Managing Locally Advanced Or Metastatic Bladder Cancer
care services have tended to be requested because of profound physical symptoms in people with terminal bladder cancer. Increasing use of cross sectional imaging is detecting incurable disease much earlier, when there are often no physical symptoms. However the psychological and spiritual impact of a terminal diagnosis will always be profound and input from specialist palliative care at this earlier stage may be of significant benefit. The specialist palliative care needs of people with advanced bladder cancer are covered in . This chapter deals with the use of for people with distant metastases and with specific symptoms from locally advanced or metastatic bladder cancer.
Database And Case Selection
Data was obtained from the custom SEER database , which collected cancer data that covers approximately 28% of the United States population . The SEER*Stat software version 126.96.36.199 was utilized to access the data from SEER database. Patients with non-metastatic bladder cancer /WHO 2008: Urinary bladder) with malignant behavior who were diagnosed between 2014 to 2015 were extracted from the database. Only patients with a single primary tumor or patients whose first primary tumor was bladder cancer were included. Patients whose diagnosis was made at autopsy or based on a death certificate were excluded . Importantly, to minimize the risk of selection bias, eligible patients who have missing information of variables in SEER program were also included for subsequent regression analysis of survival data. A flow chart of inclusions and exclusions was shown in Figure .
Causes And Risk Factors
Researchers dont know exactly what causes bladder cancer, but they do know what increases the risk of getting it. These risk factors range from family history to certain types of medication.
Data published in 2021 on MedRxiv by researchers from the online pharmacy Valisure and Memorial Sloan Kettering Cancer Center showed patients who took Zantac had elevated diagnosis rates of bladder, breast, prostate and thyroid cancer.
Patients should keep in mind that this data suggests a link between ranitidine and increased risk, but it doesnt prove that all people who take ranitidine will get bladder cancer.
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Is Bladder Cancer Treatable
Many types of therapy are used to treat bladder cancer. In general, the treatment pathway chosen depends on the type and stage of bladder cancer present and a patients overall health and individual preferences. Common treatment options include:
- Surgery: to remove tumor cells and surrounding tissue. The type of surgery used depends on factors such as the size and progression of the tumor.
- Chemotherapy: which refers to the use of drugs to destroy cancer cells. Chemotherapy may be local or systemic .
- Immunotherapy: which uses naturally occurring or man-made substances to improve or bolster the bodys immune system function. Like with chemotherapy, immunotherapy may be delivered locally or systemically.
- Radiation therapy: which uses x-rays or other high-energy waves or particles to kill cancer cells.
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Sleepiness And Difficulty Waking
People who are dying often sleep a lot. They might not respond when you try to wake them. But this doesnt mean they cant hear you. Hearing may be one of the last senses to be lost.
So it is important not to stop talking to them and comforting them. You can sit close to them and hold their hand.
It is important not to say anything you wouldnt want them to hear. It’s also a good idea to tell them when you go into or leave their room.
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Possible Changes In Body Function
- Profound weakness usually the patient cant get out of bed and has trouble moving around in bed
- Needs help with nearly everything
- Less and less interest in food, often with very little food and fluid intake for days
- Trouble swallowing pills and medicines
- More drowsiness the patient may doze or sleep much of the time if pain is relieved, and may be hard to rouse or wake
- Lips may appear to droop
- Short attention span, may not be able to focus on whats happening
- Confusion about time, place, or people
- Limited ability to cooperate with caregivers
- Sudden movement of any muscle, jerking of hands, arms, legs, or face
Managing People With Distant Metastases
Most patients who die of bladder cancer will do so with metastatic disease. The main treatment used to prolong life and palliate/alleviate the symptoms is . Most studies on chemotherapy report benefits in terms of response, symptom control and but this comes at the cost of significant treatment related toxicity. Not all patients are able to receive chemotherapy, eg, because of debility, impaired kidney function or over the age for safe use of chemotherapy, and others choose not to have it. There are anecdotal reports of long term survivors, but these are rare. The role of chemotherapy in people who progress or on first line treatment is less clear because their is usually measured in months, so benefits and drawbacks of chemotherapy are very finely balanced.
Pelvic can also be used to treat patients with symptoms of incurable bladder cancer, especially bleeding from the bladder or pain from the bladder or sites of metastatic spread.
