Treatment For Early Stage Bladder Cancer

What Screening Tests Are Used For Bladder Cancer

It is not standard to screen for bladder cancer. Bladder cancer screening may be used in people who are considered high risk. If you have a history of bladder cancer, a history of a birth defect of the bladder, or have been exposed to certain chemicals at work, you may be considered high-risk. You should ask your provider if screening tests are right for you.

Testing the urine for blood, abnormal cells, and tumor markers can help find some bladder cancers early but the results vary. Not all bladder cancers are found, and some people may have changes in their urine but do not have bladder cancer. These tests can be used in those who already have signs of bladder cancer or if the cancer has returned. However, more research is needed to determine how useful testing the urine is as a screening test.

Copy Number Clonality And Evolutionary Analyses

We determined total, allele-specific, and integer DNA copy number genome wide using the FACETS algorithm in all tumors independent of sequencing platform . Briefly, FACETS simultaneously segments total and allele-specific DNA copy number from the coverage and genotypes of polymorphic SNPs genome wide. Allele-specific segmentation is based on the log odds ratio of allele fractions at SNPs identified as heterozygous in the normal sample. A fit is applied to the resulting segments, identifying in each sample the log ratio corresponding to diploidy, purity, and average ploidy. Major and minor integer copy number is then assigned to each segment by maximum likelihood. Allelic imbalance is determined from a change in the zygosity of heterozygous SNPs. We then defined the presence of genome doubling in samples for which the majority of the genome contains multiple copies from the same parent/allele. Gene-level copy number was assigned from spanning segments of integer copy number data in each tumor. Homozygous deletion was determined from regions of total copy number of zero. Amplifications were those regions of total integer copy number greater than 5 or 6 in diploid and GD cases, respectively. Partial deletions were called whereas partial amplifications were not. This same FACETS-based analytical pipeline was run on all retrospective and prospective cohorts to allow for direct comparison of gene-level copy number calls.

Smoking Can Affect The Risk Of Bladder Cancer

Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer not having risk factors doesn’t mean that you will not get cancer. Talk to your doctor if you think you may be at risk for bladder cancer.

Risk factors for bladder cancer include the following:

• Using tobacco, especially smoking cigarettes.
• Having a family history of bladder cancer.
• Having certain changes in the genes that are linked to bladder cancer.
• Being exposed to paints, dyes, metals, or petroleum products in the workplace.
• Past treatment with radiation therapy to the pelvis or with certain anticancer drugs, such as cyclophosphamide or ifosfamide.
• Taking Aristolochia fangchi, a Chinese herb.
• Drinking water from a well that has high levels of arsenic.
• Drinking water that has been treated with chlorine.
• Having a history of bladder infections, including bladder infections caused by Schistosoma haematobium.
• Using urinarycatheters for a long time.

Older age is a risk factor for most cancers. The chance of getting cancer increases as you get older.

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Bcg Relapse And Salvage Regimens

Guideline Statement 22

22. In an intermediate- or high-risk patient with persistent or recurrent disease or positive cytology following intravesical therapy, a clinician should consider performing prostatic urethral biopsy and an upper tract evaluation prior to administration of additional intravesical therapy.

Discussion

Urothelial carcinoma, particularly CIS, is considered a field-change disease with the entire urothelium at risk in affected individuals. Clinicians should remain aware of sites outside the bladder as potential sources for metachronous tumors. While the initial diagnostic evaluation includes radiographic/endoscopic visualization of the entire urinary tract, the extra-vesical urothelium remains at long-term risk for subsequent tumor development. Moreover, these sites may harbor disease and contribute to cancer recurrence within the bladder.

Of note, the Panel recognizes that evaluation of the upper urinary tract and urethra may be withheld in select patients who have received a single induction course of intravesical BCG and subsequently have persistent evidence of disease and are to undergo a second course of BCG.

Guideline Statement 23

23. In an intermediate- or high-risk patient with persistent or recurrent Ta or CIS disease after a single course of induction intravesical BCG, a clinician should offer a second course of BCG.

Discussion

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

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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.

Clinical trials

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.

Stages Of Bladder Cancer: What You Need To Know

• Stage IV

When you are first diagnosed with bladder cancer, your doctors will perform tests to determine the stage and grade of your disease. The bladder cancer staging and grading processes help your doctors make treatment decisions and estimate your chance of recovery.

