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Actos Bladder Cancer : Sometimes an internal bladder connected to the urethra (the tube that carries urine to the outside of the body) isn’t possible and you will instead have a continent urinary diversion system. This means that you’ll have a pouch or reservoir, either external or more commonly internal, that collects your urine, and you’ll have to empty the pouch. This is also known as an ostomy or ileal conduit system.

The more common continent urinary diversion system is an internal reservoir, or pouch, made from a piece of intestine. The pouch is inside your body, but you must manually empty and flush the reservoir by inserting a syringe or catheter into a permanent ”hole” or stoma in your abdomen. Often the stoma is located unobtrusively in your navel, where it is not likely to be detected by a casual glance.

Your doctor, may, however, recommend an external pouch that is situated outside your body and attaches to your abdomen through a “hole” or stoma. You must manually empty the external pouch and cleanse the stoma. Either alternative sounds unpleasant, but having a pouch (particularly an internal reservoir) won’t interfere with your life or self-image as much as you might expect, if at all. You can still snorkel and swim. You can dance in a clingy, swingy dress or bike in Spandex shorts. You can do your job, whether it’s manning a drill press or managing a Fortune 500 company. And you can still look and feel sexy and enjoy a satisfying intimate relationship with your partner.

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One of the difficult issues for you and your medical team is to work out exactly what to do about the treatment of invasive bladder cancer. It is clear that cystectomy can be a life-saving procedure, yet many patients with invasive bladder cancer still eventually die of the disease, especially if it has penetrated the surrounding organs.

Your team will make a recommendation about treatment after carefully evaluating such very important factors as the extent of invasion by tumor cells (the stage), the normal or disorganized/abnormal appearance of die cancer cells under the microscope (grade), whether the cancer cells have invaded lymphatic channels or blood vessels, whether cancer cells are growing within the lymph nodes, and whether a specific cell control gene called P53 is normal.

If your cancer is organ-confined (i.e., if the cancer cells have not spread beyond the boundaries of the bladder and its immediate surrounding tissues), if it has not penetrated beyond the first layers of surrounding muscle, if there is no lymphatic or vascular invasion, and if lymph nodes are negative (i.e., they contain no cancer cells), the chance of permanent cure by cystectomy alone is around 80 percent.

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Since the 1950s it has been known that cancer-killing drugs (chemotherapy) can sometimes shrink bladder cancer that has spread through the body, and sometimes they can completely eliminate the deposits of cancer in different parts of the body. In the past 25 years, several studies have looked at the impact of combining chemotherapy with cystectomy or with radiotherapy in an attempt to improve survival figures. Before that discussion, let’s talk a bit about chemotherapy.

Chemotherapy is a term that refers to the use of drugs to kill cancer cells. Chemotherapy is usually given by intravenous injection (injection by needle directly into the vein), but sometimes it can be administered as a tablet or even through a urinary catheter (intravesical) for a patient with superficial bladder cancer. (See Chapter 4.) There are many different types of chemotherapy, and a detailed discussion is beyond the scope of this book. Your medical team will talk with, you about what type of chemotherapy is best for you and why.

In brief, chemotherapy drugs mostly act to interfere with the ability of cancer cells to divide and multiply, often by inhibiting the function of enzymes within the cells or by blocking cell division and the formation of RNA and DNA, the substances of life. Because these drugs act on cells that are dividing and multiplying, they can also affect some normal tissues and thus can cause a range of side effects.

Our use of the term or terms Actos Bladder Cancer is for descriptive purposes only. There is no relationship between the owners of this website and the maker of the product discussed in this post. Our use of the words Recall, Class Action Lawsuit and other similar words related to an event do not necessarily mean that this event has occurred. Refer to the website of the United States Food and Drug Administration for information on drug or medical device recalls. If a Class Action Lawsuit is formed in relation to the product discussed in this post we will provide that information at the time the Class Action is formed. A Class Action Lawsuit is not required to exist for you to file a lawsuit if you have been injured by the product discussed in this post.

