What Is Bladder Cancer
Bladder cancer is a fairly common condition that involves your bladder, or the organ in your pelvic region that contains urine. The condition generally begins in the cells that line the bladder and may spread to other parts of your system.While it is often unclear what causes bladder cancer, several related factors have been identified. Some of the primary suspects for causing cancer include smoking, parasitic infection, radiation, and chemical exposure. In any case, some factor causes the cells in your bladder to grow and divide abnormally. This abnormal growth leads to the development of a tumor or mass of abnormal cells.
Who Can Use Bcg
BCG is a treatment for early-stage bladder cancer that has not yet invaded the muscle of the bladder wall. Called non-muscle invasive bladder cancers or in situ bladder cancers, these account for about half of all bladder cancers.
For 2021, it was estimated that about 83,730 new cases of bladder cancer would be diagnosed in the United States, and about 17,200 American bladder cancer patients would die from the disease.
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Genetic Risk Assessment Program
The UCLA Genitourinary Cancer Genetic Risk Assessment Program focuses on investigation into the potential genetic causes of an individuals urologic cancer. Up to 5-10% of cancers are related to a genetic predisposition. If you have been diagnosed with a urologic cancer, UCLAs team has specific referral criteria to determine if you should pursue genetic risk assessment to evaluate for a genetic cause of cancer. For those at greatest risk, often this knowledge can more precisely tailor a treatment plan that is optimal for you.
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The Following Stages Are Used For Bladder Cancer:
In stage 0, abnormalcells are found in tissue lining the inside of the bladder. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is divided into stages 0a and 0is, depending on the type of the tumor:
- Stage 0a is also called noninvasive papillary carcinoma, which may look like long, thin growths growing from the lining of the bladder.
- Stage 0is is also called carcinoma in situ, which is a flat tumor on the tissue lining the inside of the bladder.
In stage I, cancer has formed and spread to the layer of connective tissue next to the inner lining of the bladder.
In stage II, cancer has spread to the layers of muscle tissue of the bladder.
Stage III is divided into stages IIIA and IIIB.
- In stage IIIA:
- cancer has spread from the bladder to the layer of fat surrounding the bladder and may have spread to the reproductive organs and cancer has not spread to lymph nodes or
- cancer has spread from the bladder to one lymph node in the pelvis that is not near the common iliac arteries .
Stage IV is divided into stages IVA and IVB.
- In stage IVA:
- cancer has spread from the bladder to the wall of the abdomen or pelvis or
- cancer has spread to lymph nodes that are above the common iliac arteries .
If Treatment Does Not Work
Full recovery from bladder cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or metastatic.
This diagnosis is stressful, and for some people, advanced cancer is difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, expertise, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.
People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is a specific type of palliative care designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Learn more about advanced cancer care planning.
After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.
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Interim Analysis And Monitoring
Because this is a short-term study with a 2-year follow-up period, we will not conduct interim analysis. However, the safety of PDD-EBTUR will be independently evaluated by the Safety Monitoring Committee when:
A critical modification of the study protocol is required
Any serious adverse event associated with this surgical procedure occurs
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Intraoperative Details Of Turbt
In most cases, general or regional anesthesia must be used to establish nerve paralysis, to minimize risk of obturator nerve reflex and subsequently, bladder perforation.
Complete eradication of tumor is the first step in TURBT. Most tumors are papillary and are easily removed by endoscopically transecting their narrow stalk or base. Following this, biopsy of the base or deeper resection is performed to ensure complete removal and the absence of invasion. The goal is that muscle tissue must is present in the base biopsy specimen to ensure accurate staging.
Medium and large tumors are resected in a controlled serial fashion prior to transection of the stalk. This ensures that large segments do not remain that might be too large to evacuate through the resectoscope.
Smaller and more friable tumors may be removed at least partially by knocking off fragments with the cutting loop of the resectoscope without the electricity turned on. This sometimes allows partial removal with less risk of bladder perforation.
Pulling the cutting loop away from the tumor is generally much safer than pushing it toward the tumor. Lifting the tumor away from the surrounding normal bladder tissue using the cutting loop is also advisable.
Transurethral resection syndrome, which results from absorption of electrolyte-free irrigating fluid, has become uncommon since the advent of bipolar resectoscopes, which utilize normal saline irrigation.
