Bladder Instillation Of Bacille Calmette
Bacille Calmette-Guérin is one of the most common adjuvant therapies for treatment of superficial bladder cancer, and is commonly used for patients with high-grade papillary cancers or carcinoma in situ.2 BCG is an immunotherapy that is a weakened form of the bacterium related to bacteria causing tuberculosis. BCG is instilled directly into the bladder through the urethra and exerts its anti-cancer effect by stimulating the bodyâs immune system to kill cancer cells. The primary side effects of BCG are pain in the bladder, blood in the urine and rarely, autoimmune disorders. Because BCG is a live bacteria, it may occasionally grow and cause an infection that requires antibiotic treatment.
Compared to treatment of superficial bladder cancer with TUR alone, treatment with TUR and intravesical BCG reduces the risk of recurrence and may also reduce the risk of cancer progression.3 However, even with optimal BCG therapy, many patients with superficial bladder cancer will ultimately have progression to invasive bladder cancer. This indicates the importance of frequent follow-up examinations to detect early progression to invasive cancer or new superficial cancers. Early invasive bladder cancer can be treated effectively.
What Happens After Treatment For Muscle
After treatment for muscle-invasive bladder cancer, people are carefully monitored by their healthcare providers for signs that the cancer has recurred. Most people who die from bladder cancer do not die from tumors in the bladder muscles, but from cancer that has spread out of the bladder muscles and into other parts of the body.
What Happens In The Final Stages Of Bladder Cancer
Stage 4 means that the cancer has spread to the wall of the abdomen or pelvis, the lymph nodes or to other parts of the body. If bladder cancer does spread to another part of the body, it is most likely to go to the bones, lungs or liver. These figures are for people diagnosed in England between 2013 and 2017.
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How Does Bladder Cancer Get Worse
Bladder cancer gets worse when it grows into or through other layers of the bladder wall. Over time, the cancer may grow outside the bladder into tissues close by. Bladder cancer may spread to lymph nodes nearby and farther away. The cancer may reach the bones, the lungs, or the liver and other parts of the body.
Strategies To Improve Treatment
Most new treatments are developed in clinical trials. Clinical trials are studies that evaluate the effectiveness of new treatment strategies. The development of more effective cancer treatment for bladder cancer requires that new and innovative therapies be evaluated in patients. Participation in a clinical trial may offer access to better treatments and advance the existing knowledge about treatment of bladder cancer. Patients who are interested in participating in a clinical trial should discuss the risks and benefits with their physician.
Photodynamic therapy combines a photosensitizer, such as Photofrin®, with red laser light to destroy cancer cells. The photosensitizer is injected into a vein, travels through the bloodstream and is picked up and incorporated into cancer cells. When the laser is directed at the cancer, the photosensitizer in the cancer cell captures the light from the laser, which kills the cell.
Combining Other Agents with BCG: BCG is the most active treatment modality for superficial bladder cancer. In general, adding chemotherapy to BCG has not been successful. The results of a clinical trial conducted among patients with Stage I bladder cancer, however, suggest that the combination of BCG and electromotive mitomycin C may be more effective than BCG alone. The addition of other biologic agents to BCG, such as interferon alpha, interleukin-2 and interleukin 12, is also being evaluated.
References:
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Stage Groups For Bladder Cancer
Doctors assign the stage of the bladder cancer by combining the T, N, and M classifications .
Bladder cancer
Stage 0a: This is an early cancer that is only found on the surface of the inner lining of the bladder. Cancer cells are grouped together and can often be easily removed. The cancer has not invaded the muscle or connective tissue of the bladder wall. This type of bladder cancer is also called noninvasive papillary urothelial carcinoma .
Stage 0is: This stage of cancer, also known as a flat tumor or carcinoma in situ , is found only on the inner lining of the bladder. It has not grown in toward the hollow part of the bladder, and it has not spread to the thick layer of muscle or connective tissue of the bladder . This is always a high-grade cancer and is considered an aggressive disease because it can lead to muscle-invasive disease.
Stage I: The cancer has grown through the inner lining of the bladder and into the lamina propria. It has not spread to the thick layer of muscle in the bladder wall or to lymph nodes or other organs .
Stage II: The cancer has spread into the thick muscle wall of the bladder. It is also called invasive cancer or muscle-invasive cancer. The tumor has not reached the fatty tissue surrounding the bladder and has not spread to the lymph nodes or other organs .
Stage IV: The tumor has spread into the pelvic wall or abdominal wall, or the cancer has spread to lymph nodes outside of the pelvis or to other parts of the body.