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Actos Bladder Cancer : Not resting on their laurels, the clinical research community has moved forward and is now testing a new combination that adds paclitaxel, another active drug mentioned above, to the gemcitabine- cisplatin regimen. A three-drug combination (gemcitabine-cisplatin- paclitaxel) has been compared to the two-drug standard, to see whether this produces better cancer shrinkage and improved survival. In June 2007, the first report of this trial was made public. It indicated that the three-drug combination offered no significant benefit compared to gemcitabine-cisplatin and was associated with more side effects.

Another new agent, pemetrexed, also targets the division and reproduction of cancer cells, and has a relatively gentle profile with regard to side effects. It is being tested in patients who have already been treated with gemcitabine and cisplatin to see whether it will cause tumor shrinkage. Early reports are promising, but its true use­fulness is not yet known, and it has not yet been assessed by the Food and Drug Administra tion, which must give formal approval for its use in the treatment of bladder cancer.

In addition to the use of chemotherapy, another class of anti-can- cer agents, the so-called growth inhibitors or targeted agents, is being tested in patients with advanced bladder cancer. It is known that pro­teins located on the surface of cancer cells can control the rate of DNA production and division and stimulate cancer-cell growth. An example is the epidermal growth factor receptor (EGFR), which sits on the surface of some bladder-cancer cells and helps to control the rate at which they grow and divide. Inhibitors of the function of EGFR (and of the genes that control its production) have been developed and are known to slow or stop the growth of some cancer cells.

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You may be alarmed if your doctor suggests the possibility of par­ticipating in a clinical trial Does it mean that you have no hope? What should you do? How should you respond? It’s important not to dismiss the idea out of hand. The words experimental, research, and human volunteer can be upsetting, particularly at a time when you are dealing with the emotional issues surrounding a diagnosis of advanced cancer. But treatments in clinical trials can often be highly beneficial to those who volunteer. You and your loved ones should talk with your medical team members about the kind of clinical trial they are recommending and why it may benefit you. In fact, several studies have shown that patients participating in clinical trials have better outcomes than those found in the community at large. However, this also may be due to the types of patients who agree to participate in trials.

Does referral to a clinical trial mean that there is no hope of your surviving this illness? Not at all! There is always hope of survival, and any doctor can tell you about people who have responded positively to treatment and not only survived, but thrived. Being in a clinical trial doesn’t mean that you won’t continue to receive medical treatment; you wall, and since it’s a voluntary process, you have the right to stop participating in the trial at any time.

As with any aspect of your treatment plan, you make the decision about whether to proceed. Don’t feel pressured to participate in a trial if it doesn’t feel right for you, but do give it objective thought and consideration. How do you begin thinking through the decision on whether to participate in a trial?

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Probably the first question that comes to your mind is whether clinical trials are safe. Scientists and medical investigators work hard to ensure that they are as safe as possible. The medical community and the U.S. Department of Health and Human Sendees have put rules in place ensuring that every clinical trial is highly regulated and reviewed by health-care professionals, who determine that the trial is designed and conducted in compliance with federal regulations gov­erning research on human volunteers. Everything about the trial, from the doctors involved to the people who volunteer and the treat­ment being tested, is subject to strict review and monitoring. However, it is important to understand that some clinical trials do carry increased risks.

As with any treatment, you’ll want to ask about possible risks, ben­efits, side effects, how the treatment works, and what results doctors expect from the study.You’ll want to know who is conducting the clin­ical trial and what kind of oversight is in place. Also ask what is expected of you. Where will you go for the treatments? How often will you go? Are there more tests or office visits than you might have with standard treatment? Who administers the treatments and how are the results measured? Do you have to report regularly to those running the trial? Who pays for it all? Will there be extra costs to you as a result of your participation? Will the team conducting the trial (or the doctors involved) stand to benefit personally from the results of the trial or its conduct?

Our use of the term or terms Actos Bladder Cancer is for descriptive purposes only. There is no relationship between the owners of this website and the maker of the product discussed in this post. Our use of the words Recall, Class Action Lawsuit and other similar words related to an event do not necessarily mean that this event has occurred. Refer to the website of the United States Food and Drug Administration for information on drug or medical device recalls. If a Class Action Lawsuit is formed in relation to the product discussed in this post we will provide that information at the time the Class Action is formed. A Class Action Lawsuit is not required to exist for you to file a lawsuit if you have been injured by the product discussed in this post.

