What Is Chemotherapy For Bladder Cancer
Patients who are diagnosed with metastatic bladder cancer are usually treated with chemotherapy. Chemotherapy may also be used in cases of “locally advanced” bladder cancer in an attempt to decrease the chances of the cancer coming back after radical cystectomy. This is “adjuvant chemotherapy.” Another strategy entails administering “neoadjuvant chemotherapy” by giving these medications before radical cystectomy in an attempt to improve the results of surgery and decrease the size of the tumor before the operation.
Chemotherapy has the potential to control metastatic bladder cancer and increase the chances of cure when used in a neoadjuvant or adjuvant setting along with surgery. However, chemotherapy has its own set of side effects that some individuals find intolerable.
The time-honored chemotherapy regimen for bladder cancer is the MVAC. It is a combination of four medications given in cyclical form.
- C: Cisplatin
Oncologists currently prescribe MVAC in a “dose dense” fashion. This means the patient takes the drugs more frequently than was previously done in the accepted treatment schedule, as well as taking growth factors to help the blood counts to recover faster from the effects of the chemotherapy drugs. The older schedule for MVAC therapy is no longer recommended according to the National Comprehensive Cancer Network.
Some patients with heart disease may not be in a condition to receive Adriamycin and may receive CMV instead
What Are Bladder Tumors
Bladder tumors are abnormal growths that occur in the bladder. If the tumor is benign, its noncancerous and wont spread to other parts of your body. This is in contrast to a tumor thats malignant, which means its cancerous.
There are several types of benign tumors that can develop within the bladder.
Causes Of Bladder Cancer
Most cases of bladder cancer appear to be caused by exposure to harmful substances, which lead to abnormal changes in the bladder’s cells over many years.
Tobacco smoke is a common cause and it’s estimated that more than 1 in 3 cases of bladder cancer are caused by smoking.
Contact with certain chemicals previously used in manufacturing is also known to cause bladder cancer. However, these substances have since been banned.
Read more about the causes of bladder cancer.
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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.
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.
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Bladder Cancer Treatment: Chemotherapy
Chemotherapy is given in some cases before surgery to shrink bladder cancer tumors. It can also be used after surgery to destroy any remaining tumor cells. Chemotherapy may be given intravenously or administered directly into the bladder . Intravesical chemotherapy is effective in decreasing the recurrence rate of superficial bladder cancers on a short-term basis, but not effective against bladder cancer that has already invaded the muscular walls. Systemic or intravenous chemotherapy is required when the cancer has deeply penetrated the bladder, lymph nodes, or other organs.
Chemotherapy Side Effects
Side effects vary from patient to patient. Common side effects of systemic chemotherapy include the following:
- Nausea and vomiting
- Sores on the inside of the mouth or in the digestive tract
- Feeling tired or lacking energy
- Increased susceptibility to infection
There Are Different Types Of Treatment For Patients With Bladder Cancer
Different types of treatment are available for patients with bladder cancer. Some treatments are standard , and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
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New And Experimental Treatments
Several new treatments may prove useful in treating bladder cancer. Photodynamic therapy, used in early stage cancers, uses a laser light to activate a chemical that kills cancer cells. Some gene therapies use lab-created viruses to fight cancer. And targeted therapies aim to control the growth of cancer cells. You may be eligible to participate in a clinical trial of these or other cutting-edge treatments.
21) Carol & Mike Werner / Visuals Unlimited / Corbis
American Urological Association: “Bladder Cancer.”
American Urological Association Foundation: “Hematuria.”
Journal of the American Medical Association: Association Between Smoking and Risk of Bladder Cancer Among Men and Women.
Occupational & Environmental Medicine: Bladder cancer among hairdressers: a meta-analysis.
British Journal of Cancer: Occupation and bladder cancer: a cohort study in Sweden.
National Cancer Institute: “Staging,” “Bladder Cancer Treatment,” “Drugs Approved for Bladder Cancer,” “SEER Stat Fact Sheets: Bladder.”
NIH Research Matters: “Smoking and Bladder Cancer.”
ScienceDaily: “Cigarette Smoking Implicated in Half of Bladder Cancers in Women Bladder Cancer Risk from Smoking Is Higher Than Previously Estimated, Study Confirms.”
Stanford Cancer Institute: “Information About Bladder Cancer.”
World Health Organization: “Tobacco Free Initiative — Cancer.”
Sexuality And Bladder Cancer
Having bladder cancer and treatment can change the way you feel about yourself, other people, relationships and sex. These changes can be very upsetting and hard to talk about. Doctors and nurses are very understanding and can give you support. You can ask for a referral to a counsellor or therapist who specialises in body image, sex and relationships.
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Treating A Benign Bladder Tumor
Treatment for your tumor will depend on what type of tumor you have. First, your doctor may diagnose the tumor via biopsy or endoscopy. An endoscopy will provide a visual look, while a biopsy will provide a tissue sample of the tumor.
After diagnosing the tumor, your doctor will develop a treatment plan that best suits your condition.
If the tumor is positioned so the risk of surgery damaging blood vessels, nerves, and the surrounding area is relatively low, theyll most likely recommend removing the tumor.
If the tumor doesnt pose a direct threat, wont likely grow, and isnt causing any issues currently, your doctor may suggest monitoring the tumor.
Preparing For A Cystoscopy
The process of preparing for a cystoscopy depends on which type of cystoscopy and anesthetic a patient is undergoing. For example:
- If a general anesthetic is required, a pre-assessment is carried out several days before the procedure this may involve routine pre-anesthetic checks such as blood tests and x-rays. Instructions will also be given regarding how long before the procedure to stop eating and drinking.