Other forms of specialist intervention may be considered for serious complications of advanced bladder including:
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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. Talk with your doctor about how these numbers may apply to you, as he or she is familiar with your situation.
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What Kind Of Treatment Will I Need
There are many ways to treat bladder cancer. You might want to get a second opinion about the best treatment plan for you.
Bladder cancer is most often treated with:
Sometimes more than one type is used. The treatment plan thats best for you depends on:
- The stage and grade of the cancer
- Whether the cancer has spread into the bladder wall
- The chance that a type of treatment will cure the cancer or help in some way
- Other health problems you have
- Your feelings about the treatment and the side effects that come with it
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Managing Bone Pain And Weakness
Symptoms like nausea, hot flashes, and pain can usually be relieved with medication. Some people find that complimentary treatments like acupuncture or massage help manage side effects.
Your doctor may also recommend orthopedic surgery to stabilize your bones, relieve pain, and help prevent bone fractures.
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Possible Changes In Breathing
- Breathing may speed up and slow down due to less blood circulation and build-up of waste products in the body
- Patient may grunt while breathing
- Neck muscles may look tight to help breathe
- Mucus in the back of the throat may cause rattling or gurgling with each breath
- The patient may not breathe for periods of up 10 to 30 seconds
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What Is The Difference Between High Grade And Low Grade Bladder Cancer
Low grade and high grade bladder cancer 1 Low-grade bladder cancer means the cancer has not invaded the muscles around the bladder . People rarely die from this type of bladder cancer, it often recurs after treatment. 2 High-grade bladder cancer also often recurs and has a higher chance of spreading to other parts of the body. Almost all deaths from bladder cancer result this type so it is treated more aggressively.
Symptoms Of Oral Cancer
Here are some most common symptoms of mouth cancer:
If you experience any of the above symptoms, you should immediately consult your dentist or any doctor. Rajiv Gandhi Cancer Institute and Research Centre is one of the best centres that provide effective treatment for mouth cancer.
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Your First Bladder Cancer Care Appointment
At your first appointment, you will meet the team who will take care of you throughout your treatment. During this visit, your cancer care team will discuss your medical history with you in detail, perform a physical examination, and discuss possible treatment options. During your first visit, we will share some important information about bladder cancer and your treatment options.
What Do Your Symptoms Mean Should You Worry
The condition causes decreased appetite, which in turn has your body looking at itself for nutrition. Kathryn E. Fruits and vegetables contain many vitamins and nutrients that can contribute to your health. Medically reviewed by Gerhard Whitworth, R. Disregarding any of these symptoms can also affect your finances as treating prostate cancer with severe symptoms can be expensive.
Eat a variety of fruits, vegetables and whole grains. Read this next. By continuing to use our site or clicking âAcceptâ, you consent to the use of ALL the cookies. For some, the pain experienced when they attempt to pee is one of the reasons why they would choose to hold their bladders for longer periods.
Thompson RH, et al. Journal of Urology. Warner KJ. This category only includes cookies that ensures basic functionalities and security features of the website. Many men could confuse an enlarged prostate with one of the symptoms of prostate cancer.
Trouble urinating is one of the most common symptoms. This kind of weight loss in cancer patients, if it is a significant amount, is also called cachexia. Stage 3 Prostate Cancer: What to Expect. The seeds emit a permanent low dose or temporary high dose of radiation. Manage consent.
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Bladder And Bowel Problems
Near the end of life, some people lose control of their bladder or bowels as their muscles relax. There are ways to make sure comfort and dignity are maintained as much as possible. Ask the doctor or nurse what they would suggest to help with this.
If someone is able to move around, they may be able to use a commode . If theyre less mobile, they might use pads and wipes. Some people use a catheter . It can help to talk to the doctor, nurse, and your loved one about what is needed and who should provide this care.
Constipation can be caused by medicines, moving less, and eating and drinking less . Some medicines can also cause trouble passing urine. Speak to the doctor or nurse about what can help.
Survival For All Stages Of Bladder Cancer
Generally, for people diagnosed with bladder cancer in England:
- around 75 out of every 100 survive their cancer for 1 year or more after diagnosis
- almost 55 out of every 100 survive their cancer for 5 years or more after they are diagnosed
- around 45 out of every 100 survive their cancer for 10 years or more after diagnosis
Cancer survival by stage at diagnosis for England, 2019Office for National Statistics
These statistics are for net survival. Net survival estimates the number of people who survive their cancer rather than calculating the number of people diagnosed with cancer who are still alive. In other words, it is the survival of cancer patients after taking into account that some people would have died from other causes if they had not had cancer.