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Actos Bladder Cancer :  TURBT is often the first procedure you will have once diagnosed with a bladder tumor. This surgery is typically performed under general or spinal anesthesia as an outpatient procedure and without any incision, endoscopically through the urethra, which means a cystoscope is placed through the urethra and into the bladder. Through this scope your urologist can see the inside of your bladder and has the ability to resect, or remove, tumors in the bladder under direct vision using electrocautery. The electrocautery is also used to control bleeding after the resection is completed. TURBT is extremely important for the staging of bladder tumors but can also be therapeutic for lower stage bladder cancers. Once the tumor has been removed, it can be analyzed under the microscope by a pathologist. The pathological findings dictate further treatment decisions. If the tumor is low grade and noninvasive, you will likely not need any further therapy at this point except for close follow-up.

By and large, you can expect to go home the same day that this procedure is performed. Depending on the extent and depth of resection, your urologist may decide to send you home with a Foley catheter in place for a few days to allow time for your bladder to heal. Generally, this procedure is well tolerated, but it is not uncommon to see blood in the urine for several days after the procedure. Many patients also experience lower urinary tract symptoms, including painful urination, frequency, and urgency for up to several weeks following the procedure.

Radical cystectomy is the gold standard treatment for muscle-invasive bladder cancer and is also the procedure of choice for individuals with high-grade recurrent bladder tumors. Radical cystectomy has proven to provide excellent long-term cancer-free survival in individuals whose bladder cancer has not spread beyond their bladders or into their lymph nodes. Radical cystectomy is the therapy by which all other treatments are compared and judged.

Technically speaking, radical cystectomy for men involves removal of the bladder and prostate and also includes removal of the pelvic lymph nodes. In women, the bladder and typically the uterus, ovaries, fallopian tubes, and portions of the vagina are removed, although more recently surgeons have been moving toward preservation of some of these structures to improve quality of life. Because the main function of the bladder is to store urine that is made by the kidneys, a mechanism for diversion of urine outside of the body or storage of urine in a newly created reservoir must be performed in the same setting. Various types of urinary diversion are discussed below.

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Traditionally, the surgery is performed through a lower abdominal incision in the midline from just below the umbilicus (i.e., “belly button”). Hospitalization for this procedure is generally between 5 and 10 days, and up to 6 weeks are needed for complete recovery. In recent years minimally invasive surgical approaches that replicate the technique of open radical cystectomy have been developed. Both laparoscopic and robotic-assisted radical cystectomies are currently being performed at highly specialized centers. The principles of the surgery are the same, but the procedure is performed through smaller incisions using laparoscopic instruments. Using robotic assistance, your surgeon is able to perform complex operations with higher precision, under magnification. These approaches offer die potential advantage of a shorter recovery time, less blood loss, and less postoperative pain.

A pelvic lymph node dissection should be performed at the time of your surgery. This involves removal of the lymph node tissue in the most common areas of bladder cancer metastasis (spread of the cancer). The pelvic lymph node dissection has two important roles: to stage the cancer and to guide therapy. Individuals who are found to have cancer in the lymph nodes at the time of surgery generally require additional therapy such as chemotherapy. Studies have shown that up to 30 percent of patients with disease- positive lymph nodes who undergo a pelvic lymph node dissection will be free of disease at 5 years. Although there is debate among urologists as to exactiy how extensive ofapelvic lymph node dissection should be performed, there is no debate that one should be performed. Although a pelvic lymph node dissection can add an additional 30-90 minutes to your procedure time, there is little additional morbidity associated when performed by an experienced surgeon.

