Sunday, March 19, 2023

What Is Non Invasive Bladder Cancer

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How To Diagnose Bladder Cancer

Management of Non-Muscle Invasive Bladder Cancer

And how about diagnosis and evaluation? So, the way this is often diagnosed is people can present with blood in their urine. And anytime we see blood in the urine, we should be looking inside the bladder with a camera that we put in through the tube that you pee out of. And then if there is a tumor, it is our job to resect the entire tumor and perform upper tract imaging. And what upper tract imaging means is a CT scan to look at the kidneys, the ureter tubes as well. Because those tubes are lined with the same type of cells that the bladder is lined with. And so, its important to make sure that theres no cancer in that entire tract.

Classification Criterion Of Nmibc

The staging of NMIBC in this guideline was based on Tumor Node Metastasis staging method of the Union for International Cancer Control . The histological grading of NMIBC was based on the WHO standard , but WHO/International Society of Urology standard was not excluded in the process of literature collection. The risk classification criterion for NMIBC in this guideline is shown in Additional file : Table S3. Additional file : Table S4 shows the risk classification criterion of EAU guideline .

Cancer That Grows In The Lining Of The Bladder

Urothelial carcinoma starts in a part of the bladder called the urothelium. The bladder is a hollow, flexible organ that is mostly made of muscle, which allows it to expand to hold urine. The urothelium is a thin layer of cells that line the inside of the bladder walls. This is the most common place for cancer cells to begin growing in the bladder.

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What Is Bladder Cancer

Bladder cancer starts when cells that make up the urinary bladder start to grow out of control. As more cancer cells develop, they can form a tumor and, with time, spread to other parts of the body.

The bladder is a hollow organ in the lower pelvis. It has flexible, muscular walls that can stretch to hold urine and squeeze to send it out of the body. The bladder’s main job is to store urine. Urine is liquid waste made by the 2 kidneys and then carried to the bladder through 2 tubes called ureters. When you urinate, the muscles in the bladder contract, and urine is forced out of the bladder through a tube called the urethra.

How Is Chemo Given For Bladder Cancer

Management of Non

And I will now talk about the chemotherapy. This is chemotherapy that is given inside the bladder. So, it is given through a catheter. Its instilled into your bladder, and then we would ask you to try to hold it for around two hours or so. This chemotherapy is given for low grade bladder cancer. And you can see a list of examples. I would say the most common one used today are either gemcitabine or mitomycin, and they directly kill the cells that could be floating in the urine. It reduces the risk of the cancer coming back, but it doesnt reduce the risk of it progressing. It just specifically reduces the risk of cancer coming back.

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Transurethral Resection Of Bladder Tumor

For early-stage, noninvasive bladder cancer, transurethral resection of bladder tumor is the most common treatment. TURBT is a quick, outpatient procedure performed by a urologist. During TURBT, a scope with a special wire loop is inserted through the urethra into the bladder and your urologist uses the tool to remove tumors and cancerous tissue from the bladder wall.

After receiving TURBT, your physician might recommend immunotherapy and/or chemotherapy treatments to prevent recurrence or subsequent cancer.

Section : Clinical Concerns Related To The Surgical Treatment Of Nmibc

Question 1: What are the indications for TURBT in NMIBC patients?

Recommendation: For patients with suspected NMIBC, TURBT is recommended as the diagnosis procedure and initial treatment measure. .

Implementation consideration: If the conditions permit, remove all visible tumors through TURBT, and conduct a histological examination for pathological staging and grading.

Evidence summary: We referred to the recommendations from the EAU guideline , AUA guideline , CUA guideline , and Chinese Guidelines for Diagnosis and Treatment of Urology and Andrology .

Question 2: What are the indications not to undergo TURBT as the primary procedure for patients with NMIBC?

Recommendation: TURBT is not recommended for patients with insurmountable issues that hinder the implementation of TURBT and for patients who require radical cystectomy. .

Implementation consideration: Insurmountable conditions hindering the implementation of TURBT include severe urinary tract stenosis, patients who cannot be placed in the lithotomy position due to skeletal or muscle disease. See Question 22 for indications for radical cystectomy.

Question 3: What is the extent of initial TURBT resection in NMIBC patients?

Evidence summary: We referred to the recommendations from the EAU guideline , CUA guideline , NICE guideline , NCCN guideline , and Guidelines for Diagnosis and Treatment of Urology and Andrology in China .

Question 5: What are the indications for a repeat TURBT in patients with NMIBC?

