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.
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.
Stages Of Bladder Cancer: What You Need To Know
When you are first diagnosed with bladder cancer, your doctors will perform tests to determine the stage and grade of your disease. The bladder cancer staging and grading processes help your doctors make treatment decisions and estimate your chance of recovery.
Bladder cancer is a growth that starts in the inner wall of the bladder, the organ that collects and expels urine created by the kidneys. The bladder has three layers of muscular walls that make up its structure. A cancerous growth in the bladder can grow uncontrollably and start spreading to other parts of the body.
When doctors first diagnose a cancerous tumor of any kind, they assess how much it has grown, how far it has spread in the body, and how abnormal, or wild, the cancerous cells in the tumor look. These assessments are used to determine cancers stage and grade.
Doctors use the staging information to compare treatment options and patient outcomes. Staging and grading also important in determining your eligibility for cancer treatment clinical trials.
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What Causes Bladder Cancer And Am I At Risk
Each year, about 83,730 new cases of bladder cancer will be diagnosed in the United States. It affects more men than women and the average age at diagnosis is 73.
Cigarette smoking is the biggest risk factor for bladder cancer. About half of all bladder cancers are caused by cigarette smoking. Other risk factors for developing bladder cancer include: family history, occupational exposure to chemicals , previous cancer treatment with cyclophosphamide, ifosfamide, or pelvic radiation, the medication pioglitazone, exposure to arsenic , aristolochic , bladder infections caused by schistosoma haematobium, not drinking enough fluids, a genetic condition called Lynch Syndrome, a mutation of the retinoblastoma gene or the PTEN gene. and neurogenic bladder and the overuse of indwelling catheters.
What Is The Likelihood Of Bladder Cancer Metastasis
As many as 50% of patients with muscle-invasive bladder cancer may have occult metastases that become clinically apparent within 5 years of initial diagnosis and around 5% will have distant metastasis at the time of initial diagnosis. Most patients with overt metastatic disease die within 2 years despite chemotherapy. Approximately 25-30% of patients with only limited regional lymph node metastasis discovered during cystectomy and pelvic lymph node dissection may survive beyond 5 years. Metastasis can occur through lymphatic spread, most commonly affecting the pelvic lymph nodes, or through hematogenous spread to the liver, lung, or bone.
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Start And Spread Of Bladder Cancer
The wall of the bladder has many several layers. Each layer is made up of different kinds of cells .
Most bladder cancers start in the innermost lining of the bladder, which is called the urothelium or transitional epithelium. As the cancer grows into or through the other layers in the bladder wall, it has a higher stage, becomes more advanced, and can be harder to treat.
Over time, the cancer might grow outside the bladder and into nearby structures. It might spread to nearby lymph nodes, or to other parts of the body.
How Is Recurrence Tested
After your treatment for bladder cancer has ended, your healthcare providers will monitor you regularly during check-ups for signs and symptoms that your cancer may have recurred.1,2 This might involve tests such as physical examinations, urine tests, blood tests, and/or imaging tests.
Active surveillance is a type of follow-up that involves monitoring a patients condition with specialized tests for signs that the patients condition is getting worse. Usually, treatment is not needed unless the results of the test show that the condition has changed.
It is very important to continue visiting your healthcare provider regularly as scheduled for check-ups, especially if you are receiving active surveillance. Treatment for bladder cancer recurrence tends to be more effective when the recurrence is detected as early as possible.
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Stage I Bladder Cancer
Stage I bladder cancers are cancerous tumors that have spread from the inner layer of the bladder into the connective tissue layer just under it.
These tumors havent yet reached the muscular layers of the bladder, so theyre often called non-muscle-invasive bladder cancer. Some cases of non-muscle-invasive bladder cancer progress to muscle-invasive bladder cancer, which is more serious.
According to SEER, a third of bladder cancers are diagnosed when theyre local, when they havent spread beyond the organ they developed in, stage I and II.
Stage 3 Bladder Cancer
Stage 3 bladder cancer means that the cancer cells have spread beyond the bladder muscle.1,2,3 Stage 3 bladder cancer includes the following combined TNM stages:
In all three types of stage 3 bladder cancer, the cancer cells have not spread to the lymph nodes near the bladder and they have not spread to other parts of the body.
