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Does Bladder Cancer Always Come Back

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What Are The 5

Bladder cancer and its signs and symptoms

In 2020, approximately 17,980 deaths in the United States are predicted to be attributed to bladder cancer1. This represents the eighth most common cause of cancer deaths in men.

The general 5-year survival rate for people with bladder cancer is 77%, while the 10-year survival rate is 70% and the 15-year survival rate is 65%1. Notably, as each patient and cancer are different, it is not possible to definitely know the disease course for an individual patient.

Radiotherapy With A Radiosensitiser

Radiotherapy is given by a machine that beams the radiation at the bladder . Sessions are usually given on a daily basis for 5 days a week over the course of 4 to 7 weeks. Each session lasts for about 10 to 15 minutes.

A medicine called a radiosensitiser should also be given alongside radiotherapy for muscle-invasive bladder cancer. This medicine affects the cells of a tumour, to enhance the effect of radiotherapy. It has a much smaller effect on normal tissue.

As well as destroying cancerous cells, radiotherapy can also damage healthy cells, which means it can cause a number of side effects. These include:

  • diarrhoea
  • tightening of the vagina , which can make having sex painful
  • erectile dysfunction
  • tiredness
  • difficulty passing urine

Most of these side effects should pass a few weeks after your treatment finishes, although there’s a small chance they’ll be permanent.

Having radiotherapy directed at your pelvis usually means you’ll be infertile .

After having radiotherapy for bladder cancer, you should be offered follow-up appointments every 3 months for the first 2 years, then every 6 months for the next 2 years, and every year after that. At these appointments, your bladder will be checked using a cystoscopy.

You may also be offered CT scans of your chest, abdomen and pelvis after 6 months, 1 year and 2 years. A CT scan of your urinary tract may be offered every year for 5 years.

What To Expect During Bcg Treatment

First, make sure you havent had any fluids for four hours before the treatment. Right before you go into the treatment room your doctor or nurse will have you empty your bladder.

Youll lie on your back, and the medical professional will insert a catheter into your urethra and into your bladder, likely using some local numbing, and use this tube to infuse the treatment.

Once the treatment is infused, your doctor or nurse will remove the catheter. Theyll have you lie on your back, each side, and your stomach for 15 minutes each. The BCG mycobacteria needs to touch the bladder cancer cells to activate the immune system. Youll then be free to go but will need to hold off on peeing for another hour.

Verywell / Alex Dos Diaz

For at least six hours after your infusion, youll need to disinfect your pee to ensure none of the mycobacteria spread to anyone else. Pour an equal amount of bleach into the toilet after you pee and let it sit for 15 minutes before flushing.

Also, people with a penis who undergo BCG treatment should avoid sex for 48 hours to ensure they dont pass the mycobacteria to their partners.

You will likely need multiple BCG treatments. They may be given weekly for a few weeks, then less often for months or years to prevent cancer from coming back.

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Living With Bladder Cancer

Cancer is a life-changing experience. And although there’s no surefire way of preventing a recurrence, you can take steps to feel and stay healthy. Eating plenty of fruits, veggies, whole grains, and keeping to modest portions of lean meat is a great start. If you smoke, stop. Limit alcohol to one drink a day for women and up to two drinks a day for men. Daily exercise and regular checkups will also support your health and give you peace of mind.

Treating Bladder Cancer That Progresses Or Recurs

A new test to catch bladder cancer early

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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Transurethral Resection Of Bladder Tumor

This surgery has two purposes. It can be used to confirm the diagnosis of bladder cancer and to see if the muscle layer of the bladder wall has been breached.

In addition, its used to treat early-stage bladder cancer, when the cancer has not grown outside the inner layers of the bladder.

TURBT is performed under general or regional anesthesia, but it doesnt require an abdominal incision. The surgeon accesses the bladder through the urethra with an instrument called a cystoscope.

A wire loop is passed through the cystoscope and into your bladder. The loop is used to remove abnormal tissue or tumors. Samples can then be sent to a pathologist for examination. Using an electric current or high-energy laser, the remaining cancer cells are burned and destroyed.

Most people can go home the day of surgery or the following day. Side effects from TURBT may include bloody urine or pain during urination. These symptoms usually last only a few days. You should be able to get back to your normal schedule in two weeks.

Bladder cancer has a tendency to come back in another part of the bladder. The procedure can be repeated as often as needed. Side effects of repeat TURBT may include scarring of the bladder, which can cause problems controlling urination.

