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.
Small Cell Cancer Survival Rate
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Of the over 220,000 people in the US each diagnosed with lung cancer, about 10-15% of them will be diagnosed with the subtype of small cell lung cancer. While all lung cancers are serious, the prognosis for small cell lung cancer is especially dire.
In small cell lung cancer, the cancer cells are small and have the capacity to divide quickly and metastasize, meaning that surgery tends not to be the top option for treatment. Rather, since the cancer cells are so aggressive, chemotherapy tends to be the optimal induction treatment for this patient population.
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Other Bladder Neuroendocrine Tumors
Neuroendocrine tumors in the urinary bladder besides SmCC include carcinoid tumor, large cell neuroendocrine carcinoma, paraganglioma, and neuroendocrine tumors with other histologic types. Fewer than 10 convincing cases of pure carcinoid tumor and fewer than 10 convincing cases of primary pure large cell neuroendocrine carcinoma of the urinary bladder have been reported, when employing the criteria used for their better-known pulmonary counterparts.,
Reported outcome data on primary pure carcinoid tumor of the urinary bladder are extremely limited and are inadequate to make a reliable inference on prognosis. Large cell neuroendocrine carcinoma of the urinary bladder, in contrast to bladder SmCC, has a more discernable architecture and shows more prominent nucleoli. Large cell neuroendocrine carcinoma may be pure or admixed with components of urothelial, squamous, glandular, or small cell carcinoma. For pure large cell neuroendocrine carcinoma of the urinary bladder, its response rate to currently available chemotherapy, and correspondingly its prognosis, appears to be similar to those of bladder SmCC, with both entities having a rapidly fatal outcome.
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Recalcitrant Cancer Research Act
In 2013, the US Congress passed the Recalcitrant Cancer Research Act, which mandated increased attention to certain recalcitrant cancers, including small cell lung cancer. That led to the National Cancer Institute supporting small cellspecific research through a consortium.
As a result, new experimental drugs for small cell lung cancer are currently being tested, including Iadademstat and Keytruda .
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Prognosis In Squamous Cell Carcinoma
Tumor stage, lymph node involvement, and tumor grade have been shown to be of independent prognostic value in SCC. However, pathologic stage is the most important prognostic factor. In one relatively large series of 154 cases, the overall 5-year survival rate was 56% for pT1 and 68% for pT2 tumors. However, the 5-year survival rate for pT3 and pT4 tumors was only 19%.
Several studies have demonstrated grading to be a significant morphologic parameter in SCC. In one series, 5-year survival rates for grade 1, 2, and 3 SCC was 62%, 52%, and 35%, respectively. In the same study of patients undergoing cystectomy, the investigators suggested that a higher number of newly formed blood vessels predicts unfavorable disease outcome.
In SCC, the survival rate appears to be better with radical surgery than with radiation therapy and/or chemotherapy. In locally advanced tumors, however, neoadjuvant radiation improves the outcome. Sex and age have not been prognostically significant in SCC.
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What Should You Do After Receiving A Squamous Cell Carcinoma Diagnosis
After being diagnosed with squamous cell carcinoma, its important to act quickly, since treating this malignancy early can increase the chances of survival. One of the first things you should do is choose a cancer specialistsuch as the ones at Moffitt Cancer Centerwho can stage the cancer, tell you more about your condition and the treatment options available to you and answer any questions you might have.
Squamous cell carcinoma can be treated using a variety of different methods, and a cancer expert can recommend the one thats best suited to your specific needs . Some potential treatment options include:
- Mohs surgery, which involves removing and examining thin layers of tissue until no more cancerous cells are found. Mohs surgery is offered in conjunction with the USF Department of Dermatology
- Excisional surgery, which involves removing a cancerous lesion and a portion of the surrounding healthy tissue, then examining it to confirm that the cancerous cells have all been removed
- Electrosurgery, which involves scraping away a lesion using a curette and then heating the area with an electrocautery needle in order to destroy any remaining cancerous cells and control bleeding
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Low Grade And High Grade Bladder Cancer
Bladder cancer starts in the lining of the bladder in about 90 percent of people diagnosed with this cancer. Bladder cancer is called low grade or high grade.
- Low-grade bladder cancer means the cancer has not invaded the muscles around the bladder . People rarely die from this type of bladder cancer, it often recurs after treatment.
- High-grade bladder cancer also often recurs and has a higher chance of spreading to other parts of the body. Almost all deaths from bladder cancer result this type so it is treated more aggressively.
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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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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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How Is Bladder Cancer Treated
Treatment for bladder cancer depends on
- The stage of cancer.
Treatment options based on tumor grade
- High-grade bladder cancer: High-grade cancers that are life-threatening and spread quickly need to be treated with chemotherapy, radiation or surgery.
- Low-grade cancers: Less aggressive cancers have a low chance of becoming high grade and do not require aggressive treatments, such as radiation or bladder removal.
Treatment options may vary depending on the tumor stage.
What Is The Outlook For This Type Of Cancer
The outlook for someone diagnosed with cancer of the renal pelvis and ureter depends on a number of factors that your doctor will discuss with you. In particular, the chance of recovery is dependent on:
- Stage of the cancer. People with advanced stages of the disease will have a lower survival rate, even with treatment.
- Location of the tumor. If the tumor is located beyond the ureter and renal pelvis, the cancer may quickly metastasize to the kidney or other organs, reducing chances for survival.
- Overall kidney health. If there are underlying kidney disorders, the survival rate is lower, even with treatment.
- Cancer recurrence. Cancer recurrences have lower cure and survival rates than initial cancers.
- Metastasis. If the cancer has spread to other organs in the body, the survival rate is lower.
Its important to see your doctor for regular checkups and to let them know about any new symptoms youve developed. This helps your doctor catch potentially serious conditions in the earliest stages.
