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Cleveland Clinic Bladder Cancer Treatment

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What Is The Outlook For Someone Who Has Had Bladder Tumor Biopsy And Resection

Byron Lee, MD, PhD | Cleveland Clinic Urology

Bladder tumor biopsy and resection is a successful treatment for early stage bladder cancer. It can prevent cancer from spreading into the bladder muscle wall. Invasive bladder cancers that spread require more extensive treatment.

However, bladder cancer often comes back . More TURBT procedures may be needed. Your doctor will do frequent follow-up checkups with you to look for signs that the cancer has returned. The risks of repeated TURBT procedures is small.

Some providers might choose to burn off smaller tumors rather than remove them.

If the TURBT shows that you have a more advanced bladder cancer, youll probably need further treatment. This could include:

  • A more extensive TURBT.
  • Surgery to remove the tumor.
  • Surgery to remove the bladder.
  • Bacillus Calmette-Guerin therapy or BCG. This is a type of therapy that uses the bodys own immune system to fight the cancer.

Your urologist and pathologist will determine the best course of treatment based on the staging of the tumor and your personal medical history. TURBT can help in staging the cancer by determining if the cancer has invaded the bladder wall. Staging refers to determining how serious the cancer is.

Department Of Defense Awards $24m For Bladder Cancer Immunotherapy Research

Drs. Mian, Gupta and Hwanga multi-disciplinary team of researchers and clinicianswill look for ways to optimize immune checkpoint inhibitor therapy, including testing novel combinatory treatments and identifying predictive biomarkers of treatment response.

03/24/2020

Cleveland Clinic is one of the highest volume centers of excellence for bladder cancer research and care in the nation. With a new $2.4 million Translational Team Science Award from the Department of Defense , physician-scientist and project lead Omar Mian, MD, PhDas well as partnering investigators Shilpa Gupta, MD, and Tae Hyun Hwang, PhD, and a team of talented collaboratorslook to not only bolster Cleveland Clinics bladder cancer program, but also its rapidly expanding portfolio of immuno-oncology research.

A class of drugs called immune checkpoint inhibitors have emerged as a promising immunotherapy approach for treating a host of cancers, including of the bladderthe fourth most commonly diagnosed cancer in the Veterans Administration Health System.

What Happens Before Bladder Surgery

Your healthcare provider may recommend you stop taking any medications that risk bleeding during your bladder surgery. You should stop the following medications about a week before:

NSAIDs, including:

  • Acetylsalicylic acid .

Some antibiotics, blood pressure medications and herbal medications or supplements may also be restricted. Youll also be asked to stop smoking and using tobacco products. Besides the negative health consequences that smoking has, tobacco use can lead to higher risks both during and after surgery. Tobacco has been proven to slow down the healing process and decrease the effectiveness of the immune system.

Dont discontinue any medication without your healthcare providers instruction.

Your provider will likely recommend you change your diet the day before your surgery and follow a clear liquid diet starting the morning before your surgery. This includes juices without pulp, soup broth and Jell-O. Its also important to arrange for someone to care for you after surgery as returning to normal activity is not recommended immediately.

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How Do Healthcare Providers Diagnose Bladder Cancer

Healthcare providers do a series of tests to diagnose bladder cancer, including:

  • Urinalysis: Providers use a variety of tests to analyze your pee. In this case, they may do urinalysis to rule out infection.
  • Cytology: Providers examine cells under a microscope for signs of cancer.
  • Cystoscopy: This is the primary test to identify and diagnose bladder cancer. For this test, providers use a pencil-sized lighted tube called a cystoscope to view the inside of your bladder and urethra. They may use a fluorescent dye and a special blue light that makes it easier to see cancer in your bladder. Providers may also take tissue samples while doing cystoscopies.

If urinalysis, cytology and cystoscopy results show you have bladder cancer, healthcare providers then do tests to learn more about the cancer, including:

Healthcare providers then use what they learn about the cancer to stage the disease. Staging cancer helps providers plan treatment and develop a potential prognosis or expected outcome.

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 your bladder or in the connective tissue just below the lining, but hasnt invaded the main muscle wall of your bladder.

