Is Bladder Cancer A Fatal Illness
Left untreated, bladder cancer may spread to other parts of your body. Cancer thats metastasized, or spread, may affect how long youll live with bladder cancer. Like many types of cancer, early detection and treatment increase the chance of living longer with bladder cancer. According to the National Cancer Institute, 96% of people who received treatment for early-stage cancer were alive five years after diagnosis. Overall, 77% of people with bladder cancer were alive five years after diagnosis.
Treatment For Bladder Cancer
Treatment for bladder cancer depends on how quickly the cancer is growing. Treatment is different for non-muscle invasive bladder cancer and muscle-invasive bladder cancer.
You might feel confused or unsure about your treatment options and decisions. Its okay to ask your treatment team to explain the information to you more than once. Its often okay to take some time to think about your decisions.
When deciding on treatment for bladder cancer, you may want to discuss your options with a urologist, radiation oncologist and medical oncologist. Ask your GP for referrals.
Tnm Classification For Bladder Cancer
The tumor-node-metastasis classification for staging of bladder cancer is provided below.
Table. TNM Classification for Bladder Cancer
Primary tumor cannot be assessed
No evidence of primary tumor
Carcinoma in situ: flat tumor
Tumor invades lamina propria
Tumor invades superficial muscularis propria
Tumor invades deep muscularis propria
Tumor invades pelvic wall, abdominal wall
Regional lymph nodes
Regional lymph nodes include both primary and secondary drainage regions. All other nodes above the aortic bifurcation are considered distant lymph nodes.
Lymph nodes cannot be assessed
No lymph node metastasis
Single regional lymph node metastasis in the true pelvis
Multiple regional lymph node metastasis in the true pelvis
Lymph node metastasis to the common iliac lymph nodes
Distant metastasis limited to lymph nodes beyond the common iliacs
American Joint Committee on Cancer. Urinary Bladder. Amin MB, Edge S, Greene F, Byrd DR, Brookland RK, et al, eds. AJCC Cancer Staging Manual. 8th ed. New York: Springer 2017.
Contributor Information and Disclosures
Joel DeCastro, MD, MPH Fellow in Urologic Oncology, Department of Surgery, Section of Urology, University of Chicago Medical CenterJoel DeCastro, MD, MPH is a member of the following medical societies: American Urological Association, Endourological SocietyDisclosure: Nothing to disclose.
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Why Does Cancer Stage Matter
Staging helps your doctor plan the best treatment. This may include choosing a type of surgery and whether or not to use chemotherapy or radiation therapy. Knowing the cancer stage lets your entire health care team talk about your diagnosis in the same way.
Doctors can also use staging to:
Understand the chance that the cancer will come back or spread after the original treatment.
Help forecast the prognosis, which is the chance of recovery
Help determine which cancer clinical trials may be open to you.
See how well a treatment worked
Compare how well new treatments work among large groups of people with the same diagnosis
Stage Ii Bladder Cancer
Stage II cancer has invaded the muscle of the bladder wall but is still confined to the bladder. Depending on the extent and grade of the cancer, we may recommend a partial or total cystectomy. Some people may need chemotherapy before surgery. We may be able to remove the tumor with TUR followed by radiation and chemotherapy.
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Whats The Treatment For Stage 2 Bladder Cancer
Your treatment options will depend on a number of factors, such as your age and general health. Youll probably need a combination of treatments. Your doctor will monitor your progress and adjust therapy as needed. You may also need treatments to help control symptoms of cancer and side effects of treatment.
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What Is Cancer Restaging
The stage of a cancer given at the time of diagnosis and initial treatments does not change. This is so doctors can understand a person’s medical progress, help understand the prognosis, and learn how treatment affects many people.
However, if the cancer comes back or spreads, restaging can be done. This is described with a small “r.” For example, rN1 is restaging of the lymph nodes. Usually some of the same tests that were done when the cancer was first diagnosed will be done again. After this, the doctor can assign the cancer a restage or “r stage.”