Bladder cancer is a growth that starts in the inner wall of the bladder, the organ that collects and expels urine created by the kidneys. The bladder has three layers of muscular walls that make up its structure. A cancerous growth in the bladder can grow uncontrollably and start spreading to other parts of the body.

When doctors first diagnose a cancerous tumor of any kind, they assess how much it has grown, how far it has spread in the body, and how abnormal, or wild, the cancerous cells in the tumor look. These assessments are used to determine cancers stage and grade.

Doctors use the staging information to compare treatment options and patient outcomes. Staging and grading also important in determining your eligibility for cancer treatment clinical trials.

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Treatment For Early Stages

If you are diagnosed with stage 0 or stage 1 bladder cancer, your healthcare team will discuss the range of available treatment options with you.3 A procedure that is commonly used to treat early stage bladder cancer is called transurethral resection of bladder tumor . During this procedure, a surgeon inserts a very thin, flexible instrument into the bladder through the urethra, the hollow tube-like organ that carries urine out of the body from the bladder. The surgeon removes the tumor from the inside of the bladder. After the tumor is removed, the surgeon will often use a procedure called fulguration to try to eliminate any bladder cancer cells that are left in the bladder lining or lamina propria.

A treatment called intravesical chemotherapy is commonly administered after surgery, which involves delivering a special type of chemotherapy medicine directly into the bladder.

Other patients with stage 0 or stage 1 bladder cancer may need to have surgery to remove all or part of the bladder. Some patients may decide to take part in a clinical trial investigating new types of bladder cancer treatment.

Five Types Of Standard Treatment Are Used:

Surgery

One of the following types of surgery may be done:

• Transurethral resection with fulguration: Surgery in which a cystoscope is inserted into the bladder through the urethra.A tool with a small wire loop on the end is then used to remove thecancer or to burn the tumor away with high-energy electricity. This is known as fulguration.
• Radical cystectomy: Surgery to remove the bladder and anylymph nodes and nearby organs that contain cancer. This surgery may bedone when the bladder cancer invades the muscle wall, or when superficialcancer involves a large part of the bladder. In men, the nearby organs that areremoved are the prostate and the seminal vesicles. In women, the uterus, theovaries, and part of the vagina are removed. Sometimes, when the cancer hasspread outside the bladder and cannot be completely removed, surgery to removeonly the bladder may be done to reduce urinarysymptoms caused by the cancer.When the bladder must be removed, the surgeon creates another way for urine toleave the body.
• Partial cystectomy: Surgery to remove part of thebladder. This surgery may be done for patients who have a low-grade tumor thathas invaded the wall of the bladder but is limited to one area of the bladder.Because only a part of the bladder is removed, patients are able to urinate normally afterrecovering from this surgery. This is also called segmental cystectomy.
• Urinary diversion: Surgery to make a new way forthe body to store and pass urine.

Radiation therapy

Chemotherapy

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Clarifying Your Treatment Options

So, for patients who find themselves in this situation, what factors should they consider in deciding on a treatment path? As a patient advocate, I dont offer medical office but I can tell you the kind of questions we asked when my first husband Ahmad was diagnosed. Maybe these can help you in clarifying your options:

• Has the patient gotten a second opinion both from a urologist and a pathologist with significant experience in diagnosing, staging, and treating bladder cancer?
• Are the opinions consistent?
• Is the patient willing to tolerate frequent visits to the doctor for injections of BCG and the related side effects?
• Is the patient open to considering a clinical trial?
• Is the patient healthy enough for major surgery?
• Can the patient cope emotionally with the idea of losing his or her bladder?
• Can the patient cope with the uncertainty of whether BCG will work and the options if it doesnt?

These are just some questions to consider when deciding on a treatment path. There is no right answer. It is a highly personalized decision. Whatever path is chosen, the patient should feel comfortable with the doctor and with the doctors rationale for the treatment chosen.

Symptoms Of Bladder Cancer

Symptoms of bladder cancer are relatively common symptoms of various diseases and are easy to miss. The most common symptom of bladder cancer is reddish or brownish-colored urine from blood in the urine. Other symptoms include the frequent urge to urinate, pain while urinating, and pain in the back or pelvis.

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What To Expect During Bcg Treatment

First, make sure you havent had any fluids for four hours before the treatment. Right before you go into the treatment room your doctor or nurse will have you empty your bladder.