Stages II to IV denote invasive cancer:

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

Standards Of Care Shift Toward Patient Specificities In Bladder And Prostate Cancers

Urologic Cancer: Prostate, Bladder, Kidney and Testicular Treatment ...

In Partnership With:

Shilpa Gupta, MD, discussed potential therapies for patients with cisplatin-ineligible metastatic urothelial carcinoma, the benefits of sacituzumab govitecan and erdafitinib in later-line urothelial carcinoma, and treatment options for nonmetastatic castration-resistant prostate cancer.

The future looks bright for the treatment of urothelial carcinoma in the frontline setting and beyond, ushered in by a collection of successful clinical trial readouts that may deepen the efficacy of personalized treatment sequencing, according to Shilpa Gupta, MD. Additionally, advances in prostate cancer diagnosis and treatment are arising with the use of increasingly sensitive PSMA PET scans that guide therapeutic decisions.

As the current treatment options , platinum chemotherapies still remain the backbone of frontline therapy. Single-agent immunotherapy should only be used in select patients who are platinum ineligible. Avelumab maintenance should be used after the use of platinum chemotherapy if patients dont progress, Gupta said following an OncLive® State of the Science Summit on bladder and prostate cancer, which she chaired.

Gupta is the director of Genitourinary Medical Oncology at Taussig Cancer Institute and co-leader of the Genitourinary Oncology Program in the Department of Hematology and Medical Oncology at Cleveland Clinic in Cleveland, Ohio.

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What Is Bladder Cancer

Bladder cancer is a relatively rare form of cancer that starts in the lining of your bladder. Your bladder is a small hollow organ that holds your pee . Healthcare providers have many ways to treat bladder cancer, including surgery to remove bladder cancer. Bladder cancer may come back after treatment, so people with bladder cancer should be vigilant about following up with their healthcare providers.

Healthcare providers can treat early-stage bladder cancer cancer thats found and treated before it can spread but about 75% of early-stage bladder cancers come back.

How does this condition affect my body?

Your bladder is a triangle-shaped organ thats centered between your hip bones, above your urethra and below your kidneys. Pee from your kidneys drains into your bladder, which is lined with tissue called urothelium. Urothelium is made of cells that stretch when your bladder fills with pee and collapses when its empty.

Bladder cancer happens when certain cells in the tissue lining your bladder mutate or change, becoming abnormal cells that multiply and cause tumors in your bladder. Left untreated, bladder cancer may grow through your bladder walls to nearby lymph nodes and then other areas of your body, including your bones, lungs or liver.

What are bladder cancer types?

There are three types of bladder cancer. Each type is named for the cells that line the wall of your bladder where the cancer started. Bladder cancer types include:

How common is bladder cancer?

What Is Gallbladder Cancer

Gallbladder cancer occurs when malignant cells grow in your gallbladder, a pear-shaped organ located under your liver in your upper abdomen.

The outside of your gallbladder is made up of four layers of tissue:

  • The inner layer .
  • The muscle layer.
  • The connective tissue layer.
  • The outer layer .

Gallbladder cancer begins in the mucosal layer and moves outward. It is often found by chance after gallbladder surgery or its not discovered until it has progressed to a late stage.

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Assessing Outcomes Among Surgical Approaches

In 2020, a team led by , published a study that examined perioperative outcomes for open radical cystectomy, robotic radical cystectomy with extracorporeal urinary diversion, and robotic radical cystectomy with intracorporeal urinary diversion at Cleveland Clinic. The study found that robotic radical cystectomy with intracorporeal urinary diversion outperformed the other approaches when it came to blood loss, length of stay and complication rates.

These findings underscore the perioperative benefits of this technique, which we have understood anecdotally for years, says Dr. Lee, but there were still questions regarding oncologic outcomes since robotic cystectomy is a relatively newer surgical approach, and muscle invasive bladder cancer can exhibit very different biological behavior compared with other urologic cancers that we routinely manage robotically.

Dr. Lee and his team once again examined the experience at Cleveland Clinic to evaluate found of radical cystectomy as they relate to surgical approach. They found no differences in rates or patterns of cancer recurrence.

