggest risk factor it more than doubles the risk. Pipe and cigar smoking and exposure to second-hand smoking may also increase ones risk.
  • Prior radiation exposure is the next most common risk factor .
  • Certain chemotherapy drugs also increase the risk of bladder cancer.
  • Environmental exposures increase the risk of bladder cancer. People who work with chemicals, such as aromatic amines are at risk. Extensive exposure to rubber, leather, some textiles, paint, and hairdressing supplies, typically related to occupational exposure, also appears to increase the risk.
  • Infection with a parasite known as Schistosoma haematobium, which is more common in developing countries and the Middle East.
  • People who have frequent infections of the bladder, bladder stones, or other diseases of the urinary tract, or who have chronic need for a catheter in the bladder, may be at higher risk of squamous cell carcinoma.
  • Patients with a previous bladder cancer are at increased risk to form new or recurrent bladder tumors.

Other risk factors include diets high in fried meats and animal fats, and older age. In addition, men have a three-fold higher risk than women.

Genetic Factors In Pathogenesis

Divergent, yet interconnected and overlapping, molecular pathways are likely responsible for the development of noninvasive and invasive bladder tumors. Somatic mutations in fibroblast growth receptor3 and tumor protein p53 in tumor cells appear to be important early molecular events in the noninvasive and invasive pathways, respectively.

FGFR-3, Ras, and PIK3CA mutations occur with high frequency in noninvasive tumors, leading to upregulation of Akt and mitogen-activated protein kinase . Loss of heterozygosity on chromosome 9 is among the most frequent genetic alterations in bladder tumors and is considered an early event.

Large numbers of genomic changes have been detected using karyotyping and comparative genomic hybridization analysis in urothelial carcinoma. Numerically common are losses of 2q, 5q, 8p, 9p, 10q, 18q, and Y. Gains of 1q, 5p, 8q, and 17q are frequently present, and high-level amplifications can be found however, the target genes in the regions of amplifications have not been conclusively identified.

Alterations in the TP53 gene are noted in approximately 60% of invasive bladder cancers. Progression-free survival is significantly shorter in patients with TP53 mutations and is an independent predictor of death among patients with muscle-invasive bladder cancer.

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Survival Rates For Bladder Cancer

Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain amount of time after they were diagnosed. They cant tell you how long you will live, but they may help give you a better understanding of how likely it is that your treatment will be successful.

Keep in mind that survival rates are estimates and are often based on previous outcomes of large numbers of people who had a specific cancer, but they cant predict what will happen in any particular persons case. These statistics can be confusing and may lead you to have more questions. Your doctor is familiar with your situation ask how these numbers may apply to you.

Prognosis In Squamous Cell Carcinoma

Slide Show: Bladder Cancer

Tumor stage, lymph node involvement, and tumor grade have been shown to be of independent prognostic value in SCC. However, pathologic stage is the most important prognostic factor. In one relatively large series of 154 cases, the overall 5-year survival rate was 56% for pT1 and 68% for pT2 tumors. However, the 5-year survival rate for pT3 and pT4 tumors was only 19%.

Several studies have demonstrated grading to be a significant morphologic parameter in SCC. In one series, 5-year survival rates for grade 1, 2, and 3 SCC was 62%, 52%, and 35%, respectively. In the same study of patients undergoing cystectomy, the investigators suggested that a higher number of newly formed blood vessels predicts unfavorable disease outcome.

In SCC, the survival rate appears to be better with radical surgery than with radiation therapy and/or chemotherapy. In locally advanced tumors, however, neoadjuvant radiation improves the outcome. Sex and age have not been prognostically significant in SCC.

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Risk Groups For Early Bladder Cancer

Doctors put early bladder cancer into 3 risk groups. These groups describe how likely it is that your cancer will spread further, or come back after treatment.

The 3 risk groups are:

  • intermediate risk

Your doctor tells you whether your cancer is low risk, intermediate risk or high risk. Knowing your risk group helps them decide which tests and treatment are best for you.

Your risk group depends on:

  • the size of your tumour
  • what the cells look like under a microscope
  • how many tumours there are
  • the type of bladder tumour
  • whether you have had treatment in the last year for early bladder cancer

Treating Stage I Bladder Cancer

Stage I bladder cancers have grown into the connective tissue layer of the bladder wall , but have not reached the muscle layer.

Transurethral resection with fulguration is usually the first treatment for these cancers. But its done to help determine the extent of the cancer rather than to try to cure it. If no other treatment is given, many people will later get a new bladder cancer, which often will be more advanced. This is more likely to happen if the first cancer is high-grade .