Recurrent cancer
Treating Stage 0 Bladder Cancer
Stage 0 bladder cancer includes non-invasive papillary carcinoma and flat non-invasive carcinoma . In either case, the cancer is only in the inner lining layer of the bladder. It has not invaded the bladder wall.
This early stage of bladder cancer is most often treated with transurethral resection with fulguration followed by intravesical therapy within 24 hours.
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Patients Can Enter Clinical Trials Before During Or After Starting Their Cancer Treatment
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCIs clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.
What Are The Risk Factors Of Superficial Bladder Cancer
- Nearly 70,000 new cases are of superficial Bladder cancer every year. Male Female radio is about 3:1, and the chance of developing superficial bladder cancer risk increases with age.
- The most common risk factor for causing superficial bladder cancer is smoking.
- Try to abuse phenacetin and analgesic.
- Use of cyclophosphamide for the long term can be a suppressant.
- Having chronic irritation due to a parasitic disease called schistosomiasis.
- Long-term chronic irritation is called catheterization
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Predicting Prognosis In Patients With Superficial Bladder Cancer
Frank M. Torti, MDOncology
Superficial transitional cell carcinoma of the bladder comprises an extremely heterogeneous group of tumors, both in terms of morphology and, even more importantly, in terms of tumor biology and clinical behavior. Drs. deVere White and Stapp provide a succinct overview of the challenges encountered clinically because of tumor heterogeneity and the availability of different treatment options. The authors also outline the use of traditional prognostic factors and the current state of development of biological markers that hold promise in providing significant clinically useful prognostic information.
Superficial transitional cell carcinoma of the bladder comprises an extremely heterogeneous group of tumors, both in terms of morphology and, even more importantly, in terms of tumor biology and clinical behavior. Drs. deVere White and Stapp provide a succinct overview of the challenges encountered clinically because of tumor heterogeneity and the availability of different treatment options. The authors also outline the use of traditional prognostic factors and the current state of development of biological markers that hold promise in providing significant clinically useful prognostic information.
Biology and Natural History of Superficial Bladder Tumors
Treatment Considerations
Use of Tumor Markers
Non Muscle Invasive Bladder Cancer Staging
Non muscle invasive bladder cancer means the cancer cells are only in the inner lining of the bladder. They have not grown through the inner lining and into the deeper muscle layer of the bladder. It is early in its development.
Doctors use to call this superficial bladder cancer. It is different to muscle invasive bladder cancer, where the cancer has grown into the deeper muscle layer.
The stage of your cancer describes how far your cancer has grown. This page is about the stages of non muscle invasive bladder cancer.
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Whos At Risk For Bladder Cancer
There are 70,000 new cases of bladder cancer each year in the United States. The male-to-female incidence ratio is about 3 to 1. Your chances of developing bladder cancer increase with age.
The most common risk factor is smoking, which accounts for at least half of all new cases. Other risk factors include:
- abuse of phenacetin, an analgesic
- long-term use of cyclophosphamide , a chemotherapy drug and immune suppressant
- chronic irritation due to a parasitic disease called schistosomiasis
- chronic irritation from long-term catheterization
- exposure to certain industrial chemicals used in the dye, rubber, electric, cable, paint, and textile industries
How Much Cancer Does Mibc Return
For patients with MIBC, the overall prognosis is dependent on stage and treatment. In patients who have a cystectomy , the cancer return rate can be from 20-30% for stage T2. The cancer return rate can be 40% for T3, greater than 50% for T4 and often higher when lymph nodes are involved. If bladder cancer does come back, it most often will happen within the first two years after bladder surgery.
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Genetic Factors In Pathogenesis
Divergent, yet interconnected and overlapping, molecular pathways are likely responsible for the development of noninvasive and invasive bladder tumors. Somatic mutations in fibroblast growth receptor3 and tumor protein p53 in tumor cells appear to be important early molecular events in the noninvasive and invasive pathways, respectively.
FGFR-3, Ras, and PIK3CA mutations occur with high frequency in noninvasive tumors, leading to upregulation of Akt and mitogen-activated protein kinase . Loss of heterozygosity on chromosome 9 is among the most frequent genetic alterations in bladder tumors and is considered an early event.
Large numbers of genomic changes have been detected using karyotyping and comparative genomic hybridization analysis in urothelial carcinoma. Numerically common are losses of 2q, 5q, 8p, 9p, 10q, 18q, and Y. Gains of 1q, 5p, 8q, and 17q are frequently present, and high-level amplifications can be found however, the target genes in the regions of amplifications have not been conclusively identified.
