Information Sources And Study Selection
Studies were identified by searching Ovid MEDLINE for the period 1946 to November 2013 , the Cochrane library , Google Scholar , NHS Evidence . An example search strategy was shown in Figure 1, which indicates the keywords used.
In addition, reference lists of relevant articles were searched to identify other relevant studies . For articles that did not have a complete electronic version of the full text available, the article was requested from the British Library Document Supply Service 2 articles were obtained through this means.
Intravesical Bcg Therapy For High
If patients with high-grade T1 disease have a low risk of progression, bladder sparing management should be considered. BCG instillation into bladder is the gold standard for conservative treatment for high-grade T1 disease. The therapeutic effect of BCG in high-grade T1 has already been established by several meta-analysis studies . However, we have to keep in mind that patients die upon progression to MIBC, not upon recurrence, and that the effectiveness of BCG at preventing progression was not as great as its effectiveness at preventing recurrence. In addition, BCG therapy may be associated with severe side effects with local or systemic symptoms. For that reason, the ability to predict the response to treatment before BCG instillation would be an invaluable tool in the selection of appropriate therapeutic modalities.
T1 Bladder Cancer In Norway: Treatment And Survival
Evaluation of treatment and survival of pT1 stage bladder cancer patients diagnosed with transitional cell carcinoma of the urinary bladder in Norway.
According to the Cancer Registry of Norway, 1,108 patients were diagnosed with T1 BC between 2008-2012. Information on surgical and medical procedures was provided by the Norwegian Patients Registry. Regression and survival models were applied to characterize patients receiving bacillus Calmette-Guerin and radical cystectomy as early and delayed treatment and to estimate overall and cause specific survival rates . Adjustments for sex, age, WHO grade and concomitant cis were made.
In total, 449 patients received BCG treatment, 162 as early treatment. RC represented the early treatment in 96 patients and the delayed treatment in 84 . Overall, 850 patients received neither BCG nor RC as early treatment, of whom 287 were treated with BCG and 66 with RC during follow-up. Patients < 75years and patients with high grade tumors or concomitant cis were more likely to receive BCG and RC as early treatment. 5-year survival rates for all T1 BC patients were 84% and 65% . Delayed RC was associated with the lowest 5-year CSS . After adjustment, gender did not impact treatment choice and CSS.
The use of BCG as early treatment indicates low adherence to existing guidelines. Delayed RC was associated with low survival rates. An increased focus on the management of T1 patients is needed in Norway.
Scandinavian journal of urology. 2020 Aug 12
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Tnm Staging System For Bladder Cancer
The TNM staging system uses letters and numbers to describe the bladder cancer.
- T is how far the tumour has grown into the bladder, and how far it has spread into the surrounding tissues.
- N is whether the tumour has spread to the nearby lymph nodes.
- M is whether the tumour has spread to another part of the body .
Non-muscle-invasive bladder cancer means the cancer cells are only in the inner lining of the bladder. This means non-muscle-invasive bladder cancers are always N0 and M0.
Non-muscle-invasive bladder cancer can be staged as CIS, Ta or T1.
Understanding The Statistics: Cancer Survival
It is important to remember that all cancer survival numbers are based on averages across huge numbers of people. These numbers cannot predict what will happen in your individual case.
Survival rates will not tell you how long you will live after you have been diagnosed with bladder cancer. But, these numbers can give you an idea of how likely your treatment will be successful. Also, survival rates take into account your age at diagnosis but not whether you have other health conditions too.
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Prostate Cancer Survival Rates
Prostate cancer is the second leading cause of cancer death in the United States. A mans individual survival depends on the stage of cancer. Most prostate cancers are identified at an early stage when they are organ-confined. According to the American Cancer Society, the 5-year survival rate for men with local or regional prostate cancer is nearly 100%. The relative 10-year survival rate is 98% and the 15-year relative survival rate is 91%.
However, if the cancer is stage IVB and has spread to distant parts of the body such as the lungs, liver, or bones there is only a 30% relative 5-year survival rate.
Things to consider when understanding the statistics:
- These numbers/rates apply only for the first-diagnosed cancer
- There are many more factors that can influence the survival rate of an individual
- These rates are calculated over a 5-year period. Treatments improve over time and the survival rates may positively change.
Early detection makes this deadly disease curable. Do not ignore any prostate cancer signs or symptoms and get screened as early as possible, especially if you are at high risk of developing prostate cancer, based on your family history, race or age. Talk to your doctor about your Gleason Score, Grade Group and Stage and decide upon the best treatment option for prostate cancer.
