Cellular Classification Of Bladder Cancer
More than 90% of bladder cancers are transitional cell carcinomas derived from the uroepithelium. About 2% to 7% are squamous cell carcinomas, and 2% are adenocarcinomas. Adenocarcinomas may be of urachal origin or nonurachal origin the latter type is generally thought to arise from metaplasia of chronically irritated transitional epithelium. Small cell carcinomas also may develop in the bladder. Sarcomas of the bladder are very rare.
Pathologic grade of transitional cell carcinomas, which is based on cellular atypia, nuclear abnormalities, and the number of mitotic figures, is of great prognostic importance.
References
Surgery As A Consolidation Therapy
Patients who respond to primary chemotherapy may benefit from surgical consolidation if the disease is limited and located in the regional lymph nodes or metastatic site/sites amenable to surgical removal . The concept of metastasectomy in urothelial carcinoma was first described in the early 1980s, when Cowles et al. reported long-term survival for six patients who underwent wedge resection for solitary pulmonary metastasis. After more than one decade, multiple reports started to demonstrate the suggested benefits of surgical excision of metastatic lesions as part of a multimodality approach . In the age of immunotherapeutics, reduction of tumor burden may become even more important.
Survival Rates By Stage
The numbers listed below are based upon countless people detected with bladder cancer from 1988 to 2001. These numbers originated from the National Cancer Institutes SEER database.
- The 5-year relative survival rate for people with stage 0 bladder cancer has to do with 98%.
- The 5-year relative survival rate for individuals with stage I bladder cancer has to do with 88%.
- For stage II bladder cancer, the 5-year relative survival rate is about 63%.
- The 5-year relative survival rate for stage III bladder cancer has to do with 46%.
Bladder cancer that has spread to other parts of the body is often hard to alleviate. Phase IV bladder cancer has a relative 5-year survival rate of about 15%. Still, there are typically treatment alternatives readily available for people with this phase of cancer.
Remember, these survival rates are only approximates they cant predict exactly what will happen to any individual person. We comprehend that these data can be complicated and may lead you to have more concerns. Speak with your physician to much better comprehend your certain situation.
Being diagnosed with bladder cancer can be overwhelming and scary, especially if its phase 4.
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Survival Rates For Prostate 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. These rates 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. Talk with your doctor about how these numbers may apply to you, as he or she is familiar with your situation.
Strategies To Improve Treatment
Most new treatments are developed in clinical trials. Clinical trials are studies that evaluate the effectiveness of new treatment strategies. The development of more effective cancer treatment for bladder cancer requires that new and innovative therapies be evaluated in patients. Participation in a clinical trial may offer access to better treatments and advance the existing knowledge about treatment of bladder cancer. Patients who are interested in participating in a clinical trial should discuss the risks and benefits with their physician.
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Risk Factors Of Prostate Cancer
- Age
Age is the most significant risk factor for prostate cancer. Your risk increases as you get older. Most men diagnosed with prostate cancer are over 50 years of age. If you are over the age of 50, talk to your GP about the PSA blood test which can indicate if your prostate is healthy or not.
- A family history of cancer
A family history means that you have someone in your family who has cancer. Generally, if you have a father or brother diagnosed with prostate cancer, you are 2 to 3 times more likely to get prostate cancer yourself, compared to the average man.
The risk is much higher for men with several affected relatives, particularly if their relatives were young when the cancer was found. It is always worth knowing about your family history.
- Genes
Several inherited gene changes seem to raise prostate cancer risk, but they probably account for only a small percentage of cases overall. For example, inherited mutations of the BRCA1 or BRCA2 genes raise the risk of breast and ovarian cancers in some families. Mutations in these genes may also increase prostate cancer risk in some men.
- Ethnicity
Prostate cancer is more common in black Caribbean and black African men than in white or Asian men. Asian men have half the risk of white men.
- A previous cancer
Treating Metastatic Bladder Cancer
Treatment for metastatic bladder cancer is different for each person, depending on your specific situation. Your doctor and care team will discuss different options with you, as well as the advantages and disadvantages of each type of treatment option.
