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.
What Is The Most Aggressive Form Of Bladder Cancer
In general, bladder cancers that are muscle invasive and/or have high-grade cells are the most serious and aggressive. The less common types of bladder cancer such as squamous cell carcinoma, adenocarcinoma, and small cell carcinoma have a greater tendency to be muscle invasive compared to urothelial carcinoma. However, if left untreated, initially low-grade, non-muscle invasive urothelial carcinoma can progress into the bladder wall and spread to other parts of the body.
The prognosis for bladder cancer is very favorable when the disease is detected early, so it is important to see your doctor if you are experiencing symptoms that could be due to bladder cancer. The most common early sign of bladder cancer is the presence of blood in the urine . Other symptoms that may be experienced include urinary irritation and changes in bladder habits. For further information regarding the signs and symptoms of bladder cancer, see Bladder Cancer Symptoms.
Treating Bladder Cancer That Progresses Or Recurs
If cancer continues to grow during treatment or comes back after treatment , treatment options will depend on where and how much the cancer has spread, what treatments have already been used, and the patient’s overall health and desire for more treatment. Its important to understand the goal of any further treatment if its to try to cure the cancer, to slow its growth, or to help relieve symptoms as well as the likely benefits and risks.
For instance, non-invasive bladder cancer often comes back in the bladder. The new cancer may be found either in the same place as the original cancer or in other parts of the bladder. These tumors are often treated the same way as the first tumor. But if the cancer keeps coming back, a cystectomy may be needed. For some non-invasive tumors that keep growing even with BCG treatment, and where a cystectomy is not an option, immunotherapy with pembrolizumab might be recommended.
Cancers that recur in distant parts of the body can be harder to remove with surgery, so other treatments, such as chemotherapy, immunotherapy, targeted therapy, or radiation therapy, might be needed. For more on dealing with a recurrence, see Understanding Recurrence.
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Morphologic Variants Of Urothelial Carcinoma
Some cases of urothelial carcinoma show morphologic patterns that are recognized as variants morphology. Those include nested variant, micropapillary, lymphoepithelioma-like, sarcomatoid, small cell carcinoma, and adenocarcinoma. These are frequently under-recognized in bladder biopsies and could have therapeutic implications with different criteria for surgery and different chemotherapy regimens.
Treatment Options For Bladder Cancer At Moffitt
At Moffitt Cancer Center, the multispecialty team in our Genitourinary Oncology Program will work together to diagnose your cancer and develop the best possible individualized treatment plan, always focused on preserving a positive quality of life. We are the only National Cancer Institute-designated Comprehensive Cancer Center based in Florida, and one of just 51 across the country. Focused, individualized attention from leading experts in the research and treatment of all types of bladder cancer thats the kind of assurance you need to put your mind at ease.
You dont need a referral to contact Moffitt Cancer Center, so call us at , or fill out a new patient registration form online to begin exploring the ways in which we can partner with you to return you to health.
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Treating Stage Ii Bladder Cancer
These cancers have invaded the muscle layer of the bladder wall , but no farther. Transurethral resection is typically the first treatment for these cancers, but it’s done to help determine the extent of the cancer rather than to try to cure it.
When the cancer has invaded the muscle, radical cystectomy is the standard treatment. Lymph nodes near the bladder are often removed as well. If cancer is in only one part of the bladder, a partial cystectomy may be done instead. But this is possible in only a small number of patients.
Radical cystectomy may be the only treatment for people who are not well enough to get chemo. But most doctors prefer to give chemo before surgery because it’s been shown to help patients live longer than surgery alone. When chemo is given first, surgery is delayed. This is not a problem if the chemo shrinks the bladder cancer, but it might be harmful if the tumor continues to grow during chemo.
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.
For people who have had surgery, but the features of the tumor show it is at high risk of coming back, the immunotherapy drug, nivolumab, might be offered. When given after surgery, nivolumab is given for up to one year.
For patients who cant have surgery because of other serious health problems, TURBT, radiation, chemotherapy, or some combination of these may be options.
What Tests Will I Have If My Doctor Suspects Bladder Cancer Or Another Urinary Problem
Your doctor will want to analyze your urine to determine if an infection could be a cause of your symptoms. A microscopic examination of the urine, called cytology, will look for cancer cells.