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Treatment For Hg Pt1 Bladder Cancer With Pt2 Or More Histology At Second Tur
There is no doubt about the need to perform radical cystectomy for patients with muscle-invasive disease at the second TUR. Most of these tumors are understaged at the initial TURBT due to technical problems, and may not be large or bulky like muscle-invasive tumors that are diagnosed at the initial TURBT and/or with computed tomography or magnetic resonance imaging. The discussion on the treatment strategies for these tumors does not include whether cystectomy should be performed but whether neoadjuvant chemotherapy and/or extended lymph node dissection should be performed.
Several randomized Phase III trials and meta-analyses demonstrated the survival benefit of cisplatin-based neoadjuvant chemotherapy for patients with MIBC. However, whether neoadjuvant chemotherapy prolongs the survival of patients with T1 cancer at the initial TURBT and with muscle-invasive disease detected by a second TUR is unclear. Neoadjuvant chemotherapy offers potential advantages in tumor downstaging and eradication of micrometastases, so this therapy should be indicated for patients who have risk factors for locally advanced disease or nodal metastasis.
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Standard Treatment Options For Stage Iv Bladder Cancer
Standard treatment options for patients with T4b, N0, M0 disease
Treatment options for patients with T4b, N0, M0 disease include the following:
Chemotherapy alone or as an adjunct to local treatment
Cisplatin-based combination chemotherapy regimens are the standard of care for first-line therapy for stage IV bladder cancer in patients who can tolerate it. The only chemotherapy regimens that have been shown to result in longer survival in randomized controlled trials are MVAC, dose-dense MVAC, and CMV. GC was compared with MVAC in a randomized controlled trial and neither regimen was associated with a statistically significant difference in response rate or survival. The two regimens are generally considered equivalent, but they have never been compared in a noninferiority trial. Of note, patients with good performance status and lymph node-only disease have a low but significant rate of achieving a durable complete remission with MVAC or GC. In the large, randomized, controlled trial comparing MVAC with GC, for example, 5-year OS in patients with lymph node-only disease was 20.9%. Dose-dense MVAC and standard-dose MVAC were compared in a randomized controlled trial, and dose-dense MVAC was associated with longer survival.
Ongoing studies are evaluating new chemotherapy combinations.
Ongoing studies are evaluating new chemotherapy combinations.
Cellular Classification Of Bladder Cancer
More than 90% of bladder cancers are transitional cell carcinomas derived from the uroepithelium. About 2% to 7% are squamous cell carcinomas, and 2% are adenocarcinomas. Adenocarcinomas may be of urachal origin or nonurachal origin the latter type is generally thought to arise from metaplasia of chronically irritated transitional epithelium. Small cell carcinomas also may develop in the bladder. Sarcomas of the bladder are very rare.
Pathologic grade of transitional cell carcinomas, which is based on cellular atypia, nuclear abnormalities, and the number of mitotic figures, is of great prognostic importance.
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Bladder Cancer Survival By Age
Five-year survival for bladder cancer is generally higher in younger men and women and decreases with increasing age. Five-year net survival in men ranges from 73% in 15-49 year-olds to 43% in 80-99 year-olds for patients diagnosed with bladder cancer in England during 2009-2013. In women, five-year survival ranges from 57% in 50-59 year-olds to 31% in 80-99 year-olds.
Bladder Cancer , Five-Year Net Survival by Age, England, 2009-2013
Treatment Decision Strategy Based On Risk Factors
Kitamura and Kakehi suggested that optimal management strategies should be based on pathological findings from second TUR specimens in patients with T1 disease. They recommended that patients with T0 upon second TUR be considered for BCG therapy or watchful waiting. A randomized controlled study is ongoing comparing watchful waiting to BCG therapy in high-grade T1 disease with T0 on second TUR . In cases of Ta or T2 on second TUR, unarguably patients should undergo BCG therapy or cystectomy, respectively. In the case of T1 on second TUR, however, questions remain as to which treatment is the optimal treatment for high-grade T1 disease . Such approaches are reasonable to select optimal treatment. However, if molecular risk classifiers for predicting progression or BCG response are included, it may help select treatment modalities for high-grade T1 patients, although they require validation in multiple large scale cohorts. Fig. 4 illustrates a proposed algorithm for treatment decision-making in high-grade T1 bladder cancer.
Proposed algorithm for decision-making in high-grade T1 bladder cancer. TUR, transurethral resection CIS, carcinoma in situ BCG, bacillus Calmette-Guérin.
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What Causes Bladder Cancer
Bladder cancer occurs when cells within the lining of the bladder wall begin to grow in a disordered, uncontrolled way.