Regardless of the approach, anyone who undergoes a radical cystectomy will require a form of urinary diversion because the bladder will no longer be there to store urine. This can have a significant psychological and functional impact on an individual’s quality of life. Patients are often hesitant to undergo definitive surgery because of the anxiety associated with long-term urinary diversion. There are two main types of urinary diversion: continent and noncontinent. Both forms require surgically removing a segment of bowel (most commonly the small bowel) from your gastrointestinal (GI) tract and plugging the ureter from each kidney into this segment of bowel to provide drainage of urine. Noncontinent diversions (ileal conduit) are those in which the piece of bowel is brought up through the abdominal wall to a stoma and the urine drains continuously into a drainage bag. This is die most common type of urinary diversion performed in the United States. This procedure requires approximately 8 to 10 centimeters (3 to 4 inches) of small bowel, which is far less than that used for continent urinary diversions. Although the obvious disadvantage of this procedure is its lack of continence and need for a continuous drainage bag, it has less short- and long-term complications than that of the continent diversion. An external urinary drainage appliance is very well tolerated and patients adapt to them very quickly.

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Alternatively, a continent urinary reservoir can be reconstructed using small or large bowel. Unlike noncontinent diversions, larger segments (up to 60 cm [2 feet]) of bowel are configured into a pouch that can store urine. There are two main types of continent diversions: orthotopic and continent-cutaneous. An orthotopic continent diversion is one in which the newly reconstructed pouch is reconnected back to your urethra and voiding occurs in much the same manner as before cystectomy. Continent-cutaneous diversions use a small channel made of bowel that is brought up through the skin on the abdominal wall. Unlike the noncontinent diversions, this type of diversion does not constandy drain urine but instead collects it in the pouch. Several times a day a catheter is passed through this channel in the sldn to empty the urine from the reservoir. Although these diversions allow for urinary continence, which most replicates normal function, they are associated with increased complication rates and require much more effort to maintain compared to the ileal conduit. Additionally, multiple studies have not shown that quality of life is significantly improved with continent diversion compared to noncontinent diversion.

Sexual dysfunction after pelvic surgery can have a major impact on quality of life for both men and women. In recent years radical cystectomy with the aim of preserving sexual function has been explored in both men and women. Patients with evidence of cancer invading through the bladder wall either on preoperative imaging or at the time of surgery are not ideal candidates for this type of procedure. In men this entails sparing of die nerves involved with potency that run along and underneath the prostate. In doing so, sexual potency may be preserved in a significant percentage of men. More recently, some surgeons have explored the possibility of preserving a portion of the prostate or seminal vesicles, which are traditionally removed at the time of surgery. Preservation of these structures also decreases the risk of erectile dysfunction after surgery by not damaging the nerves that run in close proximity to diem.

Preservation of a portion of the prostate at the time of surgery also may improve continence in men undergoing an orthotopic bladder reconstruction. Although nerve sparing can be performed with little risk of decreased cancer control in appropriately selected patients, prostate- and seminal vesicle-sparing surgery are more controversial because there is potential for an increased risk of cancer recurrence and also die potential for leaving undiagnosed prostate cancer behind. In women, sexual function preserving radical cystectomy has also been explored. This involves preservation of the nerves important in both clitoral engorgement and sensation. Preserving organs traditionally removed at the time of surgery, including the uterus, fallopian tube, ovaries, and portion of vagina, may also allow for improved sexual function after surgery. It should be remembered that die first goal of surgery is cancer control, and organ- and nerve-sparing procedures may not be appropriate in all cases.

Our use of the term or terms Actos Bladder Cancer is for descriptive purposes only. There is no relationship between the owners of this website and the maker of the product discussed in this post. Our use of the words Recall, Class Action Lawsuit and other similar words related to an event do not necessarily mean that this event has occurred. Refer to the website of the United States Food and Drug Administration for information on drug or medical device recalls. If a Class Action Lawsuit is formed in relation to the product discussed in this post we will provide that information at the time the Class Action is formed. A Class Action Lawsuit is not required to exist for you to file a lawsuit if you have been injured by the product discussed in this post.

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Actos Bladder Cancer : The word “invasive”refers to whether cells from your bladder cancer have “invaded” the muscle wall of the bladder, and if so, how far into the layers of muscle tissue it has penetrated.This can usually be deter­mined from biopsy results, or occasionally when an operation has been performed to remove the bladder and some of the surrounding tissues. In some cases, organs near the bladder (such as the vagina in women, or the prostate in men) may have been invaded as well.