Even if the cancer is found to be low grade , a second TURBT is often recommended several weeks later. If the doctor then feels that all of the cancer has been removed, intravesical BCG or intravesical chemo is usually given. If all of the cancer wasnt removed, options are intravesical BCG or cystectomy .

If the cancer is high grade, if many tumors are present, or if the tumor is very large when its first found, radical cystectomy may be recommended.

For people who arent healthy enough for a cystectomy, radiation therapy might be an option, but the chances for cure are not as good.

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Monitoring For Bladder Cancer Recurrence

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

Treatment For Early Stages

Bladder Cancer – Overview (types, pathophysiology, diagnosis, treatment)

If you are diagnosed with stage 0 or stage 1 bladder cancer, your healthcare team will discuss the range of available treatment options with you.3 A procedure that is commonly used to treat early stage bladder cancer is called transurethral resection of bladder tumor . During this procedure, a surgeon inserts a very thin, flexible instrument into the bladder through the urethra, the hollow tube-like organ that carries urine out of the body from the bladder. The surgeon removes the tumor from the inside of the bladder. After the tumor is removed, the surgeon will often use a procedure called fulguration to try to eliminate any bladder cancer cells that are left in the bladder lining or lamina propria.

A treatment called intravesical chemotherapy is commonly administered after surgery, which involves delivering a special type of chemotherapy medicine directly into the bladder.

Other patients with stage 0 or stage 1 bladder cancer may need to have surgery to remove all or part of the bladder. Some patients may decide to take part in a clinical trial investigating new types of bladder cancer treatment.

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Living With Advanced Cancer

Advanced cancer usually means cancer that is unlikely to be cured. Some people can live for many months or years with advanced cancer. During this time palliative care services can help.

Most people continue to have treatment for advanced cancer as part of palliative care, as it helps manage the cancer and improve their day-to-day lives. Many people think that palliative care is for people who are dying but palliative care is for any stage of advanced cancer. There are doctors, nurses and other people who specialise in palliative care.

Treatment may include chemotherapy, radiation therapy or another type of treatment. It can help in these ways:

  • slow down how fast the cancer is growing
  • shrink the cancer
  • help you to live more comfortably by managing symptoms, like pain.

Treatment depends on:

  • how far it has spread
  • your general health

Monotherapy Combination Therapy And Multi

Combination therapies based on immunomodulators such as checkpoint inhibitors have shown a synergistic effect to augment the immune response .

A discrete amount of studies are based on combination therapy with chemotherapeutic drugs, intravesical BCG, and immune checkpoint inhibitors, as some trials reported in Table 1 . Currently, an FDA-approved combination therapy is based on intravesical gemcitabine and cisplatin for NMIBCs .

As shown in Table 2, several clinical trials are designed to investigate combination therapies based on BCG immunotherapy and different chemical or biological compounds or vaccines . Combination therapies encompass also combination chemotherapies especially in recurrent and advanced BC including . Furthermore, photodynamic immunotherapy emerged recently to stimulate the immune response in NMIBC BCG-refractory or intolerant to BCG treatment as well .

One frontier of medicinal chemistry is polypharmacology . Benedetti et al. reviewed the immuno-oncological dynamic interactions to design multi-target modulators.

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Looking For More Of An Introduction

If you would like more of an introduction, explore this related item. Please note that this link will take you to another section on Cancer.Net.

  • ASCO Answers Fact Sheet:Read a 1-page fact sheet that offers an introduction to bladder cancer. This free fact sheet is available as a PDF, so it is easy to print.

Bladder Cancer Stages And Survival Rates

MBBS Medicine (Humanity First): Bladder carcinoma.

Cancer survival rates are also categorized according to the stage of the cancer when it was diagnosed. The stage of cancer generally refers to how far it has progressed, and whether it has spread to other parts of the body. For bladder cancer, the 5-year survival rate for people with:2,3

  • Bladder cancer in situ is around 96 percent
  • Localized bladder cancer is around 70 percent
  • Bladder cancer that has spread to the regional lymph nodes is 35 percent
  • Distant or metastasized bladder cancer is 5 percent

If you would like to learn more about bladder cancer statistics, consider speaking with someone on your health care team. They will be able to explain more about how these statistics apply to your cancer. Tell us about your experience in the comments below, or with the community.

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Background Of Three Types Of Cis

Primary, secondary and concurrent CIS were found in 26, 21 and 46 patients, respectively. Accompanying papillary tumor of concurrent CIS was as follows pTa/G2 tumors were seen in 3 patients, pTa/G3 tumors in 14 patients, pT1/G2 tumors in 6 patients and pT1/G3 tumors in 23 patients. Forty-three of them had G3 element and/or T1 tumors. With regard to secondary CIS, 5 cases did not have accompanying papillary tumor, and in 16 cases accompanying papillary tumors were observed. Of the 16 cases, five patients had pTa/G2 tumors, four patients pTa/G3 tumors, two patients pT1/G2 tumors and five patients pT1/G3 tumors. Eleven of them had G3 element and/or T1 tumors.

