There Are Different Types Of Treatment For Patients With Bladder Cancer
Different types of treatment are available for patients with bladder cancer. Some treatments are standard , and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Bladder Cancer Clinical Trials
Major drug companies continually research and develop new medications and treatments for bladder cancer that must be shown to be safe and effective before doctors can prescribe them to patients. Through clinical trials, researchers test the effects of new drugs on a group of volunteers who have bladder cancer. Following a strict protocol and using carefully controlled conditions, researchers evaluate the investigational drugs under development and measure the ability of the new drug to treat bladder cancer, its safety, and any possible side effects.
Some patients are reluctant to take part in clinical trials for fear of getting no treatment at all. But patients who participate in clinical trials receive the most effective therapy currently available for the condition, or they may receive treatments that are being evaluated for future use. These bladder cancer drugs may be even more effective than current treatment. Comparing them in a clinical trial is the only way to find out.
Hereâs where to find information about whether a bladder cancer clinical trial is right for you.
This website lists industry-sponsored clinical trials that are actively recruiting patients.
American Cancer Society: âBladder Cancer Treatment,â âBladder Cancer Surgery,â âRadiation Therapy for Bladder Cancer,â âChemotherapy for bladder cancer,â âFDA Approves New Immunotherapy Drug for Bladder Cancer,â âImmunotherapy for bladder cancer.â
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.
- 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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Side Effects Of Intravesical Chemotherapy
Because intravesical chemotherapy puts the drugs directly into the bladder, it has fewer side effects than systemic chemotherapy .
The main side effect is bladder inflammation . Signs of cystitis include wanting to pass urine more often or a burning feeling when urinating. Drinking plenty of fluids can help. If you develop a bladder infection, your doctor can prescribe antibiotics. In some people, intravesical chemotherapy may cause a rash on the hands or feet. Tell your doctor if this occurs.
Intravesical Therapy For Bladder Cancer
With intravesical therapy, the doctor puts a liquid drug right into your bladder rather than giving it by mouth or injecting it into your blood. The drug is put in through a soft catheter that’s put into your bladder through your urethra. The drug stays in your bladder for up to 2 hours. This way, the drug can affect the cells lining the inside of your bladder without having major effects on other parts of your body.
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Ways To Relieve Chemo Side Effects
For many patients, the side effects of chemotherapy go away after treatment is completed.1-3 However, there are also ways to help relieve side effects that do occur during or after chemotherapy treatment. Be sure to let your healthcare providers know about any side effects that you are experiencing, and if any of them have been getting worse.
To help reduce the side effects of nausea and vomiting, for example, there are medications that can be used to help prevent them. If you are experiencing a loss of appetite, it may be helpful to eat smaller meals more frequently rather than fewer larger meals. To make sure they consume enough calories to help fuel their bodies, some patients find it helpful to consume high calorie meal drinks or to add protein powders into their diet.
Because chemotherapy can cause side effects in the mouth, consider visiting your dentist for a check-up and cleaning before starting chemotherapy. If you are worried about the possibility of hair loss due to chemotherapy, it may be helpful to buy hats, scarves, or wigs in advance before treatment starts.
Treatments For Bladder Cancer
If you have bladder cancer, your healthcare team will create a treatment plan just for you. It will be based on your health and specific information about the cancer. When deciding which treatments to offer for bladder cancer, your healthcare team will consider:
- other medical problems you have
- what you prefer or want
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Side Effects Of Intravesical Therapies
BCG immunotherapy can be more toxic than Mitomycin chemotherapy. Common side effects of BCG include flu-like symptoms, fatigue, fever, chills, or bladder irritation. Recurring use of BCG increases the likelihood of more severe side effects like greater bladder irritation and inflammation and a burning feeling in the bladder and blood in urine.1
Intravesical administration helps to reduce and avoid many of the side effects usually linked to chemotherapy. Additionally, there are fewer maintenance side effects of mitomycin chemotherapy than for BCG. Side effects of mitomycin are irritation, a burning sensation in the bladder, and blood in urine.
Your physician will provide instructions on any special care requirements and advice on how to manage treatment side effects. Intravesical BCG and Mitomycin are contraindicated under certain conditions. Be sure to provide a complete medical history to your medical team before beginning treatment.