In a bladder tumor that is stage T3a or stage T3b, the bladder cancer cells have grown into the layer of fatty tissue that surrounds the outside of the bladder. This layer of fatty tissue is called perivesical tissue.
In a stage T3a bladder tumor, the bladder cancer cells in the perivesical tissue are only visible through a microscope. In a stage T3b bladder tumor, the bladder cancer cells have grown into the perivesical tissue and are large enough that they are visible using an imaging test or they can be felt by a healthcare professional. A stage T4a bladder tumor is different in women and men. In women, the stage T4a tumor has grown through the perivesical tissue and into the uterus and/or vagina. In men, the stage T4a tumor has grown through the perivesical tissue and into the prostate. However, in both women and men, a stage T4a tumor has not grown into the pelvic wall or the abdominal wall.
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Where It Can Spread To
Not all bladder cancers will spread. But If it does it’s most likely to spread to the structures close to the bladder, such as the ureters, urethra, prostate, vagina, or into the pelvis. This is called local spread.
Bladder cancer can also spread to another part of the body. This is secondary cancer or metastasis. The places it’s most likely to spread to are your:
- lymph nodes in the pelvis and tummy
- lungs
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:
- Surgery
- Chemo
- Immunotherapy
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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What Are The Risk Factors For Bladder Cancer
Some factors increase the risk of bladder cancer:
- Cigarette smoking is the biggest risk factor it more than doubles the risk. Pipe and cigar smoking and exposure to second-hand smoking may also increase one’s risk.
- Prior radiation exposure is the next most common risk factor .
- Certain chemotherapy drugs also increase the risk of bladder cancer.
- Environmental exposures increase the risk of bladder cancer. People who work with chemicals, such as aromatic amines are at risk. Extensive exposure to rubber, leather, some textiles, paint, and hairdressing supplies, typically related to occupational exposure, also appears to increase the risk.
- Infection with a parasite known as Schistosoma haematobium, which is more common in developing countries and the Middle East.
- People who have frequent infections of the bladder, bladder stones, or other diseases of the urinary tract, or who have chronic need for a catheter in the bladder, may be at higher risk of squamous cell carcinoma.
- Patients with a previous bladder cancer are at increased risk to form new or recurrent bladder tumors.
Other risk factors include diets high in fried meats and animal fats, and older age. In addition, men have a three-fold higher risk than women.
Treating Stage Iv Bladder Cancer
These cancers have reached the pelvic or abdominal wall , may have spread to nearby lymph nodes , and/or have spread to distant parts of the body . Stage IV cancers are very hard to get rid of completely.
Chemotherapy is usually the first treatment if the cancer has not spread to distant parts of the body . The tumor is then rechecked. If it appears to be gone, chemo with or without radiation or cystectomy are options. If there are still signs of cancer in the bladder, chemo with or without radiation, changing to another kind of chemo, trying an immunotherapy drug, or cystectomy may be recommended.
Chemo is typically the first treatment when bladder cancer has spread to distant parts of the body . After this treatment the cancer is rechecked. If it looks like it’s gone, a boost of radiation to the bladder may be given or cystectomy might be done. If there are still signs of cancer, options might include chemo, radiation, both at the same time, or immunotherapy.
In most cases surgery cant remove all of the cancer, so treatment is usually aimed at slowing the cancers growth and spread to help people live longer and feel better. If surgery is a treatment option, it’s important to understand the goal of the operation whether it’s to try to cure the cancer, to help a person live longer, or to help prevent or relieve symptoms from the cancer.
Because treatment is unlikely to cure these cancers, many experts recommend taking part in a clinical trial.
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Surgery For Bladder Cancer
Surgery is done for most bladder cancers. The type you have depends on the stage of the cancer.
Removing the tumor from the inside bladder is the most common surgery for early bladder cancer. This can be done during a cystoscopy. A a cystoscope with a looped wire on the end is used to remove the tumor.
When the cancer is more invasive, the cancer is removed along with part of the bladder or the entire bladder.
If only part of the bladder is removed, you’ll still be able to hold and release urine as normal, though in smaller amounts. If the entire bladder is removed, you’ll need another way to store and pass urine. Your doctor can explain the options for this.
