Stage Iv Bladder Cancer Treatment
Only a small fraction of patients with stage IV bladder cancer can be cured, and for many patients, the emphasis is on palliation of symptoms. The potential for cure is restricted to patients with stage IV disease with involvement of pelvic organs by direct extension or metastases to regional lymph nodes.
Treatment Of Bladder Cancer By Stage
Most of the time, treatment of bladder cancer is based on the tumors clinical stage when its first diagnosed. This includes how deep its thought to have grown into the bladder wall and whether it has spread beyond the bladder. Other factors, such as the size of the tumor, how fast the cancer cells are growing , and a persons overall health and preferences, also affect treatment options.
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
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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 itâs 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 itâs 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 wasnât 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.
Bladder Cancer Stages And Survival Rates
Cancer survival rates are also categorized according to the stage of the cancer when it was diagnosed. The stage of cancer generally refers to how far it has progressed, and whether it has spread to other parts of the body. For bladder cancer, the 5-year survival rate for people with:2,3
- Bladder cancer in situ is around 96 percent
- Localized bladder cancer is around 70 percent
- Bladder cancer that has spread to the regional lymph nodes is 35 percent
- Distant or metastasized bladder cancer is 5 percent
If you would like to learn more about bladder cancer statistics, consider speaking with someone on your health care team. They will be able to explain more about how these statistics apply to your cancer. Tell us about your experience in the comments below, or with the community.
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What Are The Symptoms Of Stage 4 Bladder Cancer
The most common and most noticeable symptom of bladder cancer is bloody. According to the American Cancer Society, other symptoms of bladder cancer include
- Frequent urination
- A feeling of burning or pain while urinating
- Urinary urgency, even after emptying your bladder
- Difficulty starting or maintaining a strong urine stream
- Frequent trips to the bathroom during the night
It is worth noting that these symptoms can resemble a urinary tract infection. Regardless of the cause these indicators should be quickly evaluated by a medical professional so that treatment can begin for whatever condition should be the cause.
As bladder cancer progresses, though, so do the symptoms. With the progression of cancer, come more severe symptoms such as the inability to pass urine, bone pain, weight loss, pain in the back , swelling in the feet, and generalized weakness.
What Is The First Sign Of Bladder Cancer
Blood in the urine, referred to as hematuria, is usually the first sign of bladder cancer. This is because early bladder cancer commonly causes bleeding without associated pain or other symptoms.
- Depending on the amount of blood present, urine may appear pink, red, or brownish in color.
- Blood may not be present all the time – there may be relatively long periods of clear urine .
If you have noticed blood in your urine it is important to speak to your doctor as soon as possible.
Other early symptoms of bladder cancer that may be experienced are urinary irritation or changes in bladder habits, such as increased urination frequency and/or urgency, pain or a burning sensation during urination, or difficulty passing urine.
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Muscle Invasive Bladder Cancer
24 February 2012
Patients with muscle invasive bladder cancer have at best 50% overall survival depending upon their pathological stage and lymph node status. However, despite the progress made with the use of cisplatin-based combination chemotherapy in metastatic disease, chemotherapy is seldom used for infiltrating bladder cancer in the pre and post-cystectomy settings.
Clinical trials have been fraught with difficulties. There is currently more evidence available from randomised clinical trials in favor of upfront, neoadjuvant chemotherapy. In the adjuvant post-operative setting, many clinical trials have been closed early due to poor accrual. Due to the methodological issues in many of the studies in the peri-operative setting, the only conclusions that can be drawn are from meta-analyses combining the results of randomised trials.
Neo-adjuvant chemotherapy trials in bladder cancerResults of a recently published EORTC-MRC neoadjuvant randomized clinical trial will be highlighted. Prior meta-analysis of Phase III randomised trials with cisplatin-based combination chemotherapy has suggested a 5% benefit for cisplatin-based chemotherapy in the neo-adjuvant setting.
Adjuvant chemotherapy trials
Most recently, a large cohort analysis assessing the effect of adjuvant chemotherapy from several large centers suggested the greatest impact of adjuvant chemotherapy is seen in patients with extravesical extension or N+ disease.
Ubc Occurrence Is About Threefold Higher In Europe And North America
Although usually not perceived as such by the general population, UBC is among the more commonly occurring cancers. It ranks tenth in worldwide absolute incidence: sixth in men and seventeenth in women . Approximately 550,000 new UBCs were diagnosed worldwide in 2018 . The worldwide Age Standardized Incidence Rate per year is 9.6 per 100,000 for males and 2.4 per 100,000 for females. Figure 1 shows the worldwide ASRs for UBC in both sexes.
The incidence varies significantly between geographical regions, with the highest rates observed in Europe and North America, but also in Syrian, Israeli, Egyptian and Turkish males. About threefold lower rates are seen in South-East Asia, except for Japan, and in Latin America and Northern Africa in both sexes . The lowest rates are observed in Sub-Saharan Africa, Mexico and some Middle Eastern and Central Asian countries.
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Risk Groups For Early Bladder Cancer
Doctors classify bladder cancer that has not grown into the muscle layer of the bladder wall into risk groups. These risk groups are based on several factors, including the size and grade of the cancer. The risk groups allow the doctor to estimate the chance that the cancer will come back and continue to grow and spread . Doctors also use the risk groups to help plan the best treatment.
Any non-invasive and non-muscle-invasive bladder cancers are classified as low, intermediate or high risk.
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Survival Rates For Bladder Cancer
Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain amount of time after they were diagnosed. They cant tell you how long you will live, but they may help give you a better understanding of how likely it is that your treatment will be successful.
Keep in mind that survival rates are estimates and are often based on previous outcomes of large numbers of people who had a specific cancer, but they cant predict what will happen in any particular persons case. These statistics can be confusing and may lead you to have more questions. Your doctor is familiar with your situation ask how these numbers may apply to you.