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Complete Loss Of Consciousness
At the end of life, the body’s chemical balance completely changes. The dying person then slips into unconsciousness. This is usually right towards the end, maybe only a few hours or days before death.
The persons breathing becomes irregular and may become noisy. You wont be able to wake them at all. Their breathing will stay irregular for some time and will stop at some point.
Factors That Increase The Risk Of Mortality
There are a number of things that can increase your risk of dying from bladder cancer, mainly increasing age. People make up the majority of people with bladder cancer, and being older than 60 years of age is considered one of the main risk factors of developing and dying from bladder cancer.
Other major mortality risk factors for bladder cancer include:
- exposure to toxins or chemicals
- being assigned male at birth
Overall, according to a study that divided people into groups of either men or women, the cumulative risk of dying from bladder cancer between birth and 74 years of age is
3% of people who survived 10 years or more after receiving their initial diagnosis died of primary bladder cancer.
Health factors beyond your overall health and the stage of your cancer that can increase your short-term mortality risk with bladder cancer include:
- white ethnic background
- delays in treatment with chemotherapy or radiation
- lack of health insurance
- being unmarried
Although white people have a higher overall incidence rate of bladder cancer, mortality rates from bladder cancer are higher in Black people. A 2022 study that examined cancer mortality rates in the United States from 1999 to 2019 suggests that social inequalities and barriers to healthcare contributed to higher mortality rates among Black men and women.
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Prognosis And Survival Rates For Bladder Cancer
When someone is diagnosed with bladder cancer, their doctor will give them a prognosis. A prognosis is the doctors opinion of how likely the cancer will spread and the chances of getting better. A prognosis depends on the type and stage of cancer, as well as the persons age and general health.
Bladder cancer can usually be effectively treated if it is found before it spreads outside the bladder.
If you have bladder cancer, your doctor will talk to you about your individual situation when working out your prognosis. Every persons experience is different, and there is support available to you.
If A Loved One Declines Treatment
If a loved one decides to forego lung cancer treatment, it can be a difficult, heart-wrenching thing to hear. You may not be able to fully comprehend it at first. In such instances, let your loved one know that you hear them and love them, but that you need a day or two to process the news.
If you do decide you need more information, ask compassionately. Avoid judgmental questions starting with why, and give your loved one time to express themselves fully without interruption or displays of panic or disapproval.
In the end, there will come a time when you need to respect your loved ones decision, however hard that may be. Acceptance will ultimately make you a better caregiver and prepare you emotionally for when your loved one is no longer with you.
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Treatment For Advanced Bladder Cancer
If bladder cancer has spread to other parts of the body, it is known as advanced or metastatic bladder cancer. You may be offered one or a combination of the following treatments to help control the cancer and ease symptoms:
- systemic chemotherapy
- radiation therapy.
Immunotherapy uses the bodys own immune system to fight cancer. BCG is a type of immunotherapy treatment that has been used for many years to treat non-muscle-invasive bladder cancer.
A new group of immunotherapy drugs called checkpoint inhibitors work by helping the immune system to recognise and attack the cancer. A checkpoint immunotherapy drug called pembrolizumab is now available in Australia for some people with urothelial cancer that has spread beyond the bladder. The drug is given directly into a vein through a drip, and the treatment may be repeated every 2 to 4 weeks for up to 2 years.
Other types of checkpoint immunotherapy drugs may become available soon.
Is It Normal To Feel Bad
Its not always normal to feel bad, and there are often things that can be done to help you feel better. We also give some tips on how to manage these symptoms. Communication with the people who are helping to care for you is key. Be sure to check in and tell your health care team how you are doing.
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What Is The Most Advanced Stage Of Cancer
The most advanced stage of cancer is stage 4. The stage of cancer denotes where cancer cells are in the body and how much of the body is affected. Some forms of cancer have a stage 0, but most use stages 1 to 4. Doctors will confirm the stage at the time of diagnosis, and this number will not change. Stage 4 is the most advanced stage of cancer.