The goals of most types of treatment are to slow down how fast the cancer cells are growing and to shrink the tumor as much as possible. Other important goals of treatment are to help people with bladder cancer live as long as possible and to make sure they have the best possible quality of life. Palliative care can also help relieve symptoms and treatment side effects.4
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Case : Metastatic Bladder Cancer To Adrenal Gland/liver/lung
A 56-year-old man with bladder cancer was initially treated with radical cystectomy followed by chemotherapy. Follow-up scan including a PET-CT showed an isolated area with high uptake in his left adrenal gland consistent with recurrent metastatic bladder cancer. He was also having side effects from systemic chemotherapy and needed a break. He was referred for consideration of SBRT to his isolated recurrence after surgery and chemotherapy. He was simulated in the supine position in an immobilization device. PET-CT images were co-registered with simulation CT images. Target delineation was performed by the radiation oncologist and the nuclear medicine radiologist. Tumor motion data from 4D-CT dataset were used to plan PTV. SBRT with daily image-guidance approach was taken whereby the metastatic tumor was prescribed 30 Gy in 5 fractions . Rapid fall off was achieved with the treatment plan to for conformal avoidance of small bowels and kidney . Follow-up imaging showed decrease in the adrenal mass.
Ho Kyung Seo, … Sung Han Kim, in, 2018
Standard Treatment Options For Stage I Bladder Cancer
Patients with stage I bladder tumors are unlikely to die from bladder cancer, but the tendency for new tumor formation is high. In a series of patients with Ta or T1 tumors who were followed for a minimum of 20 years or until death, the risk of bladder recurrence after initial resection was 80%. Of greater concern than recurrence is the risk of progression to muscle-invasive, locally-advanced, or metastatic bladder cancer. While progression is rare for low-grade tumors, it is common among high-grade cancers.
One series of 125 patients with TaG3 cancers followed for 15 to 20 years reported that 39% progressed to more advanced stage disease, while 26% died of urothelial cancer. In comparison, among 23 patients with TaG1 tumors, none died and 5% progressed. Risk factors for recurrence and progression include the following:
- High-grade disease.
TUR with fulguration followed by an immediate postoperative instillation of intravesical chemotherapy
TUR and fulguration are the most common and conservative forms of management. Careful surveillance of subsequent bladder tumor progression is important. Because most bladder cancers recur after TUR, one immediate intravesical instillation of chemotherapy after TUR is widely used. Numerous randomized, controlled trials have evaluated this practice, and a meta-analysis of seven trials reported that a single intravesical treatment with chemotherapy reduced the odds of recurrence by 39% .
TUR with fulguration
Evidence :
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Where Do These Numbers Come From
The American Cancer Society relies on information from the SEER* database, maintained by the National Cancer Institute , to provide survival statistics for different types of cancer.
The SEER database tracks 5-year relative survival rates for bladder cancer in the United States, based on how far the cancer has spread. The SEER database, however, does not group cancers by AJCC TNM stages . Instead, it groups cancers into localized, regional, and distant stages:
- Localized: There is no sign that the cancer has spread outside of the bladder.
- Regional: The cancer has spread from the bladder to nearby structures or lymph nodes.
- Distant: The cancer has spread to distant parts of the body such as the lungs, liver or bones.
Prognosis And Survival For Bladder Cancer
If you have bladder cancer, you may have questions about your prognosis. A prognosis is the doctors best estimate of how cancer will affect someone and how it will respond to treatment. Prognosis and survival depend on many factors. Only a doctor familiar with your medical history, the type and stage and other features of the cancer, the treatments chosen and the response to treatment can put all of this information together with survival statistics to arrive at a prognosis.
A prognostic factor is an aspect of the cancer or a characteristic of the person that the doctor will consider when making a prognosis. A predictive factor influences how a cancer will respond to a certain treatment. Prognostic and predictive factors are often discussed together. They both play a part in deciding on a treatment plan and a prognosis.
The following are prognostic and predictive factors for bladder cancer.
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Treatment Options For Advanced Stage Bladder Cancer
If you are diagnosed with stage IV bladder cancer, your healthcare team will discuss the treatment options that are available to you.3 The available options generally depend on if the cancer has spread to other parts of the body.
Treatments for stage IV bladder cancer that has not metastasized, or spread to other parts of the body, may include chemotherapy treatment, or external radiation therapy with or without chemotherapy treatment. Some patients may have a surgery called a radical cystectomy to remove the entire bladder, which may or may not be followed by chemotherapy. If you have a radical cystectomy, the surgeon will likely create another way for urine to be stored and removed from the body.
Treatment for stage IV bladder cancer that has spread to other parts of the body may include treatment with one or more of the following: chemotherapy, immunotherapy, surgery, or external radiation therapy. Some patients may choose to participate in a clinical trial to investigate new types of treatment for bladder cancer.
What Is Muscle Invasive Bladder Cancer
Muscle invasive bladder cancer is a cancer that spreads into the detrusor muscle of the bladder. The detrusor muscle is the thick muscle deep in the bladder wall. This cancer is more likely to spread to other parts of the body.