- If a local anesthetic is being used the patient can eat and drink normally beforehand.
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Who Is At Risk For Bladder Cancer
Bladder cancer can affect anyone, but certain groups are at greater risk. Men are three times more likely than women to get bladder cancer. Around 90% of cases occur in people over age 55, and whites are twice as likely as African Americans to develop the condition.
Other factors that increase the risk of getting bladder cancer include a family history of the condition and previous cancer treatment. Birth defects involving the bladder increase the risk of bladder cancer. When people are born with a visible or invisible defect that connects their bladder with another organ in the abdomen, this leaves the bladder prone to frequent infection. This increases the bladder’s susceptibility to cellular abnormalities that can lead to cancer. Chronic bladder inflammation increase the risk of developing bladder cancer.
Bladder Cancer Treatment: Urinary Diversion After Surgery
When the entire bladder is removed the surgeon will create an alternate way for urine to be stored and passed. This procedure is called urinary diversion. Depending on preference, a bag can either be placed inside or outside of the body to collect urine. Non-continent urinary diversion is when a urostomy bag is placed outside the body, worn under the clothes. Continent urinary diversion consists of a pouch, made from intestinal tissue, inside the body to hold urine. In a newly introduced surgical procedure, the insertion of an artificial bladder has also been successful for some patients.
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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.
Bladder Cancer Diagnosis: Imaging
An intravenous pyelogram is an X-ray test with contrast material to show the uterus, kidneys, and bladder. When testing for bladder cancer, the dye highlights the organs of the urinary tract allowing physicians to spot potential cancer-specific abnormalities.
CT Scans and MRI
CT scans and MRI are often used to identify tumors and trace metastasized cancers as they spread to other organ systems. A CT scan provides a three-dimensional view of the bladder, the rest of the urinary tract, and the pelvis to look for masses and other abnormalities. CT scans are often used in conjunction with Positron emission tomography to highlight cells with high metabolic rates. âHot spotsâ of cells with abnormally high metabolism may indicate the presence of cancer and require further investigation.
If a tumor is found in the bladder a bone scan may be performed to determine whether the cancer has spread to the bones. A bone scan involves having a small dose of a radioactive substance injected into the veins. A full body scan will show any areas where the cancer may have affected the skeletal system.
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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.
Bladder Cancer Treatment: Surgery
Early-stage cancers are most commonly treated by transurethral surgery. An instrument with a small wire loop is inserted through the urethra and into the bladder. The loop removes a tumor by cutting or burning it with electrical current, allowing it to be extracted from the bladder.
Partial and Radical Cystectomy
Partial cystectomy includes the removal of part of the bladder. This operation is usually for low-grade tumors that have invaded the bladder wall but are limited to a small area of the bladder. In a radical cystectomy, the entire bladder is removed, as well as its surrounding lymph nodes and other areas that contain cancerous cells. If the cancer has metastasized outside of the bladder and into neighboring tissue, other organs may also be removed such as the uterus and ovaries in women and the prostate in men.
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What Is The Treatment For Superficial Bladder Cancer
Superficial bladder cancer is a cancer that has not invaded the muscle wall of the bladder and is confined to the inner lining of the bladder. This cancer is also termed non-muscle-invasive bladder cancer. The T stage is Ta, T1, or Tis . After the initial TURBT or biopsy in case of CIS, the subsequent treatment in these cases may involve observation with regular follow-up with cystoscopy examinations of the bladder, instillation of medications in the bladder, or in certain cases, surgical removal of the bladder .
Small low-grade, superficial bladder cancers may not require aggressive management after the initial TURBT and may be simply followed up by doing repeated cystoscopy examinations at regular intervals . Some physicians will use fulguration to treat biopsy areas or other small areas that may contain bladder cancer cells.
It is very important to note that 30%-40% of these tumors tend to recur and these recurrences may not be associated with any symptoms. Hence, it is imperative to stick to a regular follow-up protocol to ensure that the disease does not go out of control. A single dose of a chemotherapy medication put inside the bladder immediately after a TURBT can decrease the chances of recurrence within the first two years after surgery.
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.
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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:
Types Of Bladder Cancer
The main types of bladder cancer are named for the type of cells that become cancerous. The most common is urothelial carcinoma , which begins in the cells that line the inside of the bladder.
Squamous cell carcinoma and adenocarcinoma are much less common.
Stage 0: Cancer stays in the inner lining.Stage I: Cancer has spread to the bladder wall.Stage II: Cancer has reached the muscle of the bladder wall.Stage III: Cancer has spread to fatty tissue around the bladder and possibly certain nearby lymph nodes. It may also have spread to the prostate in men or the uterus or vagina in women.Stage IV: Cancer has spread to the pelvic or abdominal wall, lymph nodes, or distant sites such as bone, liver, or lungs.
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Questions To Ask The Doctor
- What treatment do you think is best for me?
- Whats the goal of this treatment? Do you think it could cure the cancer?
- Will treatment include surgery? If so, who will do the surgery?
- What will the surgery be like?
- How will I pee after surgery?
- Will I have other types of treatment, too?
- Whats the goal of these treatments?
- What side effects could I have from these treatments?
- Is there a clinical trial that might be right for me?
- What about treatments like special vitamins or diets that friends tell me about? How will I know if they are safe?
- What should I do to be ready for treatment?
- Is there anything I can do to help the treatment work better?
- Whats the next step?