Youll lie on your back, and the medical professional will insert a catheter into your urethra and into your bladder, likely using some local numbing, and use this tube to infuse the treatment.

Once the treatment is infused, your doctor or nurse will remove the catheter. Theyll have you lie on your back, each side, and your stomach for 15 minutes each. The BCG mycobacteria needs to touch the bladder cancer cells to activate the immune system. Youll then be free to go but will need to hold off on peeing for another hour.

Verywell / Alex Dos Diaz

For at least six hours after your infusion, youll need to disinfect your pee to ensure none of the mycobacteria spread to anyone else. Pour an equal amount of bleach into the toilet after you pee and let it sit for 15 minutes before flushing.

Also, people with a penis who undergo BCG treatment should avoid sex for 48 hours to ensure they dont pass the mycobacteria to their partners.

You will likely need multiple BCG treatments. They may be given weekly for a few weeks, then less often for months or years to prevent cancer from coming back.

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Treating Stage Ii Bladder Cancer

These cancers have invaded the muscle layer of the bladder wall , but no farther. Transurethral resection is typically the first treatment for these cancers, but it’s done to help determine the extent of the cancer rather than to try to cure it.

When the cancer has invaded the muscle, radical cystectomy is the standard treatment. Lymph nodes near the bladder are often removed as well. If cancer is in only one part of the bladder, a partial cystectomy may be done instead. But this is possible in only a small number of patients.

Radical cystectomy may be the only treatment for people who are not well enough to get chemo. But most doctors prefer to give chemo before surgery because it’s been shown to help patients live longer than surgery alone. When chemo is given first, surgery is delayed. This is not a problem if the chemo shrinks the bladder cancer, but it might be harmful if the tumor continues to grow during chemo.

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.

For people who have had surgery, but the features of the tumor show it is at high risk of coming back, the immunotherapy drug, nivolumab, might be offered. When given after surgery, nivolumab is given for up to one year.

For patients who cant have surgery because of other serious health problems, TURBT, radiation, chemotherapy, or some combination of these may be options.

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Bladder Cancer Signs And Symptoms Can Include:

• Blood in the urine, which can cause urine to appear bright red or brown, though sometimes the urine appears normal and blood is detected on a lab test.
• Frequent urination.
• Painful urination.
• Back pain.

If you’ve been diagnosed with bladder cancer, your treatment will be based on the type, grade and stage of the cancer, as well as your overall health and preferences. Most bladder cancers are diagnosed at an early stage when the cancer is highly treatable.

But even early stage bladder cancers can recur after successful treatment. For this reason, people with bladder cancer typically need follow-up tests for years after treatment to look for bladder cancer that recurs.

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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If You’ve Been Diagnosed With Bladder Cancer Treatment Can Include:

• Surgery to remove the cancer cells.
• Chemotherapy in the bladder called intravesical chemotherapy to treat cancers that are confined to the lining of the bladder but have a high risk of recurrence or progression to a higher stage.
• Chemotherapy for the whole body, called systemic chemotherapy, to increase the chance for a cure in a person having surgery to remove the bladder, or as a primary treatment when surgery isn’t an option.
• Radiation therapy to destroy cancer cells, often as a primary treatment when surgery isn’t an option or isn’t desired.
• Immunotherapy to trigger the body’s immune system to fight cancer cells, either in the bladder or throughout the body.
• Targeted therapy to treat advanced cancer when other treatments haven’t helped.

Connect with others talking about bladder cancer and living well in the Cancer support group on Mayo Clinic Connect, an online patient community moderated by Mayo Clinic.

What Kind Of Treatment Will I Need

There are many ways to treat bladder cancer. You might want to get a second opinion about the best treatment plan for you.

Bladder cancer is most often treated with:

• Surgery
• Chemo
• Immunotherapy

Sometimes more than one type is used. The treatment plan thats best for you depends on:

• The stage and grade of the cancer
• Whether the cancer has spread into the bladder wall
• The chance that a type of treatment will cure the cancer or help in some way
• Other health problems you have
• Your feelings about the treatment and the side effects that come with it

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Who Can Have This Treatment

BCG is appropriate for noninvasive and minimally invasive bladder cancers. It usually follows a procedure called transurethral resection of bladder tumor . Its intended to help prevent recurrence.

This treatment only affects cells inside the bladder. Its not useful for later stage bladder cancer that has spread into or beyond the bladder lining, or to other tissues and organs.