Living With Advanced Cancer
Advanced cancer usually means cancer that is unlikely to be cured. Some people can live for many months or years with advanced cancer. During this time palliative care services can help.
Most people continue to have treatment for advanced cancer as part of palliative care, as it helps manage the cancer and improve their day-to-day lives. Many people think that palliative care is for people who are dying but palliative care is for any stage of advanced cancer. There are doctors, nurses and other people who specialise in palliative care.
Treatment may include chemotherapy, radiation therapy or another type of treatment. It can help in these ways:
- slow down how fast the cancer is growing
- shrink the cancer
- help you to live more comfortably by managing symptoms, like pain.
Treatment depends on:
- how far it has spread
- your general health
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 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.
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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Treatment Of Recurrent Bladder Cancer
For information about the treatments listed below, see the Treatment Option Overview section.
- Radiation therapy as palliative therapy to relieve symptoms and improve quality of life.
- A clinical trial of a new treatment.
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
Stage 0 Bladder Cancer
Stage zero bladder cancers are called noninvasive papillary carcinoma and carcinoma in situ. Theyre precancerous lesions that could develop into more serious cancers if not treated.
These growths develop on the inner lining of the bladder. Noninvasive papillary carcinoma, also called stage 0a, forms long, thin growths into the empty space inside the bladder.
Carcinoma in situ, also called stage 0is bladder cancer, forms flatter growths that tend to be of a wilder grade. It is considered a more aggressive disease and is more likely to spread into the muscular walls of the bladder.
According to the National Cancer Institutes SEER database of cancer statistics, about half of bladder cancers are diagnosed at stage 0.
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What Are The Risks Of Bladder Cancer
No single factor is directly connected to bladder cancer, but factors that can increase the risk include:
- Age: Bladder cancer typically affects people age 55 and older.
- Smoking: Carcinogens from tobacco smoke come in contact with the lining of the bladder. Smokers are three times as likely as non-smokers to get bladder cancer.
- Family history: There is evidence that bladder cancer may have a genetic component.
- Industrial chemicals: Chemicals known as aromatic amines are often used in the dye industry. Workers who have daily exposure to them, such as painters, machinists and hairdressers, may be at a higher risk for bladder cancer.
- Drinking contaminated water: This includes water that has been treated with chlorine or drinking water with a naturally high level of arsenic, which occurs in many rural communities in the United States,.
- Taking certain herb: Supplements such as Aristolochia fangchi, a Chinese herb, sometimes used for weight loss has been linked to higher rates of bladder cancer.
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.
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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 To Do Before And After Treatment
Talk with your doctors about whether you need to do anything to prepare for treatment and help your recovery. Some things they may suggest are to:
- Stop smoking if you smoke, aim to quit before starting treatment. If you keep smoking, you may not respond as well to treatment and you may have more treatment-related side effects. Continuing to smoke also increases your risk of cancer returning.
- Begin or continue an exercise program exercise will help build up your strength for treatment and recovery. It can also help you deal with side effects of treatment.
- Improve diet aim to eat a balanced diet with a variety of fruit, vegetables, wholegrains and protein. Eating well can improve your strength and you may respond better to treatment.
- See a physiotherapist they can teach you exercises to strengthen your pelvic floor muscles, which help control how your bladder and bowel work. These exercises are useful if you have a neobladder, a partial cystectomy, or radiation therapy.
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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:
Stage Iii Bladder Cancer
Stage III bladder cancers have started to spread away from the bladder itself into either local or regional organs or into lymph nodes in the pelvis. Its divided into stage IIIA and stage IIIB.
Stage IIIA bladder cancer has either:
- Spread into the fat around the bladder or into the reproductive organs, but not to the lymph nodes
- Spread from the bladder to one lymph node in the pelvis
Stage IIIB cancer has also spread. To be defined as stage IIIB, cancer needs to be found in either:
- More than one lymph node far from major arteries
- One or more lymph nodes near the major arteries
According to SEER, 7% of bladder cancer cases are diagnosed when theyve reached stage III, or regional stage.
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T Categories For Bladder Cancer
The T category describes how far the main tumor has grown into the wall of the bladder .
The wall of the bladder has 4 main layers.
