Chemotherapy In Palliative Care
Many patients with bladder cancer present with distant metastases at diagnosis or develop metastatic disease during the course of their illness. The survival time for patients with untreated metastatic bladder cancer is usually less than 6 months, and a variety of disabling symptoms can develop during this interval that disrupt quality of life.180,181 Chemotherapy may be effective in ameliorating these symptoms.
Other regimens comprising active agents with nonoverlapping toxic effects are being investigated with the aim of enhancing the therapeutic ratio. They include combinations of cisplatin with gemcitabine or paclitaxel.181 An update of a large international randomized study that compared M-VAC with gemcitabine plus cisplatin for patients with metastatic bladder cancer186,187 revealed no differences in response rate, survival rate, or quality of life between the treatment groups. However, gemcitabine plus cisplatin was significantly less toxic more patients completed the full course of treatment, fewer had significant neutropenia or sepsis, and the rate of death from side effects was lower. These findings have led to gemcitabine plus cisplatin becoming the standard of care for patients with metastatic bladder cancer.181
Bin S. Teh MD, … Arnold C. Paulino MD, in, 2008
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.
Treatment Of Stage Iv Bladder Cancer
For information about the treatments listed below, see the Treatment Option Overview section.
Treatment of stage IV bladder cancer that has not spread to other parts of the body may include the following:
- Urinary diversion or cystectomy as palliative therapy to relieve symptoms and improve quality of life.
- External radiation therapy as palliative therapy to relieve symptoms and improve quality of life.
- Urinary diversion or cystectomy as palliative therapy to relieve symptoms and improve quality of life.
- A clinical trial of new anticancer drugs.
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.
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Bladder Cancer And Its Stages
Bladder cancer is a disease that can have varying symptoms and severity according to its stage. The estimated life expectancy of people who are diagnosed with bladder cancer is dependent on their condition and treatment.
The stages of bladder cancer have different levels of effects to the patient. Although living with bladder cancer can be difficult and challenging, do not lose hope as some of the stages of bladder cancer can be treated.
If people with bladder cancer receive treatment early on the first stage of cancer, the symptoms can be neutralized. The stages of bladder cancer usually depend on the formation of cancer in other parts of the body. If the first stage is managed early, the spread of cancer can be stopped.
What Will Happen After Treatment
You’ll be glad when treatment is over. But its hard not to worry about cancer coming back. Even when cancer never comes back, people still worry about this. For years after treatment ends, you will see your cancer doctor. Be sure to go to all of your follow-up visits. People who have had bladder cancer are at high risk of having a second bladder cancer.
If you have no signs of cancer, most experts advise seeing with your doctor every 3 to 6 months. These visits might include urine tests, blood work, and other tests. If you still have your bladder, you will need regular exams of your bladder, too. The time between doctor visits may be longer after a few years if no new cancers are seen.
Having cancer and dealing with treatment can be hard, but it can also be a time to look at your life in new ways. You might be thinking about how to improve your health. Call us or talk to your doctor to find out what you can do to feel better.
You cant change the fact that you have cancer. What you can change is how you live the rest of your life making healthy choices and feeling as well as you can.
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Combination With Conventional Treatments
Far safer ground is to use phytotherapy to support the cancer patient undergoing conventional treatments. Phytotherapy may be given prior to conventional treatments to help the patient prepare for them . They may also be given during conventional treatments to improve treatment outcomes, QOL and reduce side effects. They may be given after conventional treatment for all the above reasons, but also to prevent cancer recurrence and improve survival prospects. This is the most active area of research for phytotherapy in cancer and some relevant clinical studies will be reviewed.
Twenty-five patients with a variety of very advanced cancers of the gastrointestinal tract undergoing palliative radio- or chemotherapy received up to 3 g/day of GLA as evening primrose oil . They were matched to 25 controls.45 The group receiving EPO exhibited highly statistically significant and clinically relevant survival differences and fewer adverse effects were noted from concurrent conventional treatment. Cancer markers also fell in some patients .
