How Long Does Advanced Bladder Cancer Treatment Last
Treatment options for advanced bladder cancer vary from person to person. The length of treatment depends on the overall treatment goals.
In general, most people with advanced bladder cancer receive chemotherapy for 6 to 12 months, depending on how long it takes to reduce cancer cells.
The length of time for immunotherapy also varies depending on the stage of cancer and how your body reacts to treatment.
For example, you may receive treatment every day for 2 or 3 weeks and then take a rest period before restarting treatment.
Treatment can prolong life for people living with advanced bladder cancer. However, in many cases, the disease tends to progress.
Your doctor may recommend that you continue to receive treatment to improve your quality of life.
As the cancer progresses, your doctor may suggest palliative care. You can continue treatment for the cancer while also receiving palliative care, notes the Bladder Care Advocacy Network .
Palliative care is aimed at addressing the physical, emotional, and social aspects of the condition.
It can treat specific physical symptoms, such as nausea and fatigue. It can also help improve your overall quality of life and help you manage stress related to the condition.
The goals of treatment at this stage are usually to:
- slow the spread of the cancer
- shrink the size of the affected areas
- extend your life as long as possible
- make you comfortable
For example, your health insurance policy will likely cover the cost of:
Managing Bladder Cancer Treatment Side Effects
There are often solutions to bladder cancer treatment side effects. Ask your doctor beforehand what you can expect from your specific treatment. Find out how you can avoid side effects and how your doctor plans to deal with them if they occur. Many side effects have specific solutions to relieve your symptoms. With surgery, the doctorâs experience with the procedure often plays a role in its success.
What Happens During Treatment
A urinary catheter is inserted through your urethra and into your bladder. Then the BCG solution is injected into the catheter. The catheter is clamped off so the solution stays in your bladder. Some doctors may remove the catheter at this time.
You have to hold the medicine in your bladder. Youll be instructed to lie on your back and to roll from side to side to make sure the solution reaches your entire bladder.
After about two hours, the catheter is unclamped so the fluid can be drained. If the catheter was already removed, youll be asked to empty your bladder at this time.
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What Can I Expect Following Treatment
You may be advised to drink plenty of fluid to flush the rest of the medication from your bladder.
For six hours after each treatment, youll have to be very careful when you urinate to avoid transmitting BCG to others. Men should urinate while seated to avoid splashing.
Disinfect the urine by adding 2 cups of bleach into the toilet. Let it stand for about 20 minutes before flushing. You should also wash your genital area very carefully after you urinate, so your skin doesnt become irritated from the BCG. Wash your hands thoroughly, too.
Men can pass BCG to their partner during sex. For that reason, you should avoid sex for 48 hours after each treatment. Use a condom between treatments and for six weeks following your final treatment.
Women should avoid getting pregnant or breastfeeding while on BCG therapy.
Treatment is usually given every week for six weeks. After that, you might need to do it once a month for six months to a year.
One benefit of BCG is that while it affects the cells in your bladder, it doesnt have a major effect on any other part of your body. But there can be a few side effects such as:
- fever
When comparing BCG to other bladder cancer treatments, its important to remember that treatment isnt the same for everybody. Some of the factors that determine your options are:
- type of bladder cancer
- your age and general health
- how well you tolerate certain treatments
Can Making Lifestyle Changes Help Me Manage Advanced Bladder Cancer
Along with following a treatment plan, certain lifestyle changes can make living with advanced bladder cancer a little easier. Even with limited strength and energy, there are some things you can do to feel better.
For example, eating a healthy, balanced diet can help you maintain your physical strength and boost your immune system.
A stronger immune system can help your body fight off infections, which is especially important while youre in treatment.
Some people find dietary supplements helpful while receiving treatment for cancer. Be sure to talk with your doctor before taking dietary supplements.
Staying physically active is also important. Exercise can help:
- improve your mental outlook
- improve the quality of your sleep
- increase your energy level
If you smoke, and you havent already, you should also quit smoking. The chemicals found in both cigarette and cigar smoke can accumulate in your urine and cause further damage to your bladder.
A diagnosis of advanced bladder cancer can come as a shock.
However, treatment can help:
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What Type Of Chemotherapy Is Used For Bladder Cancer
Cisplatin-based chemotherapy has been the best standard treatment for bladder cancer since the 1970s. Based on the results of clinical trials from the 1990s, the two regimens most commonly used are dose-dense MVAC and GC. Chemotherapy goes into the body through a vein. It may be infused with a catheter into a vein or through a port that is placed under the skin, usually in the right side of the chest.
MVAC uses four drugs: methotrexate , vinblastine , doxorubicin , and cisplatin . We no have effective anti-nausea medication and injections that can keep immune systems from being depleted by chemotherapy. This has have improved our ability to give MVAC safely on an accelerated dose-dense schedule. The National Comprehensive Cancer Network now recommends MVAC be given according to the dose-dense or DD schedule due to improved toxicity and suggested improvement in efficacy compared with the standard schedule. Click here to view the NCCN Guidelines.
