Post Chemo Surgery For Metastatic Bladder Cancer
The results of post chemotherapy surgery that clears the pelvis and regional LNs are encouraging, but the same cannot be held true for patients who have undergone metastatectomy of the lesions outside the pelvis. The results of the three reported series have shown median survival time of around 30 months with approximately one-third of these patients surviving for three to five years.
Risk Factors For Bladder Cancer
There are some things that can make you more likely to develop bladder cancer. These are called risk factors and they include:
- smoking chemicals in cigarettes can cause bladder cancer, so if you smoke, your risk is up to three times that of a non-smoker
- age most people with bladder cancer are over 60 years of age
- family history a first degree relative with bladder cancer increases risk up to nearly 2 times higher than the general population
- chemicals being in contact with certain chemicals for a long period of time, like aromatic amines, benzene products and aniline dyes, which have been linked to bladder cancer
- frequent infections of the bladder over a long period of time
- some types of radiation therapy around the pelvis, and the chemotherapy drug cyclophosphamide.
Having these risk factors doesnt mean you will develop bladder cancer. Often there is no clear reason for getting bladder cancer. If you are worried about your risk factors, ask your doctor for advice.
What Is Stage 3 Cancer
Stage 3 cancer is sometimes referred to as locally advanced cancer. In this stage, the tumor may have grown to a specific size, the cancer may consist of multiple tumors, and/or the cancer may have spread to adjacent lymph nodes, organs or tissue. In some cases, stage 3 cancers may be considered metastatic cancers, meaning they may have spread beyond their organ of origin.
Many stage 3 cancers have multiple subcategories, usually designated as stages 3A, 3B and 3C. These subcategories are often determined by the size of the tumors, whether multiple tumors are present and the degree to which the cancer has spread locally.
Liquid cancers, or blood cancers, such as leukemia, lymphoma or multiple myeloma, are staged differently than most other cancers because they may not always form solid tumors. Liquid cancers may be staged by a variety of factors, including:
- The ratio of healthy blood cells to cancerous cells
- Whether cancer cells are found in lymph nodes or the diaphragm
- The degree to which lymph nodes, the liver or spleen may be swollen
Stage 3 cancer is determined in the five most common cancers this way:
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After Bladder Cancer Has Been Diagnosed Tests Are Done To Find Out If Cancer Cells Have Spread Within The Bladder Or To Other Parts Of The Body
The process used to find out if cancer has spread within thebladder lining and muscle or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:
Is Bladder Cancer A Fatal Illness
Left untreated, bladder cancer may spread to other parts of your body. Cancer thats metastasized, or spread, may affect how long youll live with bladder cancer. Like many types of cancer, early detection and treatment increase the chance of living longer with bladder cancer. According to the National Cancer Institute, 96% of people who received treatment for early-stage cancer were alive five years after diagnosis. Overall, 77% of people with bladder cancer were alive five years after diagnosis.
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Bladder Cancer Stage Grouping
The results are combined to determine the stage of bladder cancer for each person. There are 5 stages: stage 0 and stages I through IV .
- Stage 0, called Papillary Carcinoma and Carcinoma in Situ, is divided into stage 0a and stage 0is, depending on the type of the tumor:
- Stage 0a : Abnormal cells are found in tissue lining the inside of the bladder. These abnormal cells, which may look like tiny mushrooms growing from the lining of the bladder, may become cancer and spread into nearby normal tissue .
- Stage 0is : A flat tumor on the tissue lining the inside of the bladder. It has not grown in toward the hollow part of the bladder, and it has not spread to the thick layer of muscle or connective tissue of the bladder .
Chemotherapy And Radiation Therapy As Primary Treatment
Over the past decade, there have been many studies in the United States and Europe evaluating the combination of radiation and chemotherapy for initial treatment of patients with Stage III bladder cancer for the purpose of preserving the bladder. Bladder-preserving therapy is appealing because patients who achieve a complete response to treatment can often avoid additional treatment with a radical cystectomy unless they experience recurrence of their cancer. In addition to avoiding a cystectomy, early treatment with chemotherapy may also kill bladder cancer cells that have already spread away from the bladder.