Codonopsis is a widely prescribed adaptogen in China, used in conjunction with conventional cancer therapies to reduce side effects and support immunity.58 It was used as an adjuvant in 76 cancer patients during radiotherapy and reduced its immunosuppressive effect.59 Pharmacological studies suggest it can help both white and red blood cell production.60
How Long Will You Live If You Have Bladder Cancer
The survival rate depends on the stage of cancer at diagnosis and other health issues.
Overall, 70 to 90 percent of people with localized bladder cancer will live for at least five years or more. The physician calculates this with the help of survival rates. Survival rates indicate the percentage of people who live with a certain type of cancer for a specific time. The physician often uses an overall five-year survival rate. Factors that may affect survival rate include
Table. Five-year survival rates of different stages of bladder cancer
|Bladder cancer SEER stages
|Five-year relative survival rate
|In situ alone
|All SEER stages combined
The surveillance, epidemiology, and end results stages are taken from the SEER database, maintained by the National Cancer Institute. SEER database groups cancers into localized, regional, and distant stages.
- Localized: There is no indication that cancer has spread outside the bladder.
- Regional: Cancer has invaded the nearby structures or lymph nodes.
- Distant: Cancer has spread to distant parts of the body, such as the lungs, liver, or bones.
Thus, bladder cancer, if detected in the early stage is treatable and has higher survival rates. However, if the cancer is detected in the advanced stages, treatment becomes difficult and the survival rate is low.
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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.
Living With Bladder Cancer
Bladder cancer symptoms and treatments can be overwhelming. No matter where you are on your treatment journey, youâll need to meet with your healthcare provider for regular checkups and tests. Talking to your healthcare team about the next steps and what to expect can provide a road map during this time.
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Sexuality And Bladder Cancer
Having bladder cancer and treatment can change the way you feel about yourself, other people, relationships and sex. These changes can be very upsetting and hard to talk about. Doctors and nurses are very understanding and can give you support. You can ask for a referral to a counsellor or therapist who specialises in body image, sex and relationships.
Take Charge Of Your Health With Cxbladder
Early detection saves lives and is a crucial factor when it comes to the treatment of bladder cancer. Cxbladder is a clinically proven cutting-edge genomic urine test that quickly and accurately detects or rules out bladder cancer in patients presenting with blood in the urine and those being monitored for recurrence. The test works at a molecular level, measuring five biomarker genes to detect the presence or absence of bladder cancer.
Cxbladder is discreet, quick, non-invasive and painless, typically giving you meaningful results within five working days. It comes as a suite of test options, each optimized for a different point in the patient journey.
- Triage: Incorporates known bladder cancer risk factors to help rapidly rule out the disease.
- Detect: Designed to work alongside other tests to improve overall detection accuracy.
- Monitor: Optimised for bladder cancer surveillance, reducing the need for further invasive tests
Cxbladder gives you peace of mind and will help your doctor make informed treatment decisions. Speak to your general practitioner or urologist to learn more about Cxbladder and which test might be right for you. You can also contact our Customer Service Team directly.Contact us for more information
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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
When Is The Right Time To Use Hospice Care
Many people believe that hospice care is only appropriate in the last days or weeks of life. Yet Medicare states that it can be used as much as 6 months before death is anticipated. And those who have lost loved ones say that they wish they had called in hospice care sooner.
Research has shown that patients and families who use hospice services report a higher quality of life than those who dont. Hospice care offers many helpful services, including medical care, counseling, and respite care. People usually qualify for hospice when their doctor signs a statement saying that patients with their type and stage of disease, on average, arent likely to survive beyond 6 months. More information about hospice can be found below in the Related Resources section of this fact sheet.
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Take Steps To Reduce Your Bladder Cancer Risk
The best way to lower your bladder cancer risk is to quit smoking. Smoking is the number one risk factor for bladder cancer, says Dr. Donat. There is some data to suggest that women metabolize carcinogens from smoking differently than men. In fact, woman may have a 30 to 50% greater risk of bladder cancer than men who smoke at comparable levels.
