Targeted Therapy For Bladder Cancer
Targeted therapy is a new type of therapy for patients with advanced cancer whose disease has progressed on chemotherapy and immunotherapy. One class of targeted therapies are antibody-drug conjugates , which can target and kill cancer cells while sparing healthy cells. ADCs are made up of 3 parts:4
- Antibody, which is a type of protein that recognises and attaches to the antigen present on cancer cells.
- Anti-cancer drug, which kills cancer cells once they are recognised.
- Linker, a compound that connects the antibody to the anti-cancer drug
How Is Radiation Therapy Given
The type of radiation most often used to treat bladder cancer is called external beam radiation therapy. It focuses radiation from a source outside of the body on the cancer.
Before your treatments start, your radiation team will take careful measurements to find the exact angles for aiming the radiation beams and the proper dose of radiation. This planning session, called simulation, usually includes getting imaging tests such as CT or MRI scans. This helps the doctor map where the tumor is in your body. You’ll be asked to empty your bladder before simulation and before each treatment.
The treatment is a lot like getting an x-ray, but the radiation is stronger. Radiation doesn’t hurt. Each treatment lasts only a few minutes, but the setup time getting you into place for treatment usually takes longer. Most often, radiation treatments are given 5 days a week for many weeks.
When To See A Doctor
There are a few side effects that can be especially dangerous, so make sure to talk to your doctor if you notice that you:
- Have a severe skin rash
- Are wheezing or having difficulty breathing
- Are finding swallowing to be difficult
- Have a high fever that isnt lowered with Tylenol or other over-the-counter fever reducers
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Treatment For Advanced Bladder Cancer
If bladder cancer has spread to other parts of the body, it is known as advanced or metastatic bladder cancer. You may be offered one or a combination of the following treatments to help control the cancer and ease symptoms:
- systemic chemotherapy
- radiation therapy.
Immunotherapy uses the bodys own immune system to fight cancer. BCG is a type of immunotherapy treatment that has been used for many years to treat non-muscle-invasive bladder cancer.
A new group of immunotherapy drugs called checkpoint inhibitors work by helping the immune system to recognise and attack the cancer. A checkpoint immunotherapy drug called pembrolizumab is now available in Australia for some people with urothelial cancer that has spread beyond the bladder. The drug is given directly into a vein through a drip, and the treatment may be repeated every 2 to 4 weeks for up to 2 years.
Other types of checkpoint immunotherapy drugs may become available soon.
Types Of Bladder Cancer
Bladder cancer can be described based on where it is found:
- non-muscle invasive the cancer has not spread to other layers of the bladder or muscle
- muscle-invasive the cancer has spread to other layers of the bladder, muscle or other parts of the body.
There are 3 main types of bladder cancer:
- urothelial carcinoma 80 to 90% of bladder cancers sometimes called transitional cell carcinoma
- squamous cell carcinoma 1 to 2% of all bladder cancers. It is more likely to be invasive
- adenocarcinoma 1 to 2% of all bladder cancers. It is more likely to be invasive .
There are other, less common types of bladder cancer. Treatment for these may be different. Speak to your doctor or nurse for information about these types of cancer.
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Drug Treatments After Turbt
Chemotherapy can be given as a once-off treatment directly into your bladder after your TURBT. This is known as intravesical chemotherapy.
If there is a moderate risk of the cancer returning you may need this treatment weekly a number of times. You may also need to have this treatment if your bladder cancer returns after the initial treatment.
BCG may be given directly into the bladder if there is a high risk of your cancer coming back after surgery. BCG was originally a vaccine used to prevent tuberculosis .
If Treatment Does Not Work
Full recovery from bladder cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or metastatic.
This diagnosis is stressful, and for some people, advanced cancer is difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, expertise, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.
People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is a specific type of palliative care designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Learn more about advanced cancer care planning.
After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.
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Treatment For Stage 4 Bladder Cancer
Treatment for stage 4 bladder cancer may include:
- chemotherapy without surgery to relieve symptoms and extend life
- radical cystectomy and removal of the surrounding lymph nodes, followed by a surgery to create a new way for urine to exit the body
- chemotherapy, radiation therapy, and immunotherapy after surgery to kill remaining cancer cells or to relieve symptoms and extend life
- clinical trial drugs
, the five-year survival rates by stage are the following:
- The five-year survival rate for people with stage 0 bladder cancer is around 98 percent.
