What Is The Treatment For Muscle
Muscle invasive bladder cancer generally requires a more aggressive treatment plan than superficial bladder cancer. The standard and most effective treatment is the surgical removal of the bladder and diversion of the urinary stream using intestinal segments. This procedure, known as radical cystectomy, is a major operation the doctor and patient should have a thorough discussion about the risks, complications, and benefits prior to this surgical procedure.
In short, the procedure entails removal of the bladder, prostate, seminal vesicles, and the fatty tissue around the bladder through an incision made in the abdomen. The surgery also includes removal of lymph nodes in the pelvis on both sides of the bladder to detect their involvement with the cancer. This helps in deciding further management after surgery, including the need for chemotherapy. Patients who undergo a thorough lymph node dissection have a better chance of cure as compared to patients who either do not receive one or undergo a less extensive dissection.
The physician must divert the urine once the bladder has been removed. There are three popular ways of doing that. All of them require the use of segments of the intestine that are still connected to their blood supply but have been disconnected from the gastrointestinal tract.
Bladder Cancer Survival Trends Over Time
Bladder cancer survival trends are difficult to interpret because of changes to classification and coding practices affecting the definition of invasive carcinoma of the bladder.The decrease in bladder cancer survival since the 1990s is likely to be due to an increasing proportion of bladder tumours now being coded as in situ or uncertain.
One-year age-standardised net survival for bladder cancer in men has increased from 63% during 1971-1972 to 80% during 1990-1991 and then decreased to 77% during 2010-2011 in England and Wales. In women, one-year survival has increased from 53% to 70% and then decreased to 62% over the same time periods.
Bladder Cancer , Age-Standardised One-Year Net Survival, Adults , England and Wales, 1971-2011
Five-year age-standardised net survival for bladder cancer in men has increased from 41% during 1971-1972 to 63% during 1990-1991 and then decreased to a predicted survival of 57% during 2010-2011 in England and Wales. In women, five-year survival has increased from 35% to 55% and then decreased to 46% over the same time periods.
Bladder Cancer , Age-Standardised Five-Year Net Survival, Adults , England and Wales, 1971-2011
Five-year survival for 2010-2011 is predicted using an excess hazard statistical model
Bladder Cancer , Age-Standardised Ten-Year Net Survival, Adults , England and Wales, 1971-2011
Ten-year survival for 2005-2006 and 2010-2011 is predicted using an excess hazard statistical model
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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There Are Three Ways That Cancer Spreads In The Body
Cancer can spread through tissue, the lymph system, and the blood:
- Tissue. The cancer spreads from where it began by growing into nearby areas.
- Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
- Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.
Symptoms In Men And Women
Bladder cancer symptoms in men and women are the same. Men are more likely to get bladder cancer, but they are also more likely to have it diagnosed earlier, according to Moffitt Cancer Center.
Women are more likely to mistake bladder cancer symptoms for urinary tract infections or menstruation.
Rarely, bladder cancer may also be misdiagnosed as interstitial cystitis in women. IC is a painful, inflammatory bladder condition that affects more women than men.
In one study, doctors found bladder cancer in about one percent out of 600 patients referred to them for IC treatment, according to an article in Urology Times.
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What Is The Outcome Of Bladder Cancer
Bladder cancer has a tendency to recur, so when treatment ends, youre still considered at high risk. Some people with superficial bladder cancer experience frequent recurrences throughout their lives. In general, the prognosis is worse when recurrence involves distant tissues, organs, or lymph nodes.
Cancer May Spread From Where It Began To Other Parts Of The Body
When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began and travel through the lymph system or blood.
- Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor in another part of the body.
- Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor in another part of the body.
The metastatic tumor is the same type of cancer as the primary tumor. For example, if bladder cancer spreads to the bone, the cancer cells in the bone are actually bladder cancer cells. The disease is metastatic bladder cancer, not bone cancer.
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What Are The Chances Of Survival With Bladder Cancer
Survival rates for bladder cancer tell you what percentage of people with the same type and stage of bladder cancer are still alive a certain amount of time after the initial diagnosis of the cancer.
Survival rates do not exactly predict how long an individual will live. But these statistics can give an understanding about how likely it is for you to live a certain amount of time after the diagnosis such as five years or two years.