In the U.S., bladder cancer is the third most common cancer in men. Each year, there are more than 83,000 new cases diagnosed in men and women. About 25% of bladder cancers are MIBC. Bladder cancer is more common as a person grows older. It is found most often in the age group of 75-84. Caucasians are more likely to get bladder cancer than any other ethnicity. But there are more African-Americans who do not survive the disease.
What is Cancer?
Cancer is when your body cells grow out of control. When this happens, the body cannot work the way it should. Most cancers form a lump called a tumor or a growth. Some cancers grow and spread fast. Others grow more slowly. Not all lumps are cancers. Cancerous lumps are sometimes called malignant tumors.
What is Bladder Cancer?
When cells of the bladder grow abnormally, they can become bladder cancer. A person with bladder cancer will have one or more tumors in his/her bladder.
How Does Bladder Cancer Develop and Spread?
The bladder wall has many layers, made up of different types of cells. Most bladder cancers start in the urothelium or transitional epithelium. This is the inside lining of the bladder. Transitional cell carcinoma is cancer that forms in the cells of the urothelium.
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Transurethral Resection Of A Bladder Tumor
A procedure called transurethral resection is commonly used to learn more about the bladder cancer. This procedure is often also part of treatment for early-stage or non-muscle invasive bladder cancer. During this procedure, a telescope is inserted into your bladder, and the tumor is then removed by scraping it from the bladder wall. Other tests may include a CT scan of the abdomen and pelvis, MRI scans, X-rays, and bone scans.3
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.
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Standard Treatment Options For Stage Iv Bladder Cancer
Standard treatment options for patients with T4b, N0, M0 disease
Treatment options for patients with T4b, N0, M0 disease include the following:
Chemotherapy alone or as an adjunct to local treatment
Cisplatin-based combination chemotherapy regimens are the standard of care for first-line therapy for stage IV bladder cancer in patients who can tolerate it. The only chemotherapy regimens that have been shown to result in longer survival in randomized controlled trials are MVAC, dose-dense MVAC, and CMV. GC was compared with MVAC in a randomized controlled trial and neither regimen was associated with a statistically significant difference in response rate or survival. The two regimens are generally considered equivalent, but they have never been compared in a noninferiority trial. Of note, patients with good performance status and lymph node-only disease have a low but significant rate of achieving a durable complete remission with MVAC or GC. In the large, randomized, controlled trial comparing MVAC with GC, for example, 5-year OS in patients with lymph node-only disease was 20.9%. Dose-dense MVAC and standard-dose MVAC were compared in a randomized controlled trial, and dose-dense MVAC was associated with longer survival.
Ongoing studies are evaluating new chemotherapy combinations.
Evidence :
Ongoing studies are evaluating new chemotherapy combinations.
Immunotherapy
Pembrolizumab
Evidence :
Overview Of Management Of Muscle Invasive Bca
RC with pelvic lymph node dissection is the standard treatment for patients with non-metastatic MIBC and patients with very high-risk non-muscle invasive BCa . The 5-year overall survival rates were estimated to be around 60% , ranging from 32% in patients with lymph node involvement to 75% in those without . RC includes pelvic lymphadenectomy as an integral part of the procedure with better oncological outcomes in patients with N0M0 MIBC. Indeed, lymph node status is the single most powerful pathologic predictors of long term disease-specific survival and OS, but the exact extent of PLND is a matter of debate with on-going randomized trials adding new knowledge soon . Despite radical treatment, the incidence of distance failure in clinically non-metastatic patients with organ confined, extravesical and lymph node positive disease were estimated to be 25%, 37% and 51%, respectively . This is attributed to the presence of micrometastasis that remains undiagnosed at the time of surgery .
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What Are The Layers Of The Bladder
The bladder consists of three layers of tissue. The innermost layer of the bladder, which comes in contact with the urine stored inside the bladder, is called the mucosa and consists of several layers of specialized cells called transitional cells, which are almost exclusively found in the urinary system of the body. These same cells also form the inner lining of the ureters, kidneys, and a part of the urethra. These cells form a waterproof lining within these organs to prevent the urine from going into the deeper tissue layers. These cells are also termed urothelial cells, and the mucosa is termed the urothelium.
The middle layer is a thin lining known as the lamina propria and forms the boundary between the inner mucosa and the outer muscular layer. This layer has a network of blood vessels and nerves and is an important landmark in terms of the staging of bladder cancer .
The outer layer of the bladder comprises of the detrusor muscle. This is the thickest layer of the bladder wall. Its main function is to relax slowly as the bladder fills up to provide low-pressure urine storage and then to contract to compress the bladder and expel the urine out during the act of passing urine. Outside these three layers is a variable amount of fat that lines and protects the bladder like a soft cushion and separates it from the surrounding organs such as the rectum and the muscles and bones of the pelvis.