Chemotherapy For Bladder Cancer
Chemotherapy uses anticancer drugs to destroy cancer cells. It is sometimes used to treat bladder cancer. Your healthcare team will consider your personal needs to plan the drugs, doses and schedules of chemotherapy. You may also receive other treatments.
Chemotherapy is given for different reasons. You may have chemotherapy to:
- destroy cancer cells in the body
- shrink a tumour before other treatments such as surgery or radiation therapy
- destroy cancer cells left behind after surgery and reduce the risk that the cancer will come back
- make cancer cells more sensitive to radiation therapy
- relieve pain or control the symptoms of advanced bladder cancer
Chemotherapy for bladder cancer that has not grown into the muscle of the bladder wall is given as intravesical therapy, which means that the drugs are placed directly into the bladder. Chemotherapy may also be a systemic therapy given through a needle into a vein. This means that the drugs travel through the bloodstream to reach and destroy cancer cells all over the body, including those that may have broken away from the primary tumour in the bladder.
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Is Combination Chemotherapy And Radiation Used For Bladder Cancer Treatment
In recent years, chemotherapy and radiation have been combined to provide a bladder preservation therapy for higher risk cases. In the past radiation therapy alone was used because it effectively shrunk tumors. Bladder cancer tumor cells are chemosensitive, susceptible to the cell-killing effects of anticancer drugs. Adding combined chemotherapy to radiation has improved results. To ensure the success of bladder preservation therapy, there are at least three requirements which should be met: 1) complete resection of the tumor by TURBT 2) no obstruction of 1 or both kidneys as a result of the bladder tumor and 3) no T4 bladder tumors.
If the tumors do not respond to an initial course of chemotherapy and radiation, it may be reasonable to perform, if medically possible, a cystectomy.
Information and services provided by the Bladder Cancer Advocacy Network are for informational purposes only. The information and services are not intended to be substitutes for professional medical advice, diagnosis, or treatment. If you are ill or suspect that you are ill, seek professional medical attention immediately! BCAN does not recommend or endorse any specific physicians, treatments, procedures, or products even though they may be mentioned on this site.
Patients May Want To Think About Taking Part In A Clinical Trial
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today’s standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
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Whats Next In Bladder
The advancements mentioned here are among the most promising, but there are plenty more.
For example, new imaging techniques may soon make radiation treatments more precise. Genetic sequencing of cancer cells is also a hot area of research. Were getting better at identifying biomarkers of the disease that allow us to tailor our approaches, Lotan says. In just the last three or four years, weve moved forward in identifying underlying signatures of cancers and gene expressions that can help us personalize treatment options.
Lotan notes that many in his field are also hopeful that the future will yield accurate screening protocols for bladder cancer. From a detection standpoint, there hasnt been any major advancement, he says. Newer detection methods use panels of RNA or DNA, which are more sophisticated, but so far we have not done the large scale studies needed to demonstrate clinical utility. Those trials involve thousands of people and a lot of money, he adds, and will hopefully happen soon.
It may be possible to use urine as a screening approach, and theres quite a lot of work going on in that area, Crabb adds. Hes optimistic this work will eventually bear fruit. I think urine screening is the way forward, he says. Its all well and good to develop these expensive new treatments, but prevention, or at least early detection, would be better.
Is There Any Preparation Involved
Its important that you follow your doctors instructions for what to do before and after the procedure. Tell your doctor about all the medications you take. Certain immunosuppressants, antimicrobial therapies, and radiation therapies can interfere with BCG treatment.
Youll be advised to limit your fluid intake for four hours prior to the procedure. You might be told to avoid caffeine for a few hours longer than that, because its a diuretic and could make things more difficult.
Youll be asked to urinate just before the procedure so youll be able to hold the medication in your bladder for several hours.
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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.
Treating Stage Iii Bladder Cancer
These cancers have reached the outside of the bladder and might have grown into nearby tissues or organs and/or lymph nodes . They have not spread to distant parts of the body.
Transurethral resection is often done first to find out how far the cancer has grown into the bladder wall. Chemotherapy followed by radical cystectomy is then the standard treatment.Partial cystectomy is rarely an option for stage III cancers.