How Common Is Bladder Surgery

Dr. Garcia on Selecting Second-line Immunotherapy in Bladder Cancer

Almost 85,000 people are expected to be diagnosed with bladder cancer in 2021. Its the sixth most common cancer in the United States and the third most common cancer for males. Bladder surgery is typically part of the treatment plan for bladder cancer. Radical cystectomy where your entire bladder is removed is the type of bladder surgery used for muscle-invasive bladder cancer .

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What Happens In Cancer Clinical Trials

In clinical trials, patients receive treatment and doctors carry out research on how the treatment affects patients. A persons progress is closely monitored during the trial. Once the treatment portion of the trial has been completed, patients may continue to be followed in order to gather information regarding specific endpoints. These endpoints are defined prior to the study being started and may include time for disease progression and/or overall survival.

While clinical trials have risks for the people who take part, each study also takes steps to protect patients.

Informed Consent

Protocols

The protocol is the action plan for a clinical trial. The plan states what will be done in the study and why. It outlines how many people will take part in the study, what types of patients may take part, what tests they will receive and how often, as well as the treatment plan. Each doctor that treats patients in the study uses the same protocol, and must follow the guidelines that are specified. The federal Food and Drug Administration has general guidelines that must be followed by any physician or institution conducting clinical trials. Before the FDA can approve a treatment, the study results are audited to ensure the trial was conducted safely and according to these guidelines.

Eligibility Criteria

Is Gallbladder Cancer Fatal Whats The Survival Rate

Gallbladder cancer is usually not found until its in a later stage. One study discovered that 43% of gallbladder cancers were diagnosed after the cancer spread to nearby organs or lymph nodes, and 42% were found after the cancer spread to distant organs or lymph nodes. Because its often found late, after it has spread to other areas of the body, gallbladder cancer can be deadly.

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Can Gallbladder Cancer Be Cured How Is Gallbladder Cancer Treated What Medicines May Help With Gallbladder Cancer

To cure gallbladder cancer, it must be found before it has spread to other organs. The stage of cancer affects the treatment. Localized cancer may be treated with:

  • Surgery: The surgical removal of your gallbladder and nearby tissue is called a cholecystectomy. The surgeon also may remove lymph nodes located near the gallbladder and part of the liver near the gallbladder.
  • Radiation: Radiation therapy uses high levels of radiation to kill the cancer cells or stop them from multiplying, while minimizing damage to healthy cells. Radiation uses a machine outside of your body to direct radiation to your cancer. If you have a radiation treatment you may experience side effects such as: skin problems, nausea and vomiting, tiredness, liver damage and/or diarrhea.
  • Chemotherapy: Chemotherapy is the use of drugs to kill cancer cells or stop them from multiplying. Chemotherapy drugs may be injected or taken orally . Examples of chemo drugs include Gemcitabine , cisplatin , 5-fluorouracil , capecitabine and oxaliplatin . Chemo side effects include tiredness, easy bruising, easy bleeding, infections, hair loss, mouth sores, loss of appetite, diarrhea and nausea and vomiting.

Some clinical trials are trying new types of treatment:

  • Radiation sensitizers.

What Conditions Are Treated With Bcg Treatment

What to Eat After You Have Your Gallbladder Removed

BCG treatment is used to address early-stage bladder cancer. This includes bladder cancers that havent invaded your bladder wall muscle, such as carcinoma in situ bladder cancers and non-muscle invasive bladder cancers . BCG treatment isnt effective against bladder cancer that has metastasized .

Clinical trials are currently underway to explore BCG treatment for fibromyalgia and diabetes. Experts believe that BCG treatment may increase cytokines , which could potentially benefit people with these conditions. More research is needed in these areas, though.

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Is There A Risk Of Bladder Cancer After Bcg Treatment

Like most cancers, bladder cancer can potentially return after treatment. Statistically, cancer will recur in up to 40% of people who receive BCG treatment. Its important to note, however, that even if the cancer comes back, it may not progress.