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The Worlds First Cancer Jabs
In April 2010 the US Food and Drug Administration approved a purpose made cancer vaccine for the first time. The sipuleucel-T vaccine, which goes by the brand name Provenge, uses a patients immune cells and a protein from prostate cancer cells, the antigen, to stimulate the immune system. The clinical trial that demonstrated the vaccines efficacy showed that it could increase a patients survival time, by a median of 4.1 months.3 Its still not very widely used, however, as its so expensive: a single course costs around $100000 .
Many other vaccines have struggled to break through. The FDA declined to approve a jab called BiovaxID4 for non-Hodgkins follicular lymphoma in 2012 when it asked the company behind the vaccine, Biovest, to repeat its phase 3 trial.5 Biovest also failed to receive approval for its vaccine from the European Medicines Agency, and its spin-off business now focuses on cell cultures.6
Because some cancers are associated with viral infections, some vaccines that protect against those viruses are considered to have an indirect prophylactic effect on cancer. The human papillomavirus vaccine is perhaps the best known example. The US Centers for Disease Control and Prevention says that this can prevent the vast majority of HPV associated cancer cases in the US every year.7
There are also oncolytic viral vaccines, which use viruses to stimulate an immune response. In 2015 the FDA approved one such vaccine, known as T-VEC, for use against melanoma.8
How Do I Take Care Of Myself
About half of all people with bladder cancer have early-stage cancer thats relatively easy to treat. But bladder cancer often comes back . People whove had bladder cancer will need regular checkups after treatment. Being vigilant about follow-up care is one thing you can do to take care of yourself. Here are some other suggestions from the Bladder Cancer Advocacy Network include:
- Follow a heart-healthy diet: Plan menus that include skinless poultry and fish, low-fat dairy products, nuts and legumes, and a variety of fruits and vegetables.
- Focus on high-fiber foods: Bladder cancer treatment may cause digestive issues and a fiber-rich diet may help.
- Get some exercise: Gentle exercise may help manage stress.
- Connect with others: Bladder cancer often comes back. Its not easy to have a rare disease thats likely to return. Connecting with people who understand what youre going through may help.
Some people with bladder cancer need surgery that removes their bladder and their bodies natural reservoir for pee. There are three types of urinary diversion surgeries. All three types involve surgically converting part of your intestine to become a passage tube for pee or a reservoir for storing pee.
Urinary diversion may be a challenging lifestyle change. If youll need urinary diversion surgery, ask your healthcare provider to explain each surgery types advantages and disadvantages. That way, youll know what to expect and how to take care of yourself.
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Lymph Node Evaluation On Ct
The most commonly used first line imaging study for evaluation of patients with suspected or known newly diagnosed bladder cancer is CT of the abdomen and pelvis, typically in the form of a CT urogram . The CT urogram, performed without and with intravenous contrast material, is considered the appropriate first line test for the detection of suspected bladder cancer in patients with either microscopic or gross hematuria and is also considered an appropriate first step in staging for those patients in whom invasive bladder cancer has been diagnosed at cystoscopy .
While the use of lymph node size alone had historically been a marker of nodal involvement and was used as a measure of nodal staging in prior iterations of the AJCC TNM criteria , size criteria alone, as a marker of disease involvement is imprecise due to the wide range of normal lymph node sizes and the potential for metastatic bladder cancer occurring within non-enlarged lymph nodes . Acknowledging these limitations, recommended size thresholds that have been utilized are â¥8 mm in short axis for suspected abnormal pelvic lymph nodes and â¥10 mm in short axis for abdominal lymph nodes .
Figure 2Figure 3Figure 4Figure 5
Doctors Say These Are The Signs Of Bladder Cancer Including Blood Clots
Although many cases of cancers are much more treatable now, it’s still the second leading cause of death in the United States, behind heart disease. There’s over 100 different types of cancer and every year an estimated 81,000 people are diagnosed with bladder cancer. According to the American Cancer Society, “About 81,180 new cases of bladder cancer About 17,100 deaths from bladder cancer . The rates of new bladder cancers and deaths linked to bladder cancer have been dropping slightly in women in recent years. In men, incidence rates have been decreasing, but death rates have been stable.”