A cystoscopy is the main procedure to identify and diagnose bladder cancer. In this procedure, a lighted telescope is inserted into your bladder from the urethra to view the inside of the bladder and, when done under anesthesia, take tissue samples , which are later examined under a microscope for signs of cancer. When this procedure is done in the doctors office, local anesthesia gel is placed into the urethra prior to the procedure to minimize the discomfort.
If the diagnosis of bladder cancer is made, then the next step is to remove the tumor for detailed staging and diagnosis.
Transurethral resection is a procedure done under general or spinal anesthesia in the operating room. A telescope is inserted into the bladder and the tumor is removed by scraping it from the bladder wall , using a special cystoscope . This procedure is diagnostic as well as therapeutic.
This often can be done as an outpatient procedure, with patients discharged from hospital the same day. After removal, the tumor is analyzed by a pathologist, who will determine the type of tumor, the tumor grade and the depth of invasion. The purpose of the procedure is to remove the tumor and obtain important staging information .
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If Treatment Does Not Work
Full recovery from bladder cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or metastatic.
This diagnosis is stressful, and for many people, advanced cancer is difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, expertise, and knowledge to support patients and their families, and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.
Patients who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is a specific type of palliative care designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Learn more about advanced cancer care planning.
After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.
Advanced Or Metastatic Transitional Cell Carcinomas
First-line regimens for advanced or metastatic transitional cell carcinomas consists of and ) or a combination of , , , and .
Taxanes or have been used as second-line therapy .
such as is often used as second-line therapy for metastatic urothelial carcinoma that has progressed despite treatment with GC or MVAC.
In May 2016, the FDA granted to for locally advanced or metastatic treatment after failure of cisplatin-based chemotherapy. The failed to achieve its of .
In April 2021, the FDA granted accelerated approval to for people with locally advanced or metastatic urothelial cancer who previously received a platinum-containing chemotherapy and either a programmed death receptor-1 or a programmed death-ligand 1 inhibitor.
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How To Prevent Bladder Cancer
Bladder cancer may not be preventable in many cases, but there are some ways to reduce the risks. Keep your dog healthy and at an ideal weight. Minimize your dog’s exposure to chemicals like pesticides and lawn treatments. Be sure to bring your dog to the vet for wellness examinations as recommended your vet may be able to identify a health problem before symptoms develop.
Early screening is available in the form of gene testing. A genetic mutation called BRAF V595E is found in about 80% of dogs with bladder cancer. Some laboratories offer a PRC test for this mutation. A negative result will not guarantee your dog is safe from bladder cancer, but a positive result may help you take early action. Ask your vet about the availability of this test.
Mutsaers, Anthony J., et al. Canine Transitional Cell Carcinoma. Journal of Veterinary Internal Medicine, vol. 17, no. 2, 2003, p. 136.
Five Types Of Standard Treatment Are Used:
One of the following types of surgery may be done:
- Transurethral resection with fulguration: Surgery in which a cystoscope is inserted into the bladder through the urethra.A tool with a small wire loop on the end is then used to remove thecancer or to burn the tumor away with high-energy electricity. This is known as fulguration.
- Radical cystectomy: Surgery to remove the bladder and anylymph nodes and nearby organs that contain cancer. This surgery may bedone when the bladder cancer invades the muscle wall, or when superficialcancer involves a large part of the bladder. In men, the nearby organs that areremoved are the prostate and the seminal vesicles. In women, the uterus, theovaries, and part of the vagina are removed. Sometimes, when the cancer hasspread outside the bladder and cannot be completely removed, surgery to removeonly the bladder may be done to reduce urinarysymptoms caused by the cancer.When the bladder must be removed, the surgeon creates another way for urine toleave the body.
- Partial cystectomy: Surgery to remove part of thebladder. This surgery may be done for patients who have a low-grade tumor thathas invaded the wall of the bladder but is limited to one area of the bladder.Because only a part of the bladder is removed, patients are able to urinate normally afterrecovering from this surgery. This is also called segmental cystectomy.
- Urinary diversion: Surgery to make a new way forthe body to store and pass urine.
