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Stage 4 Metastatic Bladder Cancer

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There Are Different Types Of Treatment For Patients With Bladder Cancer

Metastatic Stage 4 Gallbladder Cancer | John Thuo

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.

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:

Data Collection And Definitions

This study evaluated distant metastasis diagnostic predictors in UBC patients with the following variables: age, sex, race, grade, tumor size, T stage, N stage, and cancer histology type. Based on the above variables, surgery, radiotherapy, and chemotherapy were added to the prognostic model analysis. Age groups were divided into < 50 years ,5059 years ,6069 years, and > 69 years. Tumor size was categorized into four levels: < 30 mm, 3049mm, 5099mm, and > 99 mm. T stage were classified as muscle invasion and non-muscle invasion . M stages were also classified as non-distant metastasis and distant metastasis . Surgery, chemotherapy, and radiation were categorized based on whether or not patient accepted the treatment. The primary outcome for prognostic model analysis was cancer-specific survival time , which was defined as the survival time between the months of initial diagnosis of UBC and cancer-specific death.

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The Effect Of Age At Diagnosis With Pancreatic Cancer Metastasis To Liver

The Kaplan Meier survival curve showed significant difference in overall survival for patients diagnosed at different age groups . The overall survival time was negatively correlated with the age at diagnosis. Among the three groups, the prognosis of patients diagnosed at age less than 52 years old was the best, and of which the median survival time was 1 year. .

Kalpan Meier survival curve showing the effect of age at diagnosis with pancreatic cancer metastasis to liver.

Surgery For Stage Iv Bladder Cancer

New Subtype of Treatment

Radical cystectomy is sometimes recommended for treatment of patients with stage IV bladder cancer to control local spread and the complications this creates. Surgery is also utilized after an incomplete response of the primary cancer to radiation therapy and/or chemotherapy. To learn more about radical cystectomy, go to Surgery for Bladder Cancer.

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Tests For Bladder Cancer

Your doctor may do some tests to check for bladder cancer:

  • urine tests your urine will be checked for signs of bladder cancer
  • blood tests to check your general health
  • ultrasound a scan on the outside of your abdomen to check for cancer
  • cystoscopy the doctor puts a small camera into your bladder to see inside
  • biopsy the doctor takes a small sample of the cells from the bladder to check for signs of cancer.

Your doctor might ask you to have further tests. These can include:

  • CT scan and x-rays scans that take pictures of the inside of the body, sometimes also called a CT-IVP or a triple phase abdominal-pelvic CT scan
  • MRI scan a scan that uses magnetism and radio waves to take pictures of the inside of the body
  • bone scan a scan that uses dye to show changes in your bones
  • FDG-PET scan a scan that uses an injection of liquid to show cancer cells.

Managing Locally Advanced Or Metastatic Bladder Cancer

care services have tended to be requested because of profound physical symptoms in people with terminal bladder cancer. Increasing use of cross sectional imaging is detecting incurable disease much earlier, when there are often no physical symptoms. However the psychological and spiritual impact of a terminal diagnosis will always be profound and input from specialist palliative care at this earlier stage may be of significant benefit. The specialist palliative care needs of people with advanced bladder cancer are covered in . This chapter deals with the use of for people with distant metastases and with specific symptoms from locally advanced or metastatic bladder cancer.

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Genetic Factors In Pathogenesis

Divergent, yet interconnected and overlapping, molecular pathways are likely responsible for the development of noninvasive and invasive bladder tumors. Somatic mutations in fibroblast growth receptor3 and tumor protein p53 in tumor cells appear to be important early molecular events in the noninvasive and invasive pathways, respectively.

FGFR-3, Ras, and PIK3CA mutations occur with high frequency in noninvasive tumors, leading to upregulation of Akt and mitogen-activated protein kinase . Loss of heterozygosity on chromosome 9 is among the most frequent genetic alterations in bladder tumors and is considered an early event.

Large numbers of genomic changes have been detected using karyotyping and comparative genomic hybridization analysis in urothelial carcinoma. Numerically common are losses of 2q, 5q, 8p, 9p, 10q, 18q, and Y. Gains of 1q, 5p, 8q, and 17q are frequently present, and high-level amplifications can be found however, the target genes in the regions of amplifications have not been conclusively identified.

Alterations in the TP53 gene are noted in approximately 60% of invasive bladder cancers. Progression-free survival is significantly shorter in patients with TP53 mutations and is an independent predictor of death among patients with muscle-invasive bladder cancer.