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What Is A Bladder
The bladder can be described as a hollow organ, which is located next to the kidneys. The bladder functions by collecting all the urine coming from the kidneys through the ureter. It then stores the urine until it is removed from the body.
Having a bladder cancer causes an uncontrolled growth and development of cells in the bladder. The increasing production of cells is abnormal. Once the cells have grown, they can cause some complications in the personâs body including pain.
Have a question about
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Extent Of Cancer At The Time Of Diagnosis
About half of all bladder cancers are first found while the cancer is still found only in the inner layer of the bladder wall. About 1 in 3 bladder cancers have spread into deeper layers but are still only in the bladder. In most of the remaining cases, the cancer has spread to nearby tissues or lymph nodes outside the bladder. Rarely , it has spread to distant parts of the body. Black patients are slightly more likely to have more advanced disease when they’re diagnosed, compared to whites.
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C Data Abstraction And Data Management
After studies are selected for inclusion, data will be abstracted into categories that include but are not limited to: study design, year, setting, country, sample size, eligibility criteria, population and clinical characteristics , intervention characteristics , and results relevant to each key question as outlined in the previous PICOTS section. Information that will be abstracted that is relevant for assessing applicability will include the number of patients randomized relative to the number of patients enrolled, and characteristics of the population, intervention, and care settings. Sources of funding for all studies will also be recorded. All study data will be verified for accuracy and completeness by a second team member. A record of studies excluded at the full-text level with reasons for exclusion will be maintained.
Treatments To Control And Prevent Symptoms Caused By The Spread Of Prostate Cancer To The Bones
Palliative External beam radiotherapy
Radiopharmaceuticals: Strontium-89 , samarium-153
Radium-223 dichloride is now licensed and called Xofigo. This is not widely available in the UK but BPC is one of a relatively small number of specialist centres using this treatment.
Zolidronic acid a bisphosphonate given by a 15 minute intravenous infusion every 34 weeks. It reduces the risk of bone complications, including pain and fractures.
Xgeva : this is a newly licensed drug available at BPC.
Surgery may be undertaken to treat bone fractures or to relief the pressure on the spinal cord by bone metastases.
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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|
|All SEER stages combined||77|
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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Subtleties And Future Questions
Several factors have to be carefully considered in interpreting the trial results, explained Dr. Apolo.
A major one is that the study did not directly compare survival between people who got avelumab immediately versus when their cancer progressed. Only about half of the participants who initially received supportive care alone went on to receive immunotherapy after their cancer got worse. There could be many reasons for this, including lack of access to these drugs in different countries, Dr. Apolo said.
But it also might be that, for some people, the cancer was progressing too rapidly, she added. When these tumors start growing, they start growing very quickly. So if you wait to start at the time of progression, maybe its too late, added Dr. Apolo.
Not all patients will be caught by the second-line safety net, agreed Dr. Plimack.
So, for now, said Dr. Balar, the takeaway message from the JAVELIN study is after chemotherapy, dont wait to give immunotherapy.
But more and more, studies are looking at whether some patients should receive immunotherapy as first-line treatment, he continued. Immunotherapy is one of the most important advances weve made in the last 30 years, Dr. Balar said.
The JAVELIN results cant provide any insight into which patients benefit from first-line treatment with a platinum-based chemotherapy, he added. This trial wasnt designed to ask: Is chemotherapy necessarily the best choice for every patient? he explained.
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Treatment Of Invasive Bladder Cancer In The Elderly And Frail Patient
I think this is a very contemporary topic because we are living in an aging society. If you look here, and you know if you really want to look at the life expectancy you should look at charts of the insurance company and governmental agencies rather than medical reports. And this is the life expectancy nowadays where in North America. So, you can see that if you are at the octogenarians, octogenarians for the sake of this talk is 80 years old, 80 to 90, and nonagenarians are 90 and plus. And you see so when you hit 80 you still have at least seven years as a male, and nine years or more as a female. So, we are actually talking about increased population that, and Ill show you data, has more bladder cancer, and theyre actually destined to live quite long if they are in the average risk. So, if you live for example to 90 years old youre expected to live about four years if youre a male and four and a half or five years if youre a female. So, we have to bear these figures in mind.
But once its diagnosed we have a very poor, we poorly address that. This is a paper by Gore et al, and it shows that only 21% of muscle invasive bladder cancer patients over the age of 65 here actually received radical cystectomy. He shows also that there was a better overall survival, but obviously this is biased by selection.
Partial cystectomy there is very few data, none in octogenarian. This is just a series from Wes Kassouf, so I will omit that because we really dont have enough data.
Treatment Options Under Clinical Evaluation For Patients With Any T Any N M1 Disease
Prognosis is poor in patients with stage IV disease and consideration of entry into a clinical trial is appropriate.
Other chemotherapy regimens appear to be active in the treatment of metastatic disease. Chemotherapy agents that have shown activity in metastatic bladder cancer include paclitaxel, docetaxel, ifosfamide, gallium nitrate, and pemetrexed.
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What Is The Five Year Survival Rate For Bladder Cancer
A five-year survival rate is the percentage of people in a study or treatment group who are alive five years after they were diagnosed with or started treatment for a disease such as bladder cancer. Their disease may or may not have recurred during that time.
The American Cancer Society periodically reports on the five-year survival rate for bladder cancer. The most recently period studied was from 2010 to 2016 and that rate was 77%. This means that from the time of diagnosis, 77 out of 100 people diagnosed with bladder cancer were alive in five years. From 1987 1989 , the five-year survival rate was 79% and from 1975 1977, it was 72%. The survival rates are not the same for everyone, however.