If you have recurrent tumors that are non-invasive and slow growing, your doctor can choose to burn them rather than remove them with surgery. Its a simpler procedure and may prevent excessive scarring.

If You’re Concerned About Bladder Cancer Ask Your Doctor About Cxbladder

Cxbladder is a non-invasive 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.

When should you use Cxbladder?

  • When you’ve seen blood in your urine
  • If tests reveal you have blood in your urine
  • When you’re being monitored for recurrent bladder cancer

Cxbladder provides peace of mind and can make a meaningful difference to your care

  • Cxbladder gives you certainty, resolving diagnostic ambiguity and improving overall detection accuracy.
  • Most patients experiencing hematuria or who are being monitored for bladder cancer recurrence do not have cancer. Cxbladder enables the accurate rule out of patients who do not have bladder cancer, reducing the need for further invasive tests.

With performance proven in 12 peer-reviewed studies, Cxbladder is trusted by over 1,800 urologists in over 40,000 patients. The test is covered by Medicare and comes with the option of in-home sampling.

Cxbladder provides reliable results that will help your doctor make informed diagnosis and management decisions with you.

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Bladder Cancer And Treatment Options For Recurrence

If your bladder cancer recurs, you will undergo tests to find out more about the cancer cells.1-3 The type of treatment will depend on where the cancer cells have recurred and what type of treatments you received before. After learning more about the recurrence, your cancer care team will discuss all the possible treatment options that are available for you.

Some treatment options that can be used for bladder cancer recurrence, either alone or in combination, include:

  • Surgery

Advanced Symptoms Of Bladder Cancer

Bladder Cancer Symptoms, Risk Factors and Prevention

Bladder cancer is considered advanced when the tumor has grown and penetrated the bladder lining and surrounding layers of tissue and muscle. At this stage, the cancer may have spread to other parts of the body . Symptoms of advanced bladder cancer include the following:

  • Urination problems: Inability to urinate
  • Pain in the lower back: Another indication the tumor has spread is pain, particularly in the area above your pubic bone or the flank area. Pain in your perineum might also occur if your bladder cancer has reached tissues nearby. Pain may only be on one side.
  • Weight loss or loss of appetite: You lose weight without trying, or you’ve lost your appetite and aren’t as hungry as usual.
  • Feeling weak or fatigued: You may feel lethargic and extremely tired a lot of the time.
  • Bone pain: If your cancer has spread to the bone, it can cause bone pain or a bone fracture.
  • Swollen feet: Bladder cancer that has spread to your lymph nodes, for instance, could cause your feet to swell.

If the bladder cancer has spread to another part of your body, you could develop symptoms specific to that particular area. For example:

Once again, these symptoms could be due to something other than bladder cancer, so be sure to have your doctor check them out.

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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.

Another Option For Reducing Recurrences

Other studies have demonstrated that giving patients with low-grade bladder cancer the chemotherapy drug mitomycin C through a catheter following surgery can reduce the chance of a recurrence. These studies led professional groups in the United States and Europe to recommend this approach for patients with low-grade disease that has not invaded the muscle.

In the United States, however, few patients receive this treatment, in part because of concerns about the side effects of mitomycin C, as well as the availability and cost of the drug, noted Dr. Messing. Mitomycin C can be toxic if it leaks out of the bladder through a hole, and the drug can also cause severe rashes when it comes in contact with skin.

Gemcitabine, on the other hand, is a well-tolerated, readily available drug that “comes at relatively little cost in terms of side effects or expense,” said Dr. Messing. The side effects were similar between the two groups in the trial and were generally manageable, he added.

Some patients with advanced bladder cancer already receive gemcitabine, noted Piyush Agarwal, M.D., who heads the Bladder Cancer Section in NCI’s Center for Cancer Research and was not involved in the trial. “So, it makes sense that the drug would be used to treat patients with low-grade bladder cancer.”

Dr. Agarwal predicted that the new study would lead to revisions in treatment guidelines to include gemcitabine as an option for reducing recurrences in the patients with low-grade bladder cancer.

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Back Pain And Bladder Cancer

Pain in the lower back and/or abdomen can sometimes be caused by bladder cancer, and it is more common in patients who are diagnosed with bladder cancer that is advanced or metastatic. The symptom is not usually experienced by patients who are diagnosed with bladder cancer that is considered early stage. The most common symptom of bladder cancer is blood in the urine that is visible to the eye, which is experienced by around 80% to 90% of patients diagnosed. Between 20% and 30% of patients diagnosed with bladder cancer experience other problems or changes related to urination, such as

  • The need to urinate more frequently than usual
  • Pain or burning before, during or after urination
  • Feeling the urgent need to urinate despite the bladder not being full
  • Being unable to urinate

If you experience lower back or abdominal pain as well as any of those symptoms related to urinationand especially if you have ever noticed blood in your urine then you should let your healthcare provider know. If the symptoms are being caused by bladder cancer, then finding it out as soon as possible is important so you can begin treatment.