Types Of Bladder Cancer

Bladder cancer stage 4

Once diagnosed, bladder cancer can be classified by how far it has spread.

If the cancerous cells are contained inside the lining of the bladder, doctors describe it as non-muscle-invasive bladder cancer . This is the most common type of bladder cancer.

When the cancerous cells spread beyond the lining, into the surrounding bladder muscle, itâs referred to as muscle-invasive bladder cancer . This is less common, but has a higher chance of spreading to other parts of the body.

If bladder cancer has spread to other parts of the body, itâs known as advanced or metastatic bladder cancer.

Read more about diagnosing bladder cancer.

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Subtleties And Future Questions

Several factors have to be carefully considered in interpreting the trial results, explained Dr. Apolo.

A major one is that the study did not directly compare survival between people who got avelumab immediately versus when their cancer progressed. Only about half of the participants who initially received supportive care alone went on to receive immunotherapy after their cancer got worse. There could be many reasons for this, including lack of access to these drugs in different countries, Dr. Apolo said.

But it also might be that, for some people, the cancer was progressing too rapidly, she added. When these tumors start growing, they start growing very quickly. So if you wait to start at the time of progression, maybe its too late, added Dr. Apolo.

Not all patients will be caught by the second-line safety net, agreed Dr. Plimack.

So, for now, said Dr. Balar, the takeaway message from the JAVELIN study is after chemotherapy, dont wait to give immunotherapy.

But more and more, studies are looking at whether some patients should receive immunotherapy as first-line treatment, he continued. Immunotherapy is one of the most important advances weve made in the last 30 years, Dr. Balar said.

The JAVELIN results cant provide any insight into which patients benefit from first-line treatment with a platinum-based chemotherapy, he added. This trial wasnt designed to ask: Is chemotherapy necessarily the best choice for every patient? he explained.

Stage 4 Cancer Treatments

Stage 4 cancer has the highest mortality rate. Therefore, many people who have stage 4 cancer or know their family or friend has one, have already given up. They only see the people with this cancer as those who only wait for the end of their life.

The truth is the opposite. Thanks to medical sciences growth, nowadays, many data and tests show a patient with stage 4 cancer is treatable and even curable. As mentioned earlier, there are two purposes of the treatment. It is either to stop the growth and kill the cancer cell or to control the growth and wait for the end.

Regardless of the purposes, the treatment for cancer in stage 4 is similar. Here, we have the examples of the standard treatment for stage 4 cancer:

· Chemotherapy is said to be the safest method to treat stage 4 cancer. However, if cancer has spread extensively, this treatment could risk affecting other organs, which can cause another health problem for the patient.

· Radiation therapy this treatment is also suitable for cancer that hasnt spread too much. The doctor uses this treatment to reduce the size of the cancer cell and relieve the symptoms.

· Immunotherapy this method uses the natural immune system of the patients body to fight the cancer cell. It has a high success rate for low-grade cancer cells.

· Surgery remove the cancer cell or tumor and the problem is gone. Of course, it is only doable for cancer in the earlier stage of metastasis.

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Living With Metastatic Bladder Cancer: Joeys Journey

Stories@Gilead – May 04, 2022

Joey sold his business and felt like he was living the American dream when his life was turned upside down in 2019. He was diagnosed with metastatic bladder cancer.

I remember I was trying to call my wife to talk to her, recalls Joey.And then I couldn’t speak.

In the United States, the average age for a bladder cancer diagnosis is 73. Joey was 45 years old at the time of his diagnosis. Adding to his shock, he went into immediate bladder removal surgery. After additional treatments, his oncologist recommended that he check himself out of the hospital because he likely had only weeks left to live.

“I thought, No, doctor, that’s not true, says Joey.I’m going to beat this thing.”

Joeys determination seemed to pay off when just two weeks later his oncologist called him back and said a new targeted therapy was available. He started it immediately.

I’m still considered stage 4 metastatic bladder cancer, says Joey.But in general, I feel pretty good today.

Joey says when hes asked about bladder cancer, he tries to talk about how the many treatment options and ongoing research helps create what he thinks is much needed more hope.

Watch the video above to view Joeys full story.

Staging After Bladder Cancer Recurrence

Illustration of different pathological stages of bladder cancer. Stage ...

If bladder cancer returns after treatment, developing a disease called recurrent cancer, doctors may run tests again to understand more about the recurrence, including its stage and grade. This process is called restaging, and it helps doctors determine the best course of action to treat a cancer recurrence. The new stage also has a lowercase r in front of it to indicate that its the stage of the recurrence, not necessarily the original cancers stage.