Your doctor will be able to provide better idea about your individual case based the condition such as stage of cancer, your current treatment, and your overall health.
Stage 3 Bladder Cancer
Stage 3 bladder cancer means that the cancer cells have spread beyond the bladder muscle.1,2,3 Stage 3 bladder cancer includes the following combined TNM stages:
In all three types of stage 3 bladder cancer, the cancer cells have not spread to the lymph nodes near the bladder and they have not spread to other parts of the body.
In a bladder tumor that is stage T3a or stage T3b, the bladder cancer cells have grown into the layer of fatty tissue that surrounds the outside of the bladder. This layer of fatty tissue is called perivesical tissue.
In a stage T3a bladder tumor, the bladder cancer cells in the perivesical tissue are only visible through a microscope. In a stage T3b bladder tumor, the bladder cancer cells have grown into the perivesical tissue and are large enough that they are visible using an imaging test or they can be felt by a healthcare professional. A stage T4a bladder tumor is different in women and men. In women, the stage T4a tumor has grown through the perivesical tissue and into the uterus and/or vagina. In men, the stage T4a tumor has grown through the perivesical tissue and into the prostate. However, in both women and men, a stage T4a tumor has not grown into the pelvic wall or the abdominal wall.
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How Do Health Care Professionals Determine Bladder Cancer Staging
Bladder cancer is staged using the tumor node metastases system developed by the International Union Against Cancer in 1997 and updated and used by the American Joint Committee on Cancer . In addition, the American Urologic Association has a similar staging system that varies slightly from that used by the AJCC. The combination of both staging systems appears below. This staging gives your physician a complete picture of the extent of the person’s bladder cancer.
The T stage refers to the depth of penetration of the tumor from the innermost lining to the deeper layers of the bladder. The T stages are as follows:
- Ta – Noninvasive papillary carcinoma
- Tis – Carcinoma in situ
- T1 – Tumor invades connective tissue under the epithelium
- T2 – Tumor invades muscle of the bladder
- T2a – Superficial muscle affected
- T2b – Deep muscle affected
The presence and extent of involvement of the lymph nodes in the pelvic region of the body near the urinary bladder determines the N stage. The N stages are as follows:
The metastases or the M stage signifies the presence or absence of the spread of bladder cancer to other organs of the body.
- Mx – Distant metastasis cannot be evaluated
- M0 – No distant metastasis
A health care professional then assigns a stage:
What Is The Treatment For Superficial Bladder Cancer
Superficial bladder cancer is a cancer that has not invaded the muscle wall of the bladder and is confined to the inner lining of the bladder. This cancer is also termed non-muscle-invasive bladder cancer. The T stage is Ta, T1, or Tis . After the initial TURBT or biopsy in case of CIS, the subsequent treatment in these cases may involve observation with regular follow-up with cystoscopy examinations of the bladder, instillation of medications in the bladder, or in certain cases, surgical removal of the bladder .
Small low-grade, superficial bladder cancers may not require aggressive management after the initial TURBT and may be simply followed up by doing repeated cystoscopy examinations at regular intervals . Some physicians will use fulguration to treat biopsy areas or other small areas that may contain bladder cancer cells.
It is very important to note that 30%-40% of these tumors tend to recur and these recurrences may not be associated with any symptoms. Hence, it is imperative to stick to a regular follow-up protocol to ensure that the disease does not go out of control. A single dose of a chemotherapy medication put inside the bladder immediately after a TURBT can decrease the chances of recurrence within the first two years after surgery.
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Doctor Visits And Tests
Your schedule of exams and tests will depend on the stage and grade of the cancer, what treatments youve had, and other factors. Be sure to follow your doctors advice about follow-up tests.
Most experts recommend repeat exams every 3 to 6 months for people who have no signs of cancer after treatment. These are done to see if the cancer is growing back or if there’s a new cancer in the bladder or urinary system. Your follow-up plan might include urine tests, physical exams, imaging tests , and blood tests. These doctor visits and tests will be done less often as time goes by and no new cancers are found.
- If your bladder hasnt been removed, regular cystoscopy exams will also be done every 3 months for at least the first 2 years.