Bladder cancer can affect anyone, but typically people over the age of 50 are at the greatest risk. The ACS says, “About 9 out of 10 people with this cancer are over the age of 55. The average age of people when they are diagnosed is 73. Overall, the chance men will develop this cancer during their life is about 1 in 27. For women, the chance is about 1 in 89.” However, race can also play a factor. “Whites are more likely to be diagnosed with bladder cancer than African Americans or Hispanic Americans,” the ACS states.
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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.
How To Build A Cancer Vaccine
Although the jury is still out as to how to come up with effective, scalable vaccines for cancer, researchers are investigating a huge range of possibilities. Many are targeting particular cancers such as melanoma and some forms of breast cancer that are well suited to immunotherapy trials. Parker says, The immune cells are already sitting there, resident, fighting the cancer. What you need to do there, he explains, is tip the balance of that fight in the immune systems favour.
One interesting approach is under development by the Oxford based start-up Scancell. The firms Moditope platform aims to enlist CD4+ T cells, rather than CD8+ T cells. The former are sometimes called helper cells that coordinate activity by cytotoxic CD8+ T cells, which are those that directly challenge pathogens in the body. Lindy Durrant, chief executive of Scancell, explains that the idea is to prime the CD4+ T cells in such a way that, when they enter tumours, they provoke inflammation in the tumour cells, which would otherwise be absent. This should allow the CD4+ T cells to become cytotoxic themselves, detect the target peptides on the tumour cells, and then destroy themrather like ripping the invisibility cloak off an intruder.
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Treating Stage I Bladder Cancer
Stage I bladder cancers have grown into the connective tissue layer of the bladder wall , but have not reached the muscle layer.
Transurethral resection with fulguration is usually 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. If no other treatment is given, many people will later get a new bladder cancer, which often will be more advanced. This is more likely to happen if the first cancer is high-grade .
Even if the cancer is found to be low grade , a second TURBT is often recommended several weeks later. If the doctor then feels that all of the cancer has been removed, intravesical BCG or intravesical chemo is usually given. If all of the cancer wasn’t removed, options are intravesical BCG or cystectomy .
If the cancer is high grade, if many tumors are present, or if the tumor is very large when it’s first found, radical cystectomy may be recommended.
For people who arent healthy enough for a cystectomy, radiation therapy might be an option, but the chances for cure are not as good.
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.
There are three types of bladder cancer that begin in cells in the lining of the bladder. These cancers are named for the type of cells that become malignant :
- 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:
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What To Know About Bladder Cancer
Ronald Tang, DO Board certified Hematologist/Oncologist Los Angeles Cancer Network Beverly Hospital and Los Angeles Cancer Network tells us, “Bladder cancer is not a very common cancer as it only accounts for 4% of all the cancer that is diagnosed each year however it accounts for 3% of cancer deaths annually. It is the sixth most common cancer in the US. Men are four times more prone to get this cancer than women. Average age of diagnosis of a bladder cancer patient is over the age of 55. The good thing about bladder cancer is that if detected early it can be cured over 70-80% of the time. Risk factors for bladder cancer include smoking, ingestion of arsenic and exposure to aromatic amines which can be found in some hair dyes and textile work.”
Dr. Sidney Stoll, Medical Director of the Dorothy Leavy Cancer Center at Dignity Health Northridge Hospital says, “People should know that bladder cancer is the most common malignancy involving the urinary system. Transitional cell carcinoma is the predominant form found in the United States and Europe, accounting for about 90% of cases. The spectrum of bladder cancer includes superficial disease, muscle invasive disease, and metastatic bladder cancer. Each type has its own clinical behavior, biology, prognosis, and treatment.”
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
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Low Grade Vs High Grade Bladder Cancer
In addition to staging, bladder cancer is also described using its grade .2,3 To understand the cancers grade, healthcare providers compare healthy cells to cancer cells under a microscope. Low-grade cancer cells are ones that appear more like healthy tissue, while high-grade cancer cells look very different than healthy cells.