- The innermost lining is called the urothelium or transitional epithelium.
- Beneath the urothelium is a thin layer of connective tissue, blood vessels, and nerves.
- Next is a thick layer of muscle.
- Outside of this muscle, a layer of fatty connective tissue separates the bladder from other nearby organs.
Nearly all bladder cancers start in the lining or urothelium. As the cancer grows into or through the other layers in the bladder, it becomes more advanced .
The T categories are described in the table above, except for:
TX: Main tumor cannot be assessed due to lack of information
T0: No evidence of a primary tumor
What Are The Treatment Options For Bladder Cancer
There are four types of treatment for patients with bladder cancer. These include:
Sometimes, combinations of these treatments will be used.
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 .
Some common chemotherapy drugs that are used for the treatment of bladder cancer include:
Chemotherapy can be used alone, but is often used with surgery or radiation therapy.
Bladder cancer may be treated with intravesical immunotherapy or chemotherapy.
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Symptoms In Men And Women
Women are more likely to mistake bladder cancer symptoms for urinary tract infections or menstruation.
Rarely, bladder cancer may also be misdiagnosed as interstitial cystitis in women. IC is a painful, inflammatory bladder condition that affects more women than men.
In one study, doctors found bladder cancer in about one percent out of 600 patients referred to them for IC treatment, according to an article in Urology Times.
Cancer May Spread From Where It Began To Other Parts Of The Body
- Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor in another part of the body.
- Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor in another part of the body.
The metastatic tumor is the same type of cancer as the primary tumor. For example, if bladder cancer spreads to the bone, the cancer cells in the bone are actually bladder cancer cells. The disease is metastatic bladder cancer, not bone cancer.
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Other Immunotherapies For Bladder Cancer
Researchers are testing other potential immunotherapy drugs to see how well they work on their own and combined with other treatments.
Theyâre also testing combinations of immunotherapies. Early results showed that nivolumab combined with another drug, ipilimumab, worked in 26% to 38% of people who took them.
Studies are also looking at atezolizumab in combination with another checkpoint inhibitor called MTIG7192A.
Bladder Reconstructions And Stomas
If you have had your bladder removed, the way you pass urine will change. There are several options that your treatment team will talk to you about:
- Urostomy is where doctors create a new hole in your abdomen called a stoma. Urine drains from the stoma to the outside of your abdomen into a special bag.
- Neobladder is where a new bladder made from your small bowel forms a pouch inside your body to store urine. You will pass urine by squeezing your abdominal muscles. You will also pass a small tube into the neobladder each day to help drain the urine.
- Continent urinary diversion is a pouch made from your small bowel inside your body to store urine. The urine empties through a hole called a stoma to the outside of your abdomen into a special bag.
A bladder reconstruction is a big change in your life. You can speak with a continence or stomal therapy nurse for help, support and information. You can also call Cancer Council . You may be able to speak with a trained Cancer Council volunteer who has had cancer for tips and support.
If you find it difficult to adjust after your bladder reconstruction, it may help to be referred to a psychologist or counsellor.
Note: If you have a stoma, you can join a stoma association for support and free supplies. For more information about stoma associations, visit the Australian Council of Stoma Associations.
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Intermediate Risk Early Bladder Cancer
People with intermediate-risk non-muscle-invasive bladder cancer should be offered a course of at least 6 doses of chemotherapy. The liquid is placed directly into your bladder, using a catheter, and kept there for around an hour before being drained away.
You should be offered follow-up appointments at 3, 9 and 18 months, then once every year. At these appointments, your bladder will be checked using a cystoscopy. If your cancer returns within 5 years, you’ll be referred back to a specialist urology team.
Some of the chemotherapy medicine may be left in your urine after treatment, which could severely irritate your skin.
It helps if you sit down to urinate and that you’re careful not to splash yourself or the toilet seat. Always wash the skin around your genitals with soap and water afterwards.
If you’re sexually active, it’s important to use a barrier method of contraception, such as a condom. This is because the medicines may be present in your semen or vaginal fluids, which can cause irritation.
You also shouldn’t try to get pregnant or father a child while having chemotherapy for bladder cancer, as the medicines can increase the risk of having a child with birth defects.