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What Is The Laparoscopic Surgery Procedure
Laparoscopic surgery is performed under general anaesthetic and consists of making small incisions in the patients abdominal wall through which instruments are inserted like a laparoscope, which allows the surgeon to perform the operation via a video monitor.
The technique is used to perform a cystectomy, i.e., the removal of the bladder.
Are There Any Supplements That Can Help
Depending on your health, your doctor may recommend certain supplements. If youre feeling fatigued, they may check levels of iron and vitamin B12 in your blood. Fatigue can be caused by your cancer or treatment.
Fatigue may be worse if iron or B12 levels are low in your blood. Supplements can help to boost your iron and B12 levels.
If you have an infection and need antibiotics, taking probiotics afterwards may help. Your body is home to trillions of bacteria, many of which live in the digestive system. Antibiotics are important medications because they destroy harmful bacteria. Unfortunately, they also destroy some good bacteria, which can result in digestive trouble.
Probiotics can increase good bacteria in your digestive system. This may help reduce bloating, gas, and diarrhea. There is also limited evidence that probiotics could play a role in reducing bladder cancer recurrence.
Talk to your healthcare team if you have questions about whether any supplements could help you. Certain types of probiotic strains may not be safe for some people with bladder cancer, so its important to speak with your doctor before using probiotics.
Cancer treatments may reduce other nutrients in the body, including vitamin D and folate. Talk to your healthcare provider if you have questions about nutrient depletions caused by cancer treatments.
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How Is Bladder Tumor Biopsy And Resection Performed
You may have general anesthesia for this procedure, which means youll be asleep for it. Some providers might use regional anesthesia, which means youll be awake. However, you wont feel any pain.
Bladder tumor biopsy and resection is performed when a doctor inserts a rigid instrument called a resectoscope into the bladder through the urethra. Inserting the resectoscope in this way means that no incisions are necessary.
Your provider will use the resectoscope to remove the tumor, which will be sent to a pathology lab for testing. Once the tumor is removed, your doctor will attempt to destroy any remaining cancer cells by burning the area using electric current by a process called fulguration or cauterization.
Your provider may decide to insert some type of chemotherapy medicine into the bladder using the scope. This is called intravesical chemotherapy. Your provider might suggest that you have maintenance intravesical chemotherapy for a period of time, meaning that you’ll have regular treatments.
Quality Of Life After Surgery
Since bladder removal surgery involves restructuring the way urine exits the body, a person may initially experience a decrease in their quality of life. However, managing urine secretion usually becomes easier as time goes on.
Immediately following surgery, doctors usually restrict what the person can do. This restriction, though temporary, may feel frustrating.
It is common for the new urinary system, such as urinary sacks or stomas, to feel uncomfortable at first. If the person has trouble adjusting, they may want to discuss their concerns and feelings with a doctor, social worker, or counselor. Joining a support group can also help.
The person should be able to return to all their normal life activities within 46 weeks following surgery.
During recovery, the person will be able to get used to their new means of urinating. As their familiarity with the new urinary system grows, any inconvenient symptoms should lessen.
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What Are The Risks Of Cystectomy
Like any major surgical procedure, bladder removal surgery poses some risks, including:
- Organ damage
- Reactions to anesthesia
You may also have changes in how you urinate after any bladder surgery. Your bladder is smaller after partial cystectomy, so you may need to go to the bathroom more often. If you have a radical cystectomy, your ability to urinate depends on the type of reconstructive surgery you have.
For some men, bladder removal surgery causes sexual side effects. Men may have difficulty getting and maintaining erections. Because doctors remove the seminal vesicles along with the bladder, men will no longer produce semen.
Women may also experience sexual side effects. While intercourse is still possible, it may cause discomfort if doctors remove part of the vagina. Some people have nerve damage. This damage may limit a womans ability to become aroused and achieve orgasm.
After Bladder Cancer Has Been Diagnosed Tests Are Done To Find Out If Cancer Cells Have Spread Within The Bladder Or To Other Parts Of The Body
The process used to find out if cancer has spread within thebladder lining and muscle or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:
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Surgery For Bladder Cancer
Most people with bladder cancer will have surgery. The type of surgery you have depends mainly on the stage of the cancer. When planning surgery, your healthcare team will also consider other factors, such as your age and overall heath.
Surgery may be done for different reasons. You may have surgery to:
- diagnose bladder cancer and find out the stage
- completely remove the cancer
- remove as much of the cancer as possible before other treatments
- reduce pain or ease symptoms
The following types of surgery are used to treat bladder cancer. You may also have other treatments before or after surgery.