Low-grade bladder cancer usually doesnt spread to other areas of your body. But people who have low-grade bladder cancer have a higher risk of developing other low-grade cancers throughout their lifetime.

Less often, aggressive bladder cancer can develop after BCG treatment. If this happens, cystectomy is usually recommended.

What Is The Prognosis For People Who Have Cystectomy

Your recovery depends on the type of bladder removal surgery you have. Typically, patients who undergo a partial cystectomy will have a shorter recovery period compared with patients who undergo a radical cystectomy. Many patients will have poor appetite and abnormal bowel function immediately after radical cystectomy, and complete recovery may take several weeks to months.

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Are Scented Candles Toxic

For every person who loves to unwind with a scented candle, theres another person who gets a headache just thinking about them.

There isnt any science that suggests scented candles are inherently more dangerous than the unscented variety. Like all candles, they release volatile organic compounds, but do so in quantities that shouldnt pose a health risk. For the safest possible aromatherapeutic adventure, select high-quality candles that dont use dye or paraffin.

Regardless of toxicity, many people have allergic reactions to scented candles. For some, scented candles can even trigger asthma attacks.

Simply put, when it comes to scented candles, your mileage may vary.

What about wick toxicity?

While once a source of considerable concern, many countries have taken action to prevent the use of lead and metal-cored candle wicks, which can produce dangerous emissions and cause lead poisoning.

Australia was the first country to ban the use of lead wicks. While most American manufacturers stopped using lead in their candle wicks back in the 1970s, the Consumer Product Safety Commission didnt ban the sale and importation of candles with lead-core wicks until 2003.

If youre unsure whether your country has banned lead-core candle wicks, just make a point to shop for candles with paper-core, cotton or wood wicks.

Christopher Wee Md Of Cleveland Clinic Presented On The Management Of Nonmetastatic Crpc How Might The 3 National Comprehensive Cancer Network

Doctor Reconstructs Man’s Bladder Using His Small Intestine

These are all in the same class of agents, androgen receptor inhibitors. The discussion of all the studies was that theres a delay to the development of metastatic disease, but we should carefully weigh whether patients need these treatments or if we could follow them on just ADT if their prostate-specific antigen doubling time is less than 10 months.

Biomarkers will help us define this, and especially in the era of PSMA PET scans, is a shrinking area. we may not have many nonmetastatic patients because the PSMA PET is so sensitive at picking up subtle disease.

This was a great discussion on what options we have and, toxicity-wise, which agents we could use, depending on patients toxicity tolerances and comorbidities. For example, with apalutamide, the main toxicity is rash, but otherwise well tolerated. Enzalutamide can have more significant toxicity compared with darolutamide or apalutamide. Darolutamide has the most favorable toxicity profile.

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Bladder Preservation Options For Patients With Muscle

Recognizing that bladder preservation may play an increasing role in the management of muscle-invasive bladder cancer, Nima Almassi, MD, is leading research to improve patient selection for this approach. One such option is partial cystectomy, a surgical treatment in which only the portion of the bladder that contains cancer is removed, often in conjunction with chemotherapy.

Right now, only a very select group of patients qualify for this procedure, but we are actively investigating clinical characteristics and outcomes that may allow us to broaden the selection pool and offer a less-invasive approach to more patients.

Cleveland Clinic is participating in a multicenter clinical trial examining the safety of bladder-sparing in select patients with muscle-invasive bladder cancer who have a complete response to chemotherapy.

Studies have shown that patients with specific genetic changes in their bladder cancer respond very well to chemotherapy, with many patients having no residual cancer identified after completing chemotherapy. In this trial, patients who have one of these specific genetic changes and a full response to chemotherapy are managed with surveillance, rather than undergoing cystectomy.

Our goal is to provide as many novel options as possible in service of our patients, concludes Dr. Almassi.

How Should I Prepare For Bcg Treatment For Bladder Cancer

Prior to BCG treatment, your healthcare provider will give you a list of specific guidelines to help you prepare. In general, you should avoid caffeinated beverages and diuretics for four hours before your appointment. When you arrive for your procedure, you should pee to ensure that your bladder is empty.

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