Alterations in the TP53 gene are noted in approximately 60% of invasive bladder cancers. Progression-free survival is significantly shorter in patients with TP53 mutations and is an independent predictor of death among patients with muscle-invasive bladder cancer.
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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Management Of Ta T1 And Tis Bladder Cancer
Surgery
Superficial bladder cancer is typically managed with complete transurethral resection of intravesical disease. Careful pathologic examination of the resected tissue is required to exclude invasion of the muscularis propria. Given the high likelihood of disease recurrence or the development of new tumors, patients should undergo urinary cytologic and cystoscopic examinations every 4 to 6 months for 5 years after resection. Persistently abnormal findings on urine cytology after normal findings on cystoscopy should prompt evaluation of the prostatic urethra in men and the upper urinary tract in men and women.81-83 Risk factors for tumor recurrence after transurethral resection include high histologic grade, involvement of the lamina propria , multifocal disease, and the presence of CIS.84 About 15% of noninvasive cases eventually progress to involve the muscularis propria, and most of these are poorly differentiated, sessile, T1 tumors with diffuse CIS.29
Radical cystectomy should be considered for patients with extensive recurrent Ta, T1, or Tis disease that is refractory to intravesical bacillus Calmette-Guérin those with risk factors for progression to muscle invasion and those with severe, irreversible impairment of bladder function due to recurrent disease or prior treatment.
Intravesical Immunotherapy or Chemotherapy
Radiation Therapy
Basir Tareen MD, Samir S. Taneja MD, in, 2010
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
Guideline Statement 24
Discussion
Guideline Statement 25
Discussion
Guideline Statement 26
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Treatment Of Recurrent Bladder Cancer
For information about the treatments listed below, see the Treatment Option Overview section.
Treatment of recurrentbladder cancer depends on previous treatmentand where the cancer has recurred. Treatment for recurrent bladder cancer mayinclude the following:
- Radiation therapy as palliative therapy to relieve symptoms and improve quality of life.
- A clinical trial of a new treatment.
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.
What Are Types Of Bladder Cancer
There are two types of Superficial Bladder Cancer:
1) Papillary carcinoma
2) Flat carcinoma
Papillary carcinoma: Papillary Cancer, which grows thinner like projections, usually grows to the center of the Bladder, and it is known as Non- invasive papillary Cancer. A slow-growing non-invasive papillary does not refer to PUNLMP or urothelial neoplasm of the lower malignant Potential.
Flat carcinoma: it does not grow towards the center of the Bladder but remains in the inner part of the Bladder cells. It is known as flat Cancer in situ or non-invasive flat cancer.
Either if the cancer cells grow deeper into the bladder, it is called transitional cancer or carcinoma. Nearly 90% of bladder cancer is known as transitional cells cancer or known urothelial cancer. This type of cancer starts in the urothelial cells, which lay inside your Bladder, and the same type of cells can also be found in your urinary tract.
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Relevance Of The International Bcg Shortage To The Aua Guidelines
The global shortages in TICE BCG that occurred in 2014 and 2019 led the AUA to recommend several management strategies to maintain high quality care for patients with NMIBC. These recommendations may supersede the guideline statements below. In particular, the BCG shortage impacts guideline statements 17, 20, and 21. The AUA Statement on the BCG Shortage is available at .
Low Grade And High Grade 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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What Is The Mibc
What is Muscle Invasive Bladder Cancer ? Muscle invasive bladder cancer is a cancer that spreads into the detrusor muscle of the bladder. The detrusor muscle is the thick muscle deep in the bladder wall. This cancer is more likely to spread to other parts of the body. In the U.S., bladder cancer is the third most common cancer in men.
Bladder Instillation Of Chemotherapy
Instillation of chemotherapy drugs into the bladder can reduce the incidence of superficial cancer recurrences, but no single drug has been confirmed to reduce progression of superficial cancer to invasive bladder cancer. This means that multiple small new cancers can be prevented, but progression to a more invasive bladder cancer may occur despite treatment.
The optimal time to administer chemotherapy is immediately after TUR, as the drugs might prevent reseeding of cancer cells that were disrupted with surgery. Mitomycin is probably the preferred drug because it produces few side effects and is not well absorbed into the system, which allows more of the drug to remain in the bladder to treat the cancer. Thiotepa is rapidly absorbed and produces low blood counts. Doxorubicin produces the most local side effects.
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