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.
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How Do You Prepare For A Turbt
Normally, you have to stop eating and drinking the night before any procedure that requires anesthesia. Make sure your provider knows about all of the medications that you take, including over-the-counter medicines and supplements.
Your healthcare provider will tell you if you need to avoid taking any of your medication for instance, blood thinners and when you should stop. Dont just stop taking medication without discussing it with your provider.
If youre allowed to take medications in the morning before the TURBT, make sure you only take a sip or two of water.
Take a bath or shower before you go in for the procedure. Dont use any kind of lotions or perfumes or deodorants after your shower.
Dress comfortably the day of the procedure. Bring identification, but leave your money, credit cards and jewelry at home.
Bring someone who can drive you home. Between anesthesia and pain medication, it wont be safe for you to drive yourself.
Treatment Of Stages Ii And Iii Bladder Cancer
For information about the treatments listed below, see the Treatment Option Overview section.
- Transurethral resection with fulguration.
- 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.
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Liquid Biopsies May Aid Diagnosis Treatment Of Bladder Nerve Tumors
by Julia Evangelou Strait, Washington University School of Medicine
Blood and urine tests could lead to faster and less invasive methods to diagnose and monitor various types of tumors, new research indicates. Two studies led by Washington University School of Medicine in St. Louis describe the potential of liquid biopsies to identify and track tumor growth in two very different cancers: bladder cancer and peripheral nerve tumors. Despite the differences between these cancers and their associated biopsies, the studies demonstrate the possible benefits of this relatively new tool in the fight against cancer.
Both studies appear in the Aug. 31 issue of PLOS Medicine, which is a special issue of the journal dedicated to liquid biopsies.
One study reports the development of a urine biopsy to monitor bladder cancer. With an easy to collect urine sample, doctors could determine whether the initial treatment eradicated the cancer or left some remnants of disease behind. That knowledge could lead to fewer patients undergoing unnecessary surgeries. The second study describes a blood biopsy to diagnose a tumor of the sheathor liningthat covers peripheral nerves. This rare cancer is caused by an inherited genetic disorder called neurofibromatosis type 1 . In patients with NF1, it is difficult to determine whether tumors developing in the nerve sheath are benign or malignant.
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Continent Diversion With A Continent Diversion You Control Urination The Surgeon Makes A Pouch To Hold The Urine You Drain The Urine From This New Pouch Either With A Tube Or Through The Ureter A Continent Cutaneous Reservoir Is Also Called A Continent Diversion With Catheterizable Cutaneous Stoma The Surgeon Creates A Pouch Using The Right Side Of The Colon And A Piece Of The Small Intestine The Pouch Is Attached To An Opening Made In The Abdominal Wall And Skin You Drain Urine From The Pouch By Inserting A Tube Into The Opening Several Times Throughout The Day
An orthotopic neobladder is when the surgeon makes a pouch usually from part of the small intestine. The ureters are attached to the pouch, which is then attached to the urethra. You empty the pouch by urinating normally. An orthotopic neobladder is a more difficult type of surgery than other urinary diversions and there is more chance of problems . So it is usually done in younger people without serious medical problems.
Find out more about .
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What Is The Outlook For Someone Who Has Had Bladder Tumor Biopsy And Resection
Bladder tumor biopsy and resection is a successful treatment for early stage bladder cancer. It can prevent cancer from spreading into the bladder muscle wall. Invasive bladder cancers that spread require more extensive treatment.
However, bladder cancer often comes back . More TURBT procedures may be needed. Your doctor will do frequent follow-up checkups with you to look for signs that the cancer has returned. The risks of repeated TURBT procedures is small.
Some providers might choose to burn off smaller tumors rather than remove them.
If the TURBT shows that you have a more advanced bladder cancer, youll probably need further treatment. This could include:
- A more extensive TURBT.
- Surgery to remove the tumor.
- Surgery to remove the bladder.
- Bacillus Calmette-Guerin therapy or BCG. This is a type of therapy that uses the bodys own immune system to fight the cancer.
Your urologist and pathologist will determine the best course of treatment based on the staging of the tumor and your personal medical history. TURBT can help in staging the cancer by determining if the cancer has invaded the bladder wall. Staging refers to determining how serious the cancer is.