- The five-year survival rate for people with stage 1 bladder cancer is around 88 percent.
- The five-year survival rate for people with stage 2 bladder cancer is around 63 percent.
- The five-year survival rate for people with stage 3 bladder cancer is around 46 percent.
- The five-year survival rate for people with stage 4 bladder cancer is around 15 percent.
There are treatments available for all stages. Also, survival rates dont always tell the whole story and cant predict your future. Speak with your doctor about any questions or concerns you may have regarding your diagnosis and treatment.
Because doctors dont yet know what causes bladder cancer, it may not be preventable in all cases. The following factors and behaviors can reduce your risk of getting bladder cancer:
- not smoking
Coping With Bladder Problems During And After Treatment
During your treatment, you may have symptoms such as:
- passing urine more often
- rushing to the toilet to pass urine
- a burning sensation when you pass urine.
For most people, these symptoms last for a few days after treatment. Your urologist or specialist nurse can talk to you about things you can do to help. They will give you medication if needed.
Some people can have problems controlling their bladder during and for some time after treatment. This is called urinary incontinence. This can be a rare side effect of having lots of cystoscopies.
It is important that you talk to your doctor or nurse if this is a problem for you. They may refer you to a continence adviser or specialist physiotherapist who can give you advice. The Bladder and Bowel Community can also help.
- Visit our bladder cancer forum to talk with people who have been affected by bladder cancer, share your experience, and ask an expert your questions.
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Remission And The Chance Of Recurrence
A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having no evidence of disease or NED.
A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it is important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.
If the cancer returns after the original treatment, it is called recurrent cancer. It may come back in the same place , nearby , or in another place .
If a recurrence happens, a new cycle of testing will begin again to learn as much as possible about it. After this testing is done, you and your doctor will talk about the treatment options.
People with recurrent cancer sometimes experience emotions such as disbelief or fear. You are encouraged to talk with your health care team about these feelings and ask about support services to help you cope. Learn more about dealing with cancer recurrence.
Treatment For Bladder Cancer In Raleigh And Wake Forest
If you or someone you love has bladder cancer, know that a full recovery is possible. Modern medicine and new treatments have made surviving bladder cancer the new norm. Make sure to research these treatments and think about which one is right for you. Then, talk to your doctor about your plan to beat this cancer and discuss your options. Taking care of your body is essential, so make sure to take the time you need to heal.
If you or someone you love has bladder cancer, contact us today. Our highly experienced oncology team can help you understand your treatment options.
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Having Chemotherapy With Your Main Treatment
Chemotherapy uses anti-cancer drugs to destroy cancer cells. For muscle-invasive and locally advanced bladder cancer, you may have chemotherapy:
- before surgery or radiotherapy, to shrink the cancer and reduce the risk of it coming back. This is called neo-adjuvant chemotherapy.
- with radiotherapy, to make treatment work better. This is called chemoradiation.
- after surgery, if there is a high risk of the cancer coming back .
- Visit our bladder cancer forum to talk with people who have been affected by bladder cancer, share your experience, and ask an expert your questions.
Stage Information For Bladder Cancer
In This Section
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Treatment Options Under Clinical Evaluation For Patients With Any T Any N M1 Disease
Prognosis is poor in patients with stage IV disease and consideration of entry into a clinical trial is appropriate.
Other chemotherapy regimens appear to be active in the treatment of metastatic disease. Chemotherapy agents that have shown activity in metastatic bladder cancer include paclitaxel, docetaxel, ifosfamide, gallium nitrate, and pemetrexed.
Transurethral Resection Of A Bladder Tumour
If abnormalities are found in your bladder during a cystoscopy, you should be offered an operation known as TURBT. This is so any abnormal areas of tissue can be removed and tested for cancer .
TURBT is carried out under general anaesthetic.
Sometimes, a sample of the muscle wall of your bladder is also taken to check whether the cancer has spread, but this may be a separate operation within 6 weeks of the first biopsy.