Bladder Cancer Clinical Trials
What about Clinical Trials?
You may hear about clinical trials for your bladder cancer. Clinical trials are research studies that test if a new treatment or procedure is safe and effective.
Through clinical trials, doctors find new ways to improve treatments and the quality of life for people with disease. Trials are available for all stages of cancer. The results of a clinical trial can make a major difference to patients and their families. Please visit our clinical trials research webpage to learn more.
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Where Can I Find A Support Group
To find a local group, talk to your healthcare provider. Local and Zoom meeting lists are also available through organizations such as CancerCare.
Joining a support group of people dealing with advanced cancer may help provide camaraderie and knowledge. You can connect with people who understand what you’re going through.
Treating cancer means looking after your whole self. This includes keeping an active lifestyle, eating healthy, practicing mindfulness, and socializing with family and friends to improve your mood and overall health. If you smoke cigarettes or use nicotine products, this is a good time to try to quit or cut down.
It’s also important to look after your mental health. Meeting with a therapist can help you navigate intense emotions and provide you with tools to feel more in control of your daily life.
Palliative care may also be beneficial. Your palliative care provider can help you learn about pain management options. Palliative care providers can also assist with finding mental health services, such as counseling.
Low Grade And High Grade Bladder Cancer
Bladder cancer starts in the lining of the bladder in about 90 percent of people diagnosed with this cancer. Bladder cancer is called low grade or high grade.
- 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.
- 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.
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Difficulty Swallowing Or Not Wanting To Eat Or Drink At All
There will come a time when the dying person wont want to eat or drink anything. It is important not to try and force them to eat or drink. This will make them uncomfortable.
You can give them small pieces of ice to suck or sips of fluid, if they are still awake. This will keep their mouth moist. You can put lip balm on their lips to help stop them getting dry and sore.
Even if they cant take anything into their mouth, you can moisten their lips and mouth every 1 to 2 hours with lemon and glycerine swabs or water. Your GP or district nurse can get you the swabs.
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Ask Your Doctor For A Referral To A Urologist
For women diagnosed with a UTI, Dr. Donat has this advice: Make sure your doctor sends a urine culture for testing, she says. If you did have a culture, make sure it came back positive to confirm that you actually have an infection. If the culture was negative or your bladder symptoms continue despite treatment, dont be afraid to ask your doctor for a referral to a urologist to get a formal evaluation.
Tests can sometimes distinguish the bleeding associated with bladder cancer from postmenopausal uterine bleeding, but the results are not always clear-cut. Your gynecologist can send a catheterized urine sample for testing to determine the source of the blood and to evaluate for gynecologic causes of the bleeding, Dr. Donat explains. If your gynecologic exam fails to identify the source of the bleeding or is inconclusive, or if your irritative bladder symptoms persist, you should also seek out the expertise of a urologist.
Hematuria may originate in the bladder or the kidneys, says Dr. Donat, so a urologist needs to check both. This is best done with a special CT scan of the urinary tract called a CT urogram and by looking in the bladder with a lighted telescope called a cystoscope. This procedure, called a cystoscopy, is usually done in an office in just a few minutes and does not require anesthesia, says Dr. Donat. A urine test called a cytology may also be sent to check for cancer cells in the urine.
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Emotional And Spiritual Changes
Everyone will feel different emotions when they are dying. A lot depends on:
- the type of person they are
- their age
- how much support they have
- their religious and spiritual beliefs
- the experiences they have had in life
Someone dying in their 20s is likely to feel very differently from someone who is 80. And someone leaving behind young children will have different worries from someone whose children are grown up and able to take care of themselves.
As death gets closer they might begin to let go and seem more at peace with things. Others might become very anxious, fearful or angry. Some people could appear to withdraw, even from the people they love and care about. But this doesnt mean that they dont care anymore.
These events are all very normal and are a natural part of dying.