Chemotherapy before surgery can shrink the tumor, which may make surgery easier. Chemo can also kill any cancer cells that could already have spread to other areas of the body and help people live longer. It can be especially useful for T4 tumors, which have spread outside the bladder. When chemo is given first, surgery to remove the bladder is delayed. The delay is not a problem if the chemo shrinks the cancer, but it can be harmful if it continues to grow during chemo. Sometimes the chemo shrinks the tumor enough that intravesical therapy or chemo with radiation is possible instead of surgery.
Some patients get chemo after surgery to kill any cancer cells left after surgery that are too small to see. Chemo given after cystectomy may help patients stay cancer-free longer, but so far its not clear if it helps them live longer. If cancer is found in nearby lymph nodes, radiation may be needed after surgery. Another option is chemo, but only if it wasn’t given before surgery.
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Which Chemo Drugs Are Used To Treat Bladder Cancer
Chemo drugs may be used alone or in combination, depending on what theyre being used for, a persons overall health, and other factors.
When chemo is given with radiation, the most common drugs used include:
When chemo is used without radiation, the most common combinations include:
- Gemcitabine and cisplatin
- Dose-dense methotrexate, vinblastine, doxorubicin , and cisplatin
- Cisplatin, methotrexate, and vinblastine
- Gemcitabine and paclitaxel
For some people, the side effects of getting more than one chemo drug might be too much to handle. For those people, treatment with a single drug, such as gemcitabine or cisplatin, may be an option. Other drugs sometimes used alone for bladder cancer include, docetaxel, paclitaxel, doxorubicin, methotrexate, ifosfamide, and pemetrexed.
Doctors give chemo in cycles, with each period of treatment followed by a rest period to allow the body time to recover. Each cycle typically lasts for a few weeks.
Most bladder cancers are transitional cell cancers, but there are other types as well, including squamous cell carcinoma, adenocarcinoma, and small cell carcinoma. These rare types of bladder cancer may be treated with drugs different from those listed above.
Drugs Used To Treat Gallbladder Cancer
The chemo drugs most often used for gallbladder cancer include:
In some cases, 2 of these drugs are combined. For example, combining gemcitabine and cisplatin may help people live longer than getting just gemcitabine alone. When chemo is given with radiation, most often 5-FU or capecitabine is used.
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There Are Three Ways That Cancer Spreads In The Body
- Tissue. The cancer spreads from where it began by growing into nearby areas.
- Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
- Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.
A Course Of Chemotherapy Into Your Bladder
Every session the nurse or doctor puts a catheter through your urethra and into your bladder . Your doctor or specialist nurse puts a liquid chemotherapy drug into the catheter.
You usually keep the drug in the bladder for 1 or 2 hours. Some hospitals may ask you to change position every now and again to make sure the drug reaches all parts of your bladder.
After the time is up your nurse will drain the liquid out through the catheter. If you have had the catheter removed after the medicine was put in you will need to use the toilet.
Some hospitals allow you to go home with the medicine in your bladder if you live close by and are okay with the treatment. Your team will let you know if you can do this.
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Possible Chemo Side Effects
Chemo drugs attack cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body, such as those in the bone marrow , the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells can be affected by chemo, which can lead to side effects.
The side effects of chemo depend on the type and dose of drugs given and the length of time they are taken. Side effects can include:
- Hair loss
- Increased chance of infections
- Easy bruising or bleeding
These side effects are usually short-term and go away after treatment ends. There are often ways to lessen these side effects or even prevent them. For example, drugs can be given to help prevent or reduce nausea and vomiting. Be sure to ask your doctor or nurse about medicines to help reduce side effects.
Along with the possible side effects above, some drugs can have their own specific side effects. For example, cisplatin and oxaliplatin can damage nerves . This can cause numbness, tingling, weakness, and sensitivity to cold or heat, especially in the hands and feet. This goes away in most patients after treatment stops, but in some cases the effects can be long lasting.
Report any side effects you notice to your medical team so that they can be treated right away. Most side effects can be treated. In some cases, the doses of the chemo drugs may need to be reduced or treatment might need to be delayed or stopped to keep the effects from getting worse.