In some clinical trials, approximately half or more of patients who were treated with bladder-preserving therapy survived cancer-free for three to four years after treatment. These results appear as good as those observed with radical cystectomy, but there have been no direct comparisons of radical cystectomy to combination chemotherapy and radiation therapy without surgery. Furthermore, only selected patients with Stage III bladder cancer will be candidates for bladder-preserving therapy. As a result, some physicians think that bladder-preserving surgery should be limited to clinical trials and not adopted as standard therapy.
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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.
Thinking About Taking Part In A Clinical Trial
Clinical trials are carefully controlled research studies that are done to get a closer look at promising new treatments or procedures. Clinical trials are one way to get state-of-the art cancer treatment. In some cases they may be the only way to get access to newer treatments. They are also the best way for doctors to learn better methods to treat cancer. Still, they’re not right for everyone.
If you would like to learn more about clinical trials that might be right for you, start by asking your doctor if your clinic or hospital conducts clinical trials.
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Stage Iii Gallbladder Cancer:
Stage III of gallbladder cancer is further divided into two stages:
Stage IIIA: The cancer has grown through the serosa and has spread to the liver or nearby structures like the stomach, duodenum, colon, pancreas or bile ducts outside the liver but has not spread to nearby lymph nodes or distant organs and the staging is .Stage IIIB: The cancer may or may not have spread beyond the gallbladder into the nearby structures but has not grown into the main blood vessels. It has spread to no more than three nearby lymph nodes but has not spread to distant organs and the staging is where X can be 1, 2 or 3.
Prognosis And Survival Rates For Bladder Cancer
When someone is diagnosed with bladder cancer, their doctor will give them a prognosis. A prognosis is the doctors opinion of how likely the cancer will spread and the chances of getting better. A prognosis depends on the type and stage of cancer, as well as the persons age and general health.
Bladder cancer can usually be effectively treated if it is found before it spreads outside the bladder.
If you have bladder cancer, your doctor will talk to you about your individual situation when working out your prognosis. Every persons experience is different, and there is support available to you.
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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
Surgery And Radiation Therapy
Endoscopic TURBT is the first-line treatment to diagnose, stage, and treat visible tumors. TURBT is not effective for CIS, because the disease is often so diffuse and difficult to visualize that complete surgical removal may not be feasible. It is critically important to surgically remove all nonmuscle-invasive disease prior to beginning intravesical therapy. When a combination of papillary tumor and CIS is present, the papillary tumor is removed before treatment of the CIS is initiated.
The EAU guidelines recommend the use of fluorescence-guided resection, as it is more sensitive than conventional white-light cystoscopy for detection of tumors. The added detection rate with fluorescence-guided cystoscopy is 20% for all tumors and 23% for CIS. The FDA has approved the use of blue-light cystoscopy with 5-aminolevulinic acid in patients suspected or known to have nonmuscle-invasive bladder cancer on the basis of prior cystoscopy.
As many as 20% of patients initially diagnosed with CIS may have unrecognized invasion beyond the lamina propria. Thus, they may not respond to intravesical therapy. These patients are candidates for radical cystectomy or radiation therapy and/or chemotherapy. Radiation therapy with or without chemotherapy is of limited benefit in patients with pure CIS but can be useful in some patients with muscle-invasive transitional cell carcinoma .
Lymph node dissection
Small cell carcinoma
Adenocarcinoma and lymphoma
Squamous cell carcinoma
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Selected Adverse Events Analysis
Blood tests to identify hematological and hepatic treatment-related adverse events were available for 98.0% of the platinum-treated sub-cohort. The distribution of events was similar between cisplatin-based and carboplatin-based sub-cohorts, with neutropenia representing the most common grade 3 or 4 AE observed in both sub-cohorts . Severity of recorded events tended to be higher in the carboplatin sub-cohort.