You should also be offered a dose of chemotherapy after the operation. This may help to prevent the bladder cancer returning if the removed cells are found to be cancerous.
See treating bladder cancer for more information about the TURBT procedure
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Treating Stage Iii Bladder Cancer
These cancers have reached the outside of the bladder and might have grown into nearby tissues or organs and/or lymph nodes . They have not spread to distant parts of the body.
Transurethral resection is often done first to find out how far the cancer has grown into the bladder wall. Chemotherapy followed by radical cystectomy is then the standard treatment.Partial cystectomy is rarely an option for stage III cancers.
Chemotherapy before surgery can shrink the tumor, which may make surgery easier. Chemo can also kill any cancer cells that could already have spread to other areas of the body and help people live longer. It can be especially useful for T4 tumors, which have spread outside the bladder. When chemo is given first, surgery to remove the bladder is delayed. The delay is not a problem if the chemo shrinks the cancer, but it can be harmful if it continues to grow during chemo. Sometimes the chemo shrinks the tumor enough that intravesical therapy or chemo with radiation is possible instead of surgery.
Some patients get chemo after surgery to kill any cancer cells left after surgery that are too small to see. Chemo given after cystectomy may help patients stay cancer-free longer, but so far its not clear if it helps them live longer. If cancer is found in nearby lymph nodes, radiation may be needed after surgery. Another option is chemo, but only if it wasn’t given before surgery.
Risks And Side Effects Of Cystectomy
The risks with any type of cystectomy are much like those with any major surgery. Problems during or shortly after surgery can include:
- Reactions to anesthesia
- Blood clots in the legs or lungs
- Damage to nearby organs
Most people will have at least some pain after the operation, which can be controlled with pain medicines.
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Bladder Cancer Clinical Trials
Major drug companies continually research and develop new medications and treatments for bladder cancer that must be shown to be safe and effective before doctors can prescribe them to patients. Through clinical trials, researchers test the effects of new drugs on a group of volunteers who have bladder cancer. Following a strict protocol and using carefully controlled conditions, researchers evaluate the investigational drugs under development and measure the ability of the new drug to treat bladder cancer, its safety, and any possible side effects.
Some patients are reluctant to take part in clinical trials for fear of getting no treatment at all. But patients who participate in clinical trials receive the most effective therapy currently available for the condition, or they may receive treatments that are being evaluated for future use. These bladder cancer drugs may be even more effective than current treatment. Comparing them in a clinical trial is the only way to find out.
Hereâs where to find information about whether a bladder cancer clinical trial is right for you.
This website lists industry-sponsored clinical trials that are actively recruiting patients.
American Cancer Society: âBladder Cancer Treatment,â âBladder Cancer Surgery,â âRadiation Therapy for Bladder Cancer,â âChemotherapy for bladder cancer,â âFDA Approves New Immunotherapy Drug for Bladder Cancer,â âImmunotherapy for bladder cancer.â
Radiotherapy With A Radiosensitiser
Radiotherapy is given by a machine that beams the radiation at the bladder . Sessions are usually given on a daily basis for 5 days a week over the course of 4 to 7 weeks. Each session lasts for about 10 to 15 minutes.
A medicine called a radiosensitiser should also be given alongside radiotherapy for muscle-invasive bladder cancer. This medicine affects the cells of a tumour, to enhance the effect of radiotherapy. It has a much smaller effect on normal tissue.
As well as destroying cancerous cells, radiotherapy can also damage healthy cells, which means it can cause a number of side effects. These include:
- tightening of the vagina , which can make having sex painful
- erectile dysfunction
- difficulty passing urine
Most of these side effects should pass a few weeks after your treatment finishes, although there’s a small chance they’ll be permanent.
Having radiotherapy directed at your pelvis usually means you’ll be infertile .
After having radiotherapy for bladder cancer, you should be offered follow-up appointments every 3 months for the first 2 years, then every 6 months for the next 2 years, and every year after that. At these appointments, your bladder will be checked using a cystoscopy.
You may also be offered CT scans of your chest, abdomen and pelvis after 6 months, 1 year and 2 years. A CT scan of your urinary tract may be offered every year for 5 years.
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