Side effects of surgery
Any type of surgery can have some risks and side effects. For instance, removing the bladder not only changes how your body passes urine, but it can also cause sexual side effects. If you have these or any other problems, let your doctors know. There are ways to help deal with many side effects.
How Is Metastatic Bladder Cancer Treated
The way that metastatic bladder cancer is treated depends primarily on where the cancer has spread and the type of cells that make up the primary tumor. Its important to remember that when bladder cancer spreads, the secondary tumors are still considered to be bladder cancer not lung cancer, liver cancer or any other type of malignancy. Potential treatment options may include chemotherapy, radiation therapy and clinical trials.
At Moffitt Cancer Center, weve treated many patients with metastatic bladder cancer, creating tailored treatment plans for every single one. To help ease the burdens of treatment, we also offer comprehensive supportive care services for patients and their caregivers.
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What About Other Treatments That I Hear About
When you have cancer you might hear about other ways to treat cancer or treat your symptoms. These may not always be standard medical treatments. These treatments can be vitamins, herbs, special diets, and other things. You may be curious about these treatments.
Some of these are known to help, but many have not been tested. Some have been shown not to be helpful. A few have even been found to be harmful. Talk to your doctor about anything you’re thinking about using, whether its a vitamin, a diet, or anything else.
How Does Recurrence Of Bladder Cancer Affect Survival Rate
Recurrent bladder cancer is cancer that has returned after initial treatment. Recurrence rates for bladder cancer depend on the stage of the original tumor, with 5-year recurrence rates of approximately 65% in patients with non-invasive or in situ tumors and 73% in patients with slightly more advanced disease at first diagnosis.16
Many patients with non-invasive bladder cancer have recurrences that are typically not life threatening however, the prognosis is generally worse if the disease has spread into deeper layers of the bladder wall or beyond to the lymph nodes or other organs.
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Ial Or Radical Cystectomy
Some people with stage 2 or stage 3 bladder cancer will need to undergo surgery to remove part of the bladder or surgery to remove the entire bladder . If you need to have a radical cystectomy, the surgeon will often create another way for urine to be stored and removed from the body. Some people who have a radical or partial cystectomy may also have chemotherapy treatment.
Is Prostate Cancer Slow Growing
- Prostate Cancer
- Is prostate cancer slow growing?
This year, more than 300,000 American men will be diagnosed with prostate cancer. In most cases, the cancer consists of small knots of abnormal cells growing slowly in the walnut-sized prostate gland. In many men, the cancer cells grow so slowly that they never break free of the gland, spread to distant sites, and pose a serious risk to health and longevity.
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How Do Bladder Cancer Survival Rates Differ By Disease Stage
Staging of bladder cancer provides information on the extent of cancer in the body and whether the cancer has spread beyond the bladder this information helps predict how likely the cancer will respond to treatment.
Approximately half of bladder cancers are found at an early stage, when the cancer is in the surface layer of the bladder only .12 About one third of bladder cancers have spread to the deeper layers of the bladder wall but are still only in the bladder the remainder of cancers have spread into nearby tissues or lymph nodes or, rarely, to distant parts of the body.
The 5-year survival rate for bladder cancer varies by stage of the disease at diagnosis, which emphasizes the importance of detecting bladder cancer at an early stage.13
Note: In situ = cancer is confined to the surface layer of the bladder Localized = cancer has not spread outside of the bladder Regional = cancer has spread to nearby structures or lymph nodes Distant = cancer has spread to distant parts of the body
Whos At Risk For Bladder Cancer
There are 70,000 new cases of bladder cancer each year in the United States. The male-to-female incidence ratio is about 3 to 1. Your chances of developing bladder cancer increase with age.
The most common risk factor is smoking, which accounts for at least half of all new cases. Other risk factors include:
- abuse of phenacetin, an analgesic
- long-term use of cyclophosphamide , a chemotherapy drug and immune suppressant
- chronic irritation due to a parasitic disease called schistosomiasis
- chronic irritation from long-term catheterization
- exposure to certain industrial chemicals used in the dye, rubber, electric, cable, paint, and textile industries
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