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Chemotherapy In Palliative Care

Many patients with bladder cancer present with distant metastases at diagnosis or develop metastatic disease during the course of their illness. The survival time for patients with untreated metastatic bladder cancer is usually less than 6 months, and a variety of disabling symptoms can develop during this interval that disrupt quality of life.180,181 Chemotherapy may be effective in ameliorating these symptoms.

Other regimens comprising active agents with nonoverlapping toxic effects are being investigated with the aim of enhancing the therapeutic ratio. They include combinations of cisplatin with gemcitabine or paclitaxel.181 An update of a large international randomized study that compared M-VAC with gemcitabine plus cisplatin for patients with metastatic bladder cancer186,187 revealed no differences in response rate, survival rate, or quality of life between the treatment groups. However, gemcitabine plus cisplatin was significantly less toxic more patients completed the full course of treatment, fewer had significant neutropenia or sepsis, and the rate of death from side effects was lower. These findings have led to gemcitabine plus cisplatin becoming the standard of care for patients with metastatic bladder cancer.181

Bin S. Teh MD, … Arnold C. Paulino MD, in, 2008

Noninvasive Vs Invasive Bladder Cancer

Doctors often use the terms noninvasive or invasive to describe whether cancer has spread into the bladder wall. Noninvasive means the cancer is in the inner cell layers. Invasive cancers are deeper in the layers of the bladder wall. If a doctor says the cancer is superficial or non-muscle invasive, that means it isnt in the bladders main muscle layerthough it may still be invasive or noninvasive and have the potential to spread to the muscle.

Different types of bladder cancer grow in different ways, so doctors may discuss a tumor in terms of the direction its growing. Papillary carcinomas grow from the bladders lining toward the hollow center, while flat carcinomas stay flush against the bladder wall.

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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:

What Impacts The Bladder Cancer Survival Rate

Living the Best Life Possible with Metastatic Bladder Cancer

Survival rates depend on many factors, including the type and stage of bladder cancer that is diagnosed. According to the ACS, the five-year survival rate of people with bladder cancer that has not spread beyond the inner layer of the bladder wall is 96%. This is called non-muscle invasive bladder cancer . More than half of people are diagnosed at this stage.

If a tumor is invasive but has not yet spread outside the bladder, the five-year survival rate is 69%. Approximately 33% of bladders cancers are diagnosed at this stage. If the cancer extends through the bladder to the surrounding tissue or has spread to nearby lymph nodes or organs, the five-year survival rate is 37%. If the cancer has spread to distant parts of the body, the five-year survival rate is 6%. About 4% of people are diagnosed at this stage.

It is important to remember that statistics about the five-year survival rates for people with bladder cancer are estimates only and come from annual data based on the number of people with this cancer. A number of new and promising bladder cancer treatments that have been approved by the Food and Drug Administration in the last five years might not be reflected in a five-year survival rate statistic.

Just like no single treatment is appropriate for all bladder cancer patients, there is not one statistic that applies to everyone either. Talk with your doctor about your own individual situation to gain the best understanding you can.

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What Are The 5

In 2020, approximately 17,980 deaths in the United States are predicted to be attributed to bladder cancer1. This represents the eighth most common cause of cancer deaths in men.

The general 5-year survival rate for people with bladder cancer is 77%, while the 10-year survival rate is 70% and the 15-year survival rate is 65%1. Notably, as each patient and cancer are different, it is not possible to definitely know the disease course for an individual patient.

Developing A Treatment Plan

In cancer care, different types of doctors often work together to create a patients overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. This team is usually led by a urologist, a doctor who specializes in the genitourinary tract, or a urologic oncologist, a doctor who specializes in treating cancers of the genitourinary tract. Cancer care teams include a variety of other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.

Treatment options and recommendations depend on several factors, including:

  • The type, stage, and grade of bladder cancer

  • Possible side effects

  • The patients preferences and overall health

Your care plan also includes treatment for symptoms and side effects, an important part of cancer care.

The first treatment a person is given for advanced urothelial cancer is called first-line therapy. If that treatment stops working, then a person receives second-line therapy. In some situations, third-line therapy may also be available.

Adjuvant systemic therapy is treatment that is given after radical surgery has been completed. In bladder cancer, adjuvant therapy is usually cisplatin-based chemotherapy or treatment in a clinical trial. Neoadjuvant therapy is treatment that is given before surgery, such as cisplatin-based chemotherapy.

Treatments by type and stage of bladder cancer:

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