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Appendix A Search Strategy

Primary Search Strategy for Emerging Approaches to Diagnosis and Treatment of Non-Muscle-Invasive Bladder Cancer and Treatment of Non-metastatic Muscle-invasive Bladder Cancer

  • exp Urinary Bladder Neoplasms/
  • adj ) or noninvas$ or noninvad$ or noninfiltrat$) adj5 muscle$).mp.
  • exp Biological Markers/
  • or bladder tumor associated antigen$ or nuclear matrix protein or nmp22 or fluorescence in situ hybrid$ or or fibroblast growth factor receptor 3 or fgfr3 or cxbladder or immunocyt or cytokeratin fragment$ or cyfra 21-1 or ) or survivin or telomeras$ or vascular endothelial growth factor$ or vegf or metalloproteinas$ or mmp-2 or mmp-9 or twist homolog$ or twist1 or nidogen-2 or nid2).mp.
  • adj7 risk$).mp.
  • exp Surgical Procedures, Operative/
  • exp Drug Therapy/
  • 13 or 14 or 15 or 16 or 17
  • 9 or 11 or 20 or 22 or 24 or 26 or 30
  • exp Urinary Bladder Neoplasms/
  • adj5 muscl$).mp.
  • adj3 )) adj5 bladder$).mp.
  • exp Lymph Node Excision/
  • adj3 )) adj5 ).mp.
  • 39 or 42 or 45 or 48
  • limit 51 to yr=”1990 -Current”
  • limit 52 to english language
  • limit 52 to abstracts
  • Low Grade And High Grade Bladder Cancer

    Recurrence of Non Muscle Invasive Bladder Cancer

    Bladder cancer starts in the lining of the bladder in about 90 percent of people diagnosed with this cancer. Bladder cancer is called low grade or high grade.

    • Low-grade bladder cancer means the cancer has not invaded the muscles around the bladder . People rarely die from this type of bladder cancer, it often recurs after treatment.
    • High-grade bladder cancer also often recurs and has a higher chance of spreading to other parts of the body. Almost all deaths from bladder cancer result this type so it is treated more aggressively.

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    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.

    Testing To See If That Cancer Has Spread

    If you are diagnosed with urothelial carcinoma, your healthcare providers will carry out tests to find out where the bladder cancer cells have formed in the bladder, and whether they have spread beyond the bladder to other parts of the body. This will help to identify the best way to treat the cancer. Treatment for non-muscle-invasive bladder cancer is effective for many people.

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    Who Can Use Cxbladder

    We offer three different Cxbladder tests to serve a wide range of patients, including patients with hematuria, patients with suspected bladder cancer, and those monitoring bladder cancer for recurrence.

    Cxbladder Triage is our test designed to help physicians rule out the presence of bladder cancer in low-risk patients with hematuria.

    For patients with a greater risk of bladder cancer, doctors can use Cxbladder Detect, which can inform a bladder cancer diagnosis when combined with other tests in a urological evaluation.

    Finally, doctors and cancer specialists can use Cxbladder Monitor to assess patients with a history of bladder cancer for disease recurrence. This cancer test can reduce the number of invasive procedures required, allowing Cxbladder Monitor to significantly improve quality of life for people in recovery.Learn More About Cxbladder

    Clinical Outcomes Of The Gemdoce Combination Were Promising Approaching 50 Percent Recurrence

    Staging and grading of bladder cancer

    A better approach? Kates and colleagues have begun investigating a combination of two chemotherapy drugs, gemcitabine and docetaxel , delivered directly in the bladder in the same way that BCG is instilled for newly diagnosed bladder cancer patients. In previously published work at the Brady, as part of a multi-institutional study, Kates and Trinity Bivalacqua, M.D., Ph.D., evaluated patients who were given GEMDOCE when bladder tumors recurred after BCG. Clinical outcomes of the GEMDOCE combination were promising, says Kates, approaching 50 percent recurrence-free survival at two years when used with monthly maintenance. Based on these promising results, Kates has opened a Phase 2 clinical trial to evaluate this combination for newly diagnosed patients who have not had previous BCG. We will also be looking for a biomarker that can predict response to GEMDOCE, which would help us guide newly diagnosed patients either to intravesical chemotherapy or BCG immunotherapy, based on their tumor biology. More information on this clinical trial can be found here.

    Even more exciting: We identified unique immune gene expression signatures found only in patients with CIS, says Hahn. Next, the team plans to investigate whether these new CIS signatures are associated with response to BCG and other forms of bladder cancer immune therapy.

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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.

    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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    What Is The Most Aggressive Form Of Bladder Cancer

    In general, bladder cancers that are muscle invasive and/or have high-grade cells are the most serious and aggressive. The less common types of bladder cancer such as squamous cell carcinoma, adenocarcinoma, and small cell carcinoma have a greater tendency to be muscle invasive compared to urothelial carcinoma. However, if left untreated, initially low-grade, non-muscle invasive urothelial carcinoma can progress into the bladder wall and spread to other parts of the body.

    The prognosis for bladder cancer is very favorable when the disease is detected early, so it is important to see your doctor if you are experiencing symptoms that could be due to bladder cancer. The most common early sign of bladder cancer is the presence of blood in the urine . Other symptoms that may be experienced include urinary irritation and changes in bladder habits. For further information regarding the signs and symptoms of bladder cancer, see Bladder Cancer Symptoms.

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    Role Of Cystectomy In Nmibc

    Guideline Statement 27

    27. In a patient with Ta low- or intermediate-risk disease, a clinician should not perform radical cystectomy until bladder-sparing modalities have failed.