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Are There Different Types Of Bladder Cancer
Yes. There are two broad types of cancers in the bladder: primary and metastatic. Primary bladder cancers are those that begin in the bladder itself. Metastatic cancers are those that originated in another organ and then spread to the bladder. Other tumors can get into the bladder through the bloodstream, through the lymphatic system, or by directly extending from a nearby organ, such as the prostate or the cervix.
Cancers originating in the bladder are far more common than cancers that spread to the bladder from another location. There are several types of primary tumors. Recall that transitional cell cancer accounts for at least 90% of all bladder cancers. Transitional cell tumors can be classified as papillary, sessile, or a mix of both types. Papillary tumors look like a piece of cauliflower attached to the wall by a short stalk sessile tumors look flat and are broad-based. Almost 70% of transitional cell tumors are papillary types, which tend to have a better prognosis than sessile tumors. Less common types of bladder cancer include squamous cell cancer, adenocarcinoma, and urachal carcinoma.
Other Squamous Cell Carcinoma Risk Factors
Having bladder diverticula may increase an individuals chance of developing SCC. Rarely, bacillus Calmette-Guerin treatment for CIS has been reported to lead to development of SCC. Development of bladder cancer at a younger age has been associated with bladder exstrophy. SCC has also been described in urachal remnants.
Coffee consumption does not increase the risk of developing bladder cancer. Early studies of rodents and a minority of human studies suggested a weak connection between artificial sweeteners and bladder cancer however, most recent studies show no significant correlation.
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After Bladder Cancer Has Been Diagnosed Tests Are Done To Find Out If Cancer Cells Have Spread Within The Bladder Or To Other Parts Of The Body
The process used to find out if cancer has spread within thebladder lining and muscle or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:
Other Types Of Bladder Cancer
Approximately 2% of bladder cancers are adenocarcinomas. Nonurothelial primary bladder tumors are extremely rare and may include small cell carcinoma, carcinosarcoma, primary lymphoma, and sarcoma . Small cell carcinoma of the urinary bladder accounts for only 0.3-0.7% of all bladder tumors. High-grade urothelial carcinomas can also show divergent histologic differentiation, such as squamous, glandular, neuroendocrine, and sarcomatous features.
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World Health Organisation Grades
Another grading system sometimes used for early bladder cancer. This divides bladder cancers into 4 groups:
- urothelial papilloma means it is a non cancerous tumour
- papillary urothelial neoplasm of low malignant potential means it is a very slow growing tumour that is unlikely to spread
- low grade papillary urothelial carcinoma is a slow growing cancer that is unlikely to spread
- high grade papillary urothelial carcinoma is a quicker growing cancer that is more likely to spread
American Joint Committee on Cancer manual S Edge and othersSpringer, 2017
The 2016 WHO Classification of Tumours of the Urinary System and Male Genital Organs Part B: Prostate and Bladder TumoursP A Humphrey and othersEuropean Urology, 2016. Volume 70, Issue 1, Pages 106-119
Bladder cancer: diagnosis and management of bladder cancerNational Institute of Health and Clinical Excellence, 2015
BMJ Best Practice. Bladder CancerD Lamm and othersBMJ Publishing Group,
About The Bladder Renal Pelvis And Ureter
The bladder is a hollow organ in the pelvis that stores urine before it leaves the body during urination. This function makes the bladder an important part of the urinary tract. The urinary tract is also made up of the kidneys, ureters, and urethra. The renal pelvis is a funnel-like part of the kidney that collects urine and sends it into the ureter. The ureter is a tube that runs from each kidney into the bladder. The urethra is the tube that carries urine out of the body. The prostate gland is also part of the urinary tract.
The bladder, like other parts of the urinary tract, is lined with a layer of cells called the urothelium. This layer of cells is separated from the bladder wall muscles, called the muscularis propria, by a thin, fibrous band called the lamina propria.
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Treatment For Stage 2 And Stage 3
Treatment for stage 2 and stage 3 bladder cancer may include:
- removal of part of the bladder in addition to chemotherapy
- removal of the whole bladder, which is a radical cystectomy, followed by surgery to create a new way for urine to exit the body
- chemotherapy, radiation therapy, or immunotherapy that can be done to shrink the tumor before surgery, to treat the cancer when surgery isnt an option, to kill remaining cancer cells after surgery, or to prevent the cancer from recurring