Why Do Some Cancers Come Back

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Sometimes, people who were successfully treated for cancer are diagnosed with a recurrence. This does not mean that their treatment was incorrect or unsuccessful. Rather, it is important to understand that some cancers are more likely to return than others.

It only takes a few cancer cells left over after treatment for that cancer to grow again. It takes many millions of cancer cells together to form a tumor that can be detected with even the most advanced imaging techniques.

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What Are The Treatment Options For Bladder Cancer

There are four types of treatment for patients with bladder cancer. These include:

  • Surgery

Sometimes, combinations of these treatments will be used.

Surgical options

Surgery is a common treatment option for bladder cancer. The type of surgery chosen will depend on the stage of the cancer.

  • Transurethral resection of the bladder is used most often for early stage disease . It is done under general or spinal anesthesia. In this procedure, a special telescope called a resectoscope is inserted through the urethra into the bladder. The tumor is then trimmed away with the resectoscope, using a wire loop, and the raw surface of the bladder is then fulgurated .
  • Partial cystectomy is the removal of a section of the bladder. At times, it is used for a single tumor that invades the bladder wall in only one region of the bladder. This type of surgery retains most of the bladder. Chemotherapy or radiation therapy is often used in combination. Only a minority of patients will qualify for this bladder-sparing procedure.
  • Radical cystectomy is complete removal of the bladder. It is used for more extensive cancers and those that have spread beyond the bladder .

This surgery is often done using a robot, which removes the bladder and any other surrounding organs. In men, this is the prostate and seminal vesicles. In women, the ovaries, uterus and a portion of the vagina may be removed along with the bladder.

Chemotherapy

  • Methotrexate

Intravesical therapy

Radiation therapy

Treatment For Bladder Cancer In Raleigh And Wake Forest

If you or someone you love has bladder cancer, know that a full recovery is possible. Modern medicine and new treatments have made surviving bladder cancer the new norm. Make sure to research these treatments and think about which one is right for you. Then, talk to your doctor about your plan to beat this cancer and discuss your options. Taking care of your body is essential, so make sure to take the time you need to heal.

If you or someone you love has bladder cancer, contact us today. Our highly experienced oncology team can help you understand your treatment options.

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What Are The Stages Of Bladder Cancer

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 the bladder or in the connective tissue just below the lining, but has not invaded into the main muscle wall of the bladder.

Stages II to IV denote invasive cancer:

  • In Stage II, cancer has spread to the muscle wall of the bladder.
  • In Stage III, the cancer has spread to the fatty tissue outside the bladder muscle.
  • In Stage IV, the cancer has metastasized from the bladder to the lymph nodes or to other organs or bones.

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

  • Invasive bladder tumors can range from T2 all the way to T4 .
  • Lymph node involvement ranges from N0 to N3 .
  • M0 means that there is no metastasis outside of the pelvis. M1 means that it has metastasized outside of the pelvis.

Types Of Bladder Cancer

Life After Bladder Cancer â Malcolm and Ieva

Bladder cancer can be described based on where it is found:

  • non-muscle invasive the cancer has not spread to other layers of the bladder or muscle
  • muscle-invasive the cancer has spread to other layers of the bladder, muscle or other parts of the body.

There are 3 main types of bladder cancer:

  • urothelial carcinoma 80 to 90% of bladder cancers sometimes called transitional cell carcinoma
  • squamous cell carcinoma 1 to 2% of all bladder cancers. It is more likely to be invasive
  • adenocarcinoma 1 to 2% of all bladder cancers. It is more likely to be invasive .

There are other, less common types of bladder cancer. Treatment for these may be different. Speak to your doctor or nurse for information about these types of cancer.

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Dipstick Studies And Urine Microscopy

Dipstick and microscopic examination of the urine allows detection of hematuria or infection. Hematuria suggests the likelihood of bladder cancer recurrence.

Infection should delay instrumentation because of the risk of sepsis and because of the concern that inflammatory changes might further complicate evaluation of the urothelium.

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

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.
  • Chemotherapy.
  • Radiation.
  • 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.

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