Table shows the background according to the three types of CIS. Concurrent CIS occupied more extent than secondary CIS, and the difference was significant . Seventy-three, 57 and 50% of patients with primary CIS, secondary CIS and concurrent CIS, respectively, had positive urine cytology. Patients with primary CIS tended to show positive preoperative urine cytology compared with those with concurrent CIS . On the other factors of background and therapy, there were not any significant differences among the three types of CIS.

The recurrence-free survival in overall patients treated for carcinoma in situ . The 5-year recurrence-free survival rate was 53.3%.

Signs And Symptoms Of Bladder Cancer

Sometimes bladder cancer doesnt have many symptoms. Signs or symptoms can include:

  • blood in your urine
  • pain or burning when passing urine
  • not being able to pass urine when you need to.

Not everyone with these symptoms has bladder cancer. If you have any of these symptoms or are worried, always see your doctor.

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What Causes Bladder Cancer

Bladder cancer occurs when cells within the lining of the bladder wall begin to grow in a disordered, uncontrolled way.

Exactly what prompts this disordered growth is not fully known. However, several factors associated with a higher risk of bladder cancer have been identified, including:

  • Age – most people diagnosed with bladder cancer are older than 55 years.
  • Sex – compared to women, men are 4 times more likely to develop bladder cancer.
  • Smoking – smoking is associated with around half of all bladder cancers in men and women.
  • Race – in the United States, White Americans have the highest rate of bladder cancer.
  • Previous bladder cancer – people who have had bladder cancer may have a recurrence.
  • Workplace exposures – certain chemicals in some workplaces may contribute to higher rates of bladder cancer in workers. For example, painters, hairdressers, and truck drivers are at increased risk.
  • Arsenic in drinking water.
  • Certain types of medication.

Treatment Of Stage Iv Bladder Cancer

Histopathology Bladder Transitional Carcinoma-in-situ

For information about the treatments listed below, see the Treatment Option Overview section.

Treatment of stage IV bladder cancer that has not spread to other parts of the body may include the following:

Treatment of stage IV bladder cancer that has spread to other parts of the body, such as the lung, bone, or liver, may include the following:

  • External radiation therapy as palliative therapy to relieve symptoms and improve quality of life.
  • Urinary diversion or cystectomy as palliative therapy to relieve symptoms and improve quality of life.
  • A clinical trial of new anticancer drugs.

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

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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

Can Bladder Cancer Be Cured

When detected at an early stage, bladder cancer can usually be treated successfully whereas later-stage cancers may present greater challenges for the patient and their healthcare team. As discussed later, people who have had bladder cancer are at risk for recurrence for the best chance of successfully treating recurrent cancer, early detection is again important.

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Survival Of Patients With Carcinoma In Situ Of The Urinary Bladder

Liang Cheng M.D.

Department of Pathology, Indiana University School of Medicine, Indianapolis, Indiana

Department of Pathology, Mayo Clinic, Rochester, Minnesota

Department of Urology, Mayo Clinic, Rochester, Minnesota

Liang Cheng M.D.

Department of Pathology, Indiana University School of Medicine, Indianapolis, Indiana

Department of Pathology, Mayo Clinic, Rochester, Minnesota

Department of Urology, Mayo Clinic, Rochester, Minnesota

Understanding Your Bladder Cancer Stage

Slide Show: Bladder Cancer

A staging system is a standard way for the cancer care team to describe how far a cancer has spread. The staging system most often used for bladder cancer is the American Joint Committee on Cancer TNM system, which is based on 3 key pieces of information:

  • T describes how far the main tumor has grown through the bladder wall and whether it has grown into nearby tissues.
  • N indicates any cancer spread to lymph nodes near the bladder. Lymph nodes are bean-sized collections of immune system cells, to which cancers often spread first.
  • M indicates if the cancer has spread to distant sites, such as other organs, like the lungs or liver, or lymph nodes that are not near the bladder.

Numbers or letters after T, N, and M provide more details about each of these factors. Higher numbers mean the cancer is more advanced. Once a persons T, N, and M categories have been determined, usually after surgery, this information is combined in a process called stage grouping to assign an overall stage.

The earliest stage cancers are called stage 0 , and then range from stages I through IV .

As a rule, the lower the number, the less the cancer has spread. A higher number, such as stage IV, means a more advanced cancer. And within a stage, an earlier letter means a lower stage. Cancers with similar stages tend to have a similar outlook and are often treated in much the same way.

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