Figure 4. Adverse events recorded for study cohort by common terminology criteria for adverse events grade of severity and by platinum sub-cohort. Numbers tested: blood disorders , liver disorders . Cis, cisplatin sub-cohort carbo, carboplatin sub-cohort ALT, alanine aminotransferase AST, aspartate aminotransferase ALK, alkaline.
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Trimodal Therapy For Stage Ii Or Iii
A select group of people with Stage II or III bladder cancer may be able to be treated with trimodal therapy. This involves 3 modes of treatment:
- TURBT Your doctor will insert a scope into your bladder and use a wire loop to remove the tumor.
- Radiation Given after surgery, daily, for 4 to 6 weeks. Some patients may receive a radiosensitizer. This is a chemotherapy drug that helps make the radiation more effective.
- Systemic Chemotherapy May be given before the TURBT to shrink the tumor.
Trimodal therapy may cause common chemo and radiation side effects. Patients may also have problems with bladder, bowel, and sexual function.
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What Are The Stages Of Bladder Cancer
Bladder cancer can be either early stage or invasive .
The stages range from TA to IV . In the earliest stages , the cancer is confined to the lining of the bladder or in the connective tissue just below the lining, but has not invaded into the main muscle wall of the bladder.
Stages II to IV denote invasive cancer:
- In Stage II, cancer has spread to the muscle wall of the bladder.
- In Stage III, the cancer has spread to the fatty tissue outside the bladder muscle.
- In Stage IV, the cancer has metastasized from the bladder to the lymph nodes or to other organs or bones.
A more sophisticated and preferred staging system is known as TNM, which stands for tumor, node involvement and metastases. In this system:
- Invasive bladder tumors can range from T2 all the way to T4 .
- Lymph node involvement ranges from N0 to N3 .
- M0 means that there is no metastasis outside of the pelvis. M1 means that it has metastasized outside of the pelvis.
What Is Bladder Cancer In Dogs
Bladder cancer in dogs is a tumor that develops due to the abnormal growth of cells in the urinary bladder. This type of tumor of the urinary tract is relatively rare in dogs and accounts for about 1% or less of all canine tumors.
Bladder cancer is usually diagnosed in the late stages. This is because the obvious symptoms and signs of bladder cancer in dogs are similar to those of urinary tract infections . Plus, invasive transitional cell carcinoma, as the most common type of bladder cancer in dogs, develops really quickly and aggressively.
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Bladder Cancer Diagnosis: Imaging
Intravenous Pyelogram
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.
Bone Scan
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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Can Cystectomy Be Avoided In Muscle
The answer is yes for many patients. Radical cystectomy is a major operation and requires diversion of the urinary stream, which has life-altering implications. Identification of patients that can have their cancer eradicated with transurethral resection plus systemic therapy alone and avoid cystectomy is a priority. Transurethral resection of bladder tumor plus systemic therapy has been known for decades to achieve durable bladder-intact survival in a subset of patients. Research presented at the 2021 America Society of Clinical Oncology Annual Meeting defined an approach using Gemzar , cisplatin chemotherapy combined with Opdivo immunotherapy designed to preserve the bladder in as many patients as possible.
Researchers initially treated patients with with 4 cycles of Gemzar, cisplatin, plus Opdivo immunotherapy followed by clinical re-staging to determine next steps. Re-staging was comprehensive and included urine cytology, MRI/CT of the bladder, cystoscopy, and bladder/prostatic urethral biopsies. Patients achieving a clinical complete response were eligible to proceed without cystectomy and receive Opdivo every 2 weeks and close surveillance otherwise, patients underwent cystectomy. If local recurrence occurred patients proceeded to cystectomy. This approach allowed a majority of patients with MIBC to avoid cystectomy.10
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What Is Cancer Restaging
The stage of a cancer given at the time of diagnosis and initial treatments does not change. This is so doctors can understand a persons medical progress, help understand the prognosis, and learn how treatment affects many people.
However, if the cancer comes back or spreads, restaging can be done. This is described with a small r. For example, rN1 is restaging of the lymph nodes. Usually some of the same tests that were done when the cancer was first diagnosed will be done again. After this, the doctor can assign the cancer a restage or r stage.
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