- If you have a urinary diversion, you will be checked for signs of infection and changes in the health of your kidneys. Urine tests, blood tests, and x-rays might be used to do this. Your vitamin B12 will be checked at least once a year because urinary diversions made with your intestine can affect B12 absorption. Your doctor will also talk to you about how well you’re able to control your urine. Tests will be done to look for signs of cancer in other parts of your urinary tract, too.
Some doctors recommend other lab tests as well, such as the urine tumor marker tests discussed in Can Bladder Cancer Be Found Early? Many of these tests can be used to help see if the cancer has come back, but so far none of these can take the place of cystoscopy.
Can I Lower My Risk Of The Bladder Cancer Progressing Or Coming Back
If you have bladder cancer, you probably want to know if there are things you can do that might lower your risk of the cancer growing or coming back, such as exercising, eating a certain type of diet, or taking nutritional supplements. Unfortunately, its not yet clear if there are things you can do that will help.
Adopting healthy behaviors such as not smoking, eating well, getting regular physical activity, and staying at a healthy weight might help, but no one knows for sure. Still, we do know that these types of changes can have positive effects on your health that can extend beyond your risk of bladdercancer or other cancers.
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How Is Bladder Cancer Treated
Treatment for bladder cancer depends on
- The stage of cancer.
- If cancer has spread beyond the lining of the bladder.
- The extent of cancer spread.
Treatment options based on tumor grade
- High-grade bladder cancer: High-grade cancers that are life-threatening and spread quickly need to be treated with chemotherapy, radiation or surgery.
- Low-grade cancers: Less aggressive cancers have a low chance of becoming high grade and do not require aggressive treatments, such as radiation or bladder removal.
Treatment options may vary depending on the tumor stage.
Treatment Of Stage I Bladder Cancer
For information about the treatments listed below, see the Treatment Option Overview section.
Treatment of stage I bladder cancer may include the following:
- Transurethral resection with fulguration. This may be followed by one of the following:
- Intravesicalchemotherapy given right after surgery.
- Intravesical chemotherapy given right after surgery and then regular treatments with intravesical BCG or intravesical chemotherapy.
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
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What Goes Into A Prognosis
When figuring out your prognosis, your healthcare provider will consider all the things that could affect the cancer and its treatment. He or she will look at risk estimates about the exact type and stage of the cancer you have. These estimates are based on what results researchers have seen over many years in thousands of people with the same type and stage of cancer.
If your cancer is likely to respond well to treatment, your healthcare provider will say you have a favorable prognosis. This means youre expected to live many years and may even be cured. If your cancer is likely to be hard to control, your prognosis may be less favorable. The cancer may shorten your life. Its important to keep in mind that a prognosis states whats likely or probable. It’s not a prediction of what will definitely happen. No healthcare provider can be fully certain about an outcome.
Your prognosis depends mainly on:
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The type and location of the cancer
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The stage of the cancer
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Your overall health
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Your treatment decisions
Grade And Risk Category
The biopsy results will show the grade of the cancer. This is a score that describes how quickly a cancer might grow. Knowing the grade helps your urologist predict how likely the cancer is to come back and if you will need further treatment after surgery.
| Low grade | The cancer cells look similar to normal bladder cells, are usually slow-growing and are less likely to invade and spread. Most bladder tumours are low grade. |
| High grade | The cancer cells look very abnormal and grow quickly. They are more likely to spread both into the bladder muscle and outside the bladder.
In non-muscle-invasive tumours, the grade may be low or high, while almost all muscle-invasive cancers are high grade. Carcinoma in situ is a high-grade tumour that needs prompt treatment to prevent it invading the muscle layer. |
| Risk category | Based on the stage, grade and other features, a non-muscle-invasive bladder cancer will also be classified as having a low, medium or high risk of returning after treatment. This will help your doctors work out which treatments to recommend. |
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Living As A Bladder Cancer Survivor
For some people with bladder cancer , treatment can remove or destroy the cancer. The end of treatment can be both stressful and exciting. You may be relieved to finish treatment, but find it hard not to worry about cancer coming back. This is very common if youve had cancer.
For other people, bladder cancer might never go away completely or might come back in another part of the body. Some people may get regular treatment with chemotherapy , immunotherapy, or other treatments to try to keep the cancer in check. Learning to live with cancer that doesn’t go away can be difficult and very stressful.
Life after bladder cancer means returning to some familiar things and also making some new choices.