Exactly what prompts this disordered growth is not fully known. However, several factors associated with a higher risk of bladder cancer have been identified, including:
- Age – most people diagnosed with bladder cancer are older than 55 years.
- Sex – compared to women, men are 4 times more likely to develop bladder cancer.
- Smoking – smoking is associated with around half of all bladder cancers in men and women.
- Race – in the United States, White Americans have the highest rate of bladder cancer.
- Previous bladder cancer – people who have had bladder cancer may have a recurrence.
- Workplace exposures – certain chemicals in some workplaces may contribute to higher rates of bladder cancer in workers. For example, painters, hairdressers, and truck drivers are at increased risk.
- Arsenic in drinking water.
- Certain types of medication.
Ajcc Stage Groupings And Tnm Definitions
The American Joint Committee on Cancer has designated staging by TNM classification to define bladder cancer.
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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.
Standard Treatment Options For Stages Ii And Iii Bladder Cancer
The most common treatments for muscle-invasive bladder cancer are radical cystectomy and radiation therapy. There is no strong evidence from randomized controlled trials to determine whether surgery or radiation therapy is more effective. There is strong evidence that both therapies become more effective when combined with chemotherapy. The treatments with the highest level of evidence supporting their effectiveness are radical cystectomy preceded by multiagent cisplatin-based chemotherapy and radiation therapy with concomitant chemotherapy.
Radical cystectomy is a standard treatment option for stage II and stage III bladder cancer, and its effectiveness at prolonging survival increases if it is preceded by cisplatin-based multiagent chemotherapy. Radical cystectomy is accompanied by pelvic lymph node dissection and includes removal of the bladder, perivesical tissues, prostate, and seminal vesicles in men and removal of the uterus, fallopian tubes, ovaries, anterior vaginal wall, and urethra in women. Studies of outcomes after radical cystectomy report increased survival in patients who had more, rather than fewer, lymph nodes resected whether this represents a therapeutic benefit of resecting additional nodes or stage migration is unknown. There are no randomized controlled trials evaluating the therapeutic benefit of lymph node dissection in this setting.
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Survival Rates For Prostate Cancer
Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain amount of time after they were diagnosed. These rates cant tell you how long you will live, but they may help give you a better understanding of how likely it is that your treatment will be successful.
Keep in mind that survival rates are estimates and are often based on previous outcomes of large numbers of people who had a specific cancer, but they cant predict what will happen in any particular persons case. These statistics can be confusing and may lead you to have more questions. Talk with your doctor about how these numbers may apply to you, as he or she is familiar with your situation.
Risk Factors Of Prostate Cancer
Age is the most significant risk factor for prostate cancer. Your risk increases as you get older. Most men diagnosed with prostate cancer are over 50 years of age. If you are over the age of 50, talk to your GP about the PSA blood test which can indicate if your prostate is healthy or not.
- A family history of cancer
A family history means that you have someone in your family who has cancer. Generally, if you have a father or brother diagnosed with prostate cancer, you are 2 to 3 times more likely to get prostate cancer yourself, compared to the average man.
The risk is much higher for men with several affected relatives, particularly if their relatives were young when the cancer was found. It is always worth knowing about your family history.
Several inherited gene changes seem to raise prostate cancer risk, but they probably account for only a small percentage of cases overall. For example, inherited mutations of the BRCA1 or BRCA2 genes raise the risk of breast and ovarian cancers in some families. Mutations in these genes may also increase prostate cancer risk in some men.
Prostate cancer is more common in black Caribbean and black African men than in white or Asian men. Asian men have half the risk of white men.
- A previous cancer
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Treatment Options For Recurrent Bladder Cancer
Treatment options for patients with recurrent bladder cancer include the following:
Palliative radiation therapy should be considered for patients with symptomatic tumors.
Recurrent or progressive disease in distant sites or after definitive local therapy has an extremely poor prognosis, and clinical trials should be considered whenever possible.
Bladder Cancer And Its Stages
Bladder cancer is a disease that can have varying symptoms and severity according to its stage. The estimated life expectancy of people who are diagnosed with bladder cancer is dependent on their condition and treatment.
The stages of bladder cancer have different levels of effects to the patient. Although living with bladder cancer can be difficult and challenging, do not lose hope as some of the stages of bladder cancer can be treated.
If people with bladder cancer receive treatment early on the first stage of cancer, the symptoms can be neutralized. The stages of bladder cancer usually depend on the formation of cancer in other parts of the body. If the first stage is managed early, the spread of cancer can be stopped.
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