A clinical trial conducted in the late 1990s showed that the combination of gemcitabine , plus cisplatin , gives similar anticancer effects to standard MVAC combination. Both GC and DD MVAC have been useful in bladder cancer in delaying recurrence, extending life and sometimes achieving a cure, and both regimens are routinely used in the neoadjuvant and metastatic settings. Clinical trials are underway to assess whether the addition of another agent to these regimens improves outcomes.
How Vitamins Affect Chemotherapy Drugs
Many people want to take an active role in improving their overall health. They want to help their bodys natural defenses fight the cancer and speed up their recovery from chemo. Most people think of vitamins as a safe way to improve health, so its not surprising that many people with cancer take high doses of one or more vitamins. But some vitamins might make chemo less effective.
More research is needed, but until more is known about the effects of vitamins on chemo, keep these points in mind:
- If your doctor has not told you to take vitamins, its best not to take any.
- Always check with your doctor first before starting to take a vitamin of any kind, even a simple multivitamin.
- Ask your doctors if and when it might be OK to start taking vitamins after treatment.
- If youre concerned about nutrition, you can usually get plenty of vitamins by eating a well-balanced diet. See Nutrition for People With Cancer to learn more about nutrition during and after cancer treatment.
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Effects Of Bladder Cancer Treatment
Cancer treatment is geared toward positive outcomes, such as removing the cancer, reducing tumor size and preventing recurrence. However, many of the treatments used to accomplish that have their own challenges for our bodies. Prior knowledge of what to expect helps in treatment decision-making and getting the support you need to deal with these effects.
Side Effects Requiring Immediate Medical Attention
Along with its needed effects, bcg may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor as soon as possible if any of the following side effects occur while taking bcg:
More common
- painful urination
Rare
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What Appetite Changes Can Occur
Many patients with bladder cancer experience changes in their appetites.4 This may include eating less than usual, feeling full after eating a small amount, and/or not feeling hungry at all. These symptoms can have many different causes related to the cancer or to treatments such as chemotherapy. It is important for patients to talk to their healthcare providers to develop strategies to help manage this symptom, because patients who are not eating well can become malnourished and lose weight, muscle mass, and strength.
A Course Of Chemotherapy Into Your Bladder
Every session the nurse or doctor puts a catheter through your urethra and into your bladder . Your doctor or specialist nurse puts a liquid chemotherapy drug into the catheter.
You usually keep the drug in the bladder for 1 or 2 hours. Some hospitals may ask you to change position every now and again to make sure the drug reaches all parts of your bladder.
After the time is up your nurse will drain the liquid out through the catheter. If you have had the catheter removed after the medicine was put in you will need to use the toilet.
Some hospitals allow you to go home with the medicine in your bladder if you live close by and are okay with the treatment. Your team will let you know if you can do this.
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Is Combination Chemotherapy And Radiation Used For Bladder Cancer Treatment
In recent years, chemotherapy and radiation have been combined to provide a bladder preservation therapy for higher risk cases. In the past radiation therapy alone was used because it effectively shrunk tumors. Bladder cancer tumor cells are chemosensitive, susceptible to the cell-killing effects of anticancer drugs. Adding combined chemotherapy to radiation has improved results. To ensure the success of bladder preservation therapy, there are at least three requirements which should be met: 1) complete resection of the tumor by TURBT 2) no obstruction of 1 or both kidneys as a result of the bladder tumor and 3) no T4 bladder tumors.
If the tumors do not respond to an initial course of chemotherapy and radiation, it may be reasonable to perform, if medically possible, a cystectomy.
Information and services provided by the Bladder Cancer Advocacy Network are for informational purposes only. The information and services are not intended to be substitutes for professional medical advice, diagnosis, or treatment. If you are ill or suspect that you are ill, seek professional medical attention immediately! BCAN does not recommend or endorse any specific physicians, treatments, procedures, or products even though they may be mentioned on this site.
Is There Any Preparation Involved
Its important that you follow your doctors instructions for what to do before and after the procedure. Tell your doctor about all the medications you take. Certain immunosuppressants, antimicrobial therapies, and radiation therapies can interfere with BCG treatment.
Youll be advised to limit your fluid intake for four hours prior to the procedure. You might be told to avoid caffeine for a few hours longer than that, because its a diuretic and could make things more difficult.
Youll be asked to urinate just before the procedure so youll be able to hold the medication in your bladder for several hours.
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Common Side Effects Of Chemotherapy
Different drugs cause different side effects. Certain types of chemotherapy often have specific side effects. But each persons experience is different.