    Discussion

    Low-grade, noninvasive tumors very rarely metastasize, and even large-volume, multifocal cancers can usually be managed with techniques, such as staged resection. Patients with low-grade recurrences can be successfully managed with intravesical chemotherapy 225 or BCG. 177,226,227 In addition, small, multifocal recurrences despite intravesical therapy can usually be treated effectively with office fulguration, repeat TURBT or even surveillance, in select cases. 64-67

    Guideline Statement 28

    28. In a high-risk patient who is fit for surgery with persistent high-grade T1 disease on repeat resection, or T1 tumors with associated CIS, LVI, or variant histologies, a clinician should consider offering initial radical cystectomy.

    Discussion

    Guideline Statement 29

    29. In a high-risk patient with persistent or recurrent disease within one year following treatment with two induction cycles of BCG or BCG maintenance, a clinician should offer radical cystectomy.

    Clinicalapplication Of Histological Grading Systems

    Staging and Standards of Care for Non Muscle Invasive Bladder Cancer
    • Two classification systems the WHO 1973 and the WHO 2004/2016, are currently availablefor routine clinical application.
    • The most important parameters, which must be considered for clinical application of anygrading system are its interobserver reproducibility and prognostic value .
    • To facilitate the clinical utilisation in daily practice, these guidelines providerecommendations for tumours classified based on both classification systems.

    Table 4.2: WHO classification in 1973 and in 2004/2016

    1973 WHO classification system

    High-grade papillary urothelial carcinoma

    Figure 4.1: Stratification of tumoursaccording to grade in the WHO 1973 and 2004/2016 classifications *

    *1973 WHO Grade 1 carcinomas have beenreassigned to papillary urothelial neoplasm of low malignant potential and low-grade carcinomas in the 2004 WHO classification, and Grade 2carcinomas to LG and high-grade carcinomas. All 1973 WHO Grade 3 carcinomashave been reassigned to HG carcinomas .

    PUNLMP is a non-invasive neoplasm and thereforeconsidered stage pTa in the AJCC/UICC staging systems.

    Table 4.3: WHO 2004 histological classification for flat lesions

    Non-malignant lesions

    Urothelial CIS is always high grade.

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    Summary Of Evidence And Guidelines Fortransurethral Resection Of The Bladder Biopsies And Pathology Report

    Summary of evidence

    Transurethral resection of the bladder tumour followed by pathology investigation of the obtained specimen is an essentialstep in the management of NMIBC.

    The absence of detrusor muscle in the specimen isassociated with a significantly higher risk of residual disease and tumourunder-staging .

    In patients with a history of small Ta LG/G1 tumours,fulguration of small papillary recurrences on an outpatient basis is feasibleand safe.

    A second TURB can detect residual tumours and tumourunder-staging, increase recurrence-free survival, improve outcomes after BCGtreatment and provide prognostic information.

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    Strategy Of The Procedure

    The goal of TURB in TaT1 BC is to make the correct diagnosis and completelyremove all visible lesions. It is a crucial procedure in the management of BC. Transurethralresection of the bladder should be performed systematically in individual steps .

    The operative steps necessary to achieve a successful TURB includeidentifying the factors required to assign disease risk , clinical stage , adequacy of the resection , and presence of complications . To measure the size of thelargest tumour, one can use the end of cutting loop, which is approximately 1 cm wide as areference. The characteristics of the tumour are described as sessile, nodular, papillary orflat.

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    How Can You Learn More About Our Tests

    Whether you’re a physician deciding how to best help your patients, or a patient worried about having bladder cancer yourself, we know choosing a reliable test can feel daunting. At Cxbladder, we aim to provide all the information you need to make a confident decision.

    In one large clinical assessment, Cxbladder Detect outperformed other urine tests and cytology. When used in combination with cystoscopy, Cxbladder Detect found 97 percent of all high-grade tumors. With comparatively high accuracy, Cxbladder tests offer useful guidance and peace of mind.

    On our website, you’ll find resources tailored to the unique needs of physicians and their patients. Whether you’re looking for information on bladder cancer signs and symptoms or seeking detailed information on our tests and their accuracy, we can help.

    You can read more about our full suite of bladder cancer test products or reach out to a Cxbladder representative to request more information today.

    Nature And Burden Of Non

    Bladder Cancer

    Bladder cancer is the fourth most commonly diagnosed cancer in men and tenth most commonly diagnosed cancer in women in the United States.1 The American Cancer Society estimates there will be 72,570 new cases of bladder cancer in the U.S. in 2013 , and about 15,210 deaths due to bladder cancer .1 The lifetime probability of developing bladder cancer in the U.S. is approximately 3.8 percent in men and 1.2 percent in women, although the incidence of bladder cancer is increasing in women. Bladder cancer occurs primarily in men older than 60 and roughly twice as frequently in white compared to black men,2 though mortality is similar, presumably due to delayed diagnosis in black men.

    Bladder cancer remains an important health problem, with no improvement in associated mortality since 1975.3 Economic analyses have shown bladder cancer to be the costliest cancer to treat in the U.S. on a per capita basis, taking into account diagnostic testing, management, and long term follow up.4 The most common risk factor for bladder cancer is smoking, though other risk factors include occupational exposures and family history. The most common symptom of bladder cancer is painless hematuria .

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