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Prognosis Of Early Stage Small Cell Bladder Cancer Is Not Always Dismal
Small cell carcinoma of the urinary bladder is an extremely rare malignancy which is often associated with poor survival outcome. Literature reporting such disease is scarce. There is no standardised management. This retrospective audit examines a UK Cancer Centre’s SCCB management and survival outcomes.
Histopathology database at Nottingham University Hospitals, UK, was used to identify patients diagnosed with SCCB from January 2008 to January 2016.
27 patients had confirmed diagnosis of SCCB. Mean age at diagnosis was 68.7 . 30% of the cases had pure small cell histology, while the rest were mixed histological subtype. Of the 12 patients with early stage disease , three had radical cystectomy and chemotherapy, six had both radiotherapy and chemotherapy, two had either radiotherapy or chemotherapy alone, and one declined active treatment. Of the 12 patients with advanced disease , four had chemotherapy alone, four had both radiotherapy and chemotherapy and four was for best supportive care. 13 out of 16 patients who had chemotherapy received combination of carboplatin and etoposide. Patients with advanced stage disease had medial survival of 9 months . The median survival for patients with early disease was not reached. There is significant difference in survival between early and late stage disease .
Clinical Oncology, Nottingham City Hospital NHS Trust, Nottingham, UK.
Primary Small Cell Carcinoma Of The Urinary Bladder: A 10
Xue-Jun Liu, Cheng Liu, Duo Liu and Dong-Wei Yao*
Department of Urology, the Second Peoples Hospital of Lianyungang, Lianyungang, Jiangsu, PR China
- *Corresponding Author:
- Department of UrologyThe Second Peoples Hospital of LianyungangLianyungang,Jiangsu,PR China
Accepted on February 06, 2018
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Small Cell Carcinoma Of The Urinary Bladder: A Rare Aggressive Neuroendocrine Malignancy
Xiangrong Zhao, Ethan A. Flynn Small Cell Carcinoma of the Urinary Bladder: A Rare, Aggressive Neuroendocrine Malignancy. Arch Pathol Lab Med 1 November 2012 136 : 14511459. doi:
Small cell carcinoma of the urinary bladder is a rare, often fatal, disease. Its presenting symptoms and gross morphology are similar to those of conventional urothelial carcinoma, whereas its prognosis is much poorer with frequent metastasis. Small cell carcinoma of the urinary bladder shares similar histology with its counterparts in other organs however, its immunoreactivity to conventional neuroendocrine markers is low. Its diagnosis is thus considered permissible on morphologic grounds alone. Multimodal treatments are often employed, although no definite treatment algorithm has been established. For this extremely aggressive malignancy with an as-yet inconclusive etiology, further studies are needed to clarify its molecular pathogenesis to serve as a basis for diagnostic markers and therapeutic targets. The clinical, morphologic, immunoreactive, molecular, and therapeutic features of bladder small cell carcinoma are reviewed, including a detailed discussion on the utility of immunohistochemical markers.
Bladder Cancer Treatment: Surgery
Transurethral Resection
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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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.
Other Types Of Bladder Cancer
Approximately 2% of bladder cancers are adenocarcinomas. Nonurothelial primary bladder tumors are extremely rare and may include small cell carcinoma, carcinosarcoma, primary lymphoma, and sarcoma . Small cell carcinoma of the urinary bladder accounts for only 0.3-0.7% of all bladder tumors. High-grade urothelial carcinomas can also show divergent histologic differentiation, such as squamous, glandular, neuroendocrine, and sarcomatous features.
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Symptoms In Men And Women
Bladder cancer symptoms in men and women are the same. Men are more likely to get bladder cancer, but they are also more likely to have it diagnosed earlier, according to Moffitt Cancer Center.
Women are more likely to mistake bladder cancer symptoms for urinary tract infections or menstruation.
Rarely, bladder cancer may also be misdiagnosed as interstitial cystitis in women. IC is a painful, inflammatory bladder condition that affects more women than men.
In one study, doctors found bladder cancer in about one percent out of 600 patients referred to them for IC treatment, according to an article in Urology Times.
Small Cell Cancer Survival Rates By Stage
The survival rates for small cell lung cancerexpressed in terms of 5 year relative survival, meaning the percentage of people expected to be alive five years after initial diagnosisare collected by the National Cancer Institutes Surveillance Epidemiology and End Results .
- Stage I: 31%
- Stage III 9%
- Stage IV: 2%
These 5 year relative survival rates reflect the extremely poor prognosis in patients with small cell lung cancer, but they do indicate that the earlier the disease is found, the better the chances of survival.
Also one must keep in mind that each patient is different and will be evaluated differently .
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How Is Transitional Cell Carcinoma Of The Prostate Diagnosed
This disease is hard to diagnose. Itâs often mistaken for something else at first. Thatâs partly why itâs hard to treat successfully. By the time itâs caught, itâs usually already advanced.
The symptoms are the same as for other kinds of prostate problems. You may have:
- A hard time peeing
- Pain or irritation when you pee
- Blood in your urine
The level of prostate specific antigen in your blood, which is often an early clue you have prostate cancer, may not be high when you have this kind. Cancerous urothelial cells donât make PSA.
Your prostate will feel hard or lumpy in a digital rectal exam, but that isnât usually how itâs diagnosed.
Most men find out they have transitional cell carcinoma of the prostate after theyâve had a transurethral resection of the prostate. Thatâs a procedure to treat urinary problems caused when your prostate becomes enlarged.
A surgeon inserts an instrument into the urethra through the end of the penis. With either an electric current or laser, they cut away pieces of prostate tissue. When they look at that tissue under a microscope, they can spot cancerous urothelial cells.
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
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