Tell your doctor about all the side effects you notice. For most types of chemotherapy, side effects do not show how well treatment is working. But they can for some types of drugs called targeted therapies. Below is a list of common side effects of traditional chemotherapy. Fatigue. Fatigue is feeling tired or exhausted almost all the time. It is the most common side effect of chemotherapy. Learn about how to cope with fatigue. Pain. Chemotherapy sometimes causes pain. This can include:
-
Headaches
-
Muscle pain
-
Stomach pain
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Pain from nerve damage, such as burning, numbness, or shooting pains, usually in the fingers and toes
Most types of pain related to chemotherapy get better or go away between treatments. However, nerve damage often gets worse with each dose. Sometimes the drug causing the nerve damage has to be stopped. It can take months or years for nerve damage from chemotherapy to improve or go away. In some people, it never completely goes away.
Treatment of pain often differs based on what is causing it. It is important to talk with your health care team about pain while you are taking chemotherapy. There can be other reasons for pain besides the chemotherapy, such as the cancer itself. If the pain is related to chemotherapy, doctors can treat it by:
-
Giving pain-relieving medications
Side Effects From Removal Of The Bladder
- Sexual Dysfunction and urinary incontinence: Patients with radical cystectomies may experience these problems due to nerve damage. Our nerve-sparing approach to surgery allows small tumors to be removed without these effects in most cases.
- Urgency, frequency,temporary blood in urine, slow return to bowel function: Work with your provider in managing these symptoms.
- Increased amount of care: including, perhaps, self-catheterization.
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Side Effects Of Chemotherapy
Chemo drugs attack cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body, such as those in the bone marrow , the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells are also likely to be affected by chemo, which can lead to side effects.
The side effects of chemo depend on the type and dose of drugs given and how long they are taken. When chemo and radiation are given at the same time, side effects tend to be worse. Common side effects of chemo include:
- Nausea and vomiting
- Constipation
- Increased risk of infections
- Easy bleeding or bruising, even after minor cuts or injuries
- Fatigue
These side effects usually go away over time after treatment ends. There are often ways to lessen these side effects, some can even be prevented. For instance, drugs can be used to help prevent or reduce nausea and vomiting. Ask your health care team about the side effects your chemo drugs may cause and what can be done to prevent and/or treat them.
Some chemo drugs can cause other, less common side effects. For example, drugs like cisplatin, docetaxel, and paclitaxel can damage nerves. This can sometimes lead to symptoms such as pain, burning or tingling, sensitivity to cold or heat, or weakness. This is called peripheral neuropathy.
That’s A Lot Of Side Effects
Combined, that’s nearly 70 documented side effects. Of those, at various points, I personally experienced about half of them. I was scheduled for a grueling cycle of 6 rounds. Each round consisted of 2 back-to-back days of treatments. I received each of the cocktail drugs separately in addition to being infused with saline for hydration purposes and anti-nausea and vomiting medications plus Lasix between 2 of the medications. Lasix to keep the drugs from interacting with each other ! Each round was 2 weeks apart.
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How Can Cystitis Be Prevented
Three treatments have been shown to help prevent cystitis, the drug mesnex , intravenous hyperhydration and continuous bladder irrigation.
Mesnex: The drug mesnex has been shown to prevent cyclophosphamide- and ifosfamide-induced cystitis., This drug works by binding to the metabolite acrolein in the bladder to form an inactive product that is then excreted. In this way, the bladder is protected, but the antitumor activity of the chemotherapy drug remains the same.
Hyperhydration: Another approach to preventing hemorrhagic cystitis is to increase fluid intake to help flush the bladder. Researchers have shown that hyperhydration by IV saline with administration of furosemide , a diuretic drug to maintain a urine output, effectively prevented hemorrhagic cystitis in patients who received high-dose cyclophosphamide before a bone marrow transplant.5
Continuous bladder irrigation: Cystitis may also be prevented by continuously flushing the bladder, also called continuous bladder irrigation. This technique has been shown to decrease the incidence of hemorrhagic cystitis in patients receiving a stem cell transplant.1
Going Home For The First Time After Surgery
Due to the post-op complications, I was bouncing between the hospital and a rehab facility for 2 months before I was discharged home. I took some time to adjust to being home with a urostomy. I wanted to enjoy my birthday 5 days after returning home and Thanksgiving a few days after that. The week after Thanksgiving, I saw my oncologist, got my port, and started chemo.
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How Can Bladder Problems Be Treated
While there is no treatment to reverse cystitis, the first step is to stop the treatment that is causing it. If you have hemorrhagic cystitis, which is usually accompanied with copious bleeding from the bladder, your doctor may administer a drug into your bladder to stop the bleeding. Other treatments are aimed at managing symptoms, such as acetaminophen or other pain relievers for pain and antibiotics for infection.
When To Call Your Cancer Care Team About Chemo Side Effects
Because your cancer care team will give you lots of information about side effects, you might be more aware of physical changes. Do not take any physical symptoms you have lightly. Some side effects are short-lived and minor, but others may be a sign of serious problems. Make sure you know how to reach someone on your team any time, including after hours, weekends, and holidays.
Contact your cancer care team right away if you have any of the following symptoms during chemo treatment:
- A fever higher than what your cancer care team has instructed
- Bleeding or unexplained bruising
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