Invasive cancer extends further into the body than superficial TCC does and is therefore a more serious stage of the disease. It requires more complicated treatment, such as surgical removal of the bladder. This may, in turn, change how you manage basic physical functions in your everyday life, such as your bathroom habits and even your sex life. Also of importance is the significant rate of recurrence connected with invasive cancer. Often other organs, such as the lymph nodes, lung or liver, are involved.

Despite such a gloomy introduction to this chapter, there is every reason for you to be hopeful if youVe been diagnosed with invasive cancer. Current treatment, which includes surgery (cystectomy), chemotherapy, radiation therapy, or two of these approaches com­bined, offers you an excellent chance for long-term survival and, in many cases, for a cure. This applies particularly to those invasive tumors that have not penetrated outside the bladder, the so-called ” organ- confined” tumors.

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There is no question that the after effects of surgical removal of the bladder (cystectomy) can be unsettling to think about. You won’t have a bladder or maybe even a urethra any longer. How will you be able to pass urine? Will you have to have some type of urine-collect­ing bag? Will there be an odor? Will it show when you wear certain clothing? We’ll talk about all those things in more detail, but in brief, your team will need to surgically create an artificial urine-collection system for you. This is known as a urinary diversion system. In years past, the only option was a urine-collection bag worn outside the body which many people found to be unpleasant or even embarrassing.

The good news is that now, in many cases, an artificial bladder (sometimes called a neobladder) can be fashioned from a piece taken from the intestine (bowel), enabling you to void urine in a normal or near-normal fashion. You’ll have to learn to use a different set of mus­cles when urinating, and there may be some leakage now and then, particularly at night. Leakage can be controlled by wearing under­wear designed with a disposable pad or, for men, a sort of condom. Overall, it’s a more attractive option that makes it easier to face a complicated and often scary surgery such as cystectomy. And with modern techniques, most patients no longer have to contend with urinary leakage, except on rare occasions.

Even if you are disappointed because the creation of an internal urinary diversion system is not possible in your situation, keep in mind that there is also no question that cystectomy is a powerful weapon against invasive bladder cancer that can increase your odds of living a long, cancer-free life. Cystectomy is the most common treatment option for invasive blad­der cancer. In most cases, your medical team will recommend a com­plete (or radical) cystectomy. This means that your bladder, the lymph nodes tucked around your bladder in the abdomen, the prostate in men, and the uterus, ovaries, and part of the vaginal wall in women will be surgically removed. Depending on where the cancer is locat­ed, the urethra may also be removed.

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It’s easy to confuse some of the terms your doctors use, such as “cystoscopy”(a diagnostic pro- cedure that introduces a tube into the bladder so that the doctor can look at the inner surface and take a biopsy) and “cystectomy” (the surgical removal of the bladder). Don’t hesitate to ask your doctors for clarification. Cystectomy seems like a drastic surgery, doesn’t it? Why remove so many body parts? Why not just take the tumor and some surrounding tissue?

Depending on where your tumor is located, the cancer-causing substances responsible for the tumors in your bladder were also fil­tered through the kidney, ureters, and urethra, and there is a possibil­ity that tumors may be forming in those organs, too. In particular, the tissues lining the bladder, ureters, and urethra (known as the urothe­lial tissues) may be at risk from the after effects of cancer-causing substances, such as agents in cigarette smoke or industrial dyes. Also, because your cancer may have penetrated the muscle wall, it’s possi­ble that organs surrounding the bladder, such as the prostate, uterus, or vagina, may also be at risk from further growth of the cancer cells.

So in the case of bladder cancer, which often recurs or spreads to other organs, you’ll have a much better chance of a cure once organs and tissue have been removed in areas where the disease is likely to spread or where it may already have infiltrated. And a cure is what you and your doctors most definitely want to strive for. Sometimes, if the cancer is very localized and surrounded by plenty of healthy, noncancerous tissue, a partial cystectomy might be recommended, whereby only a portion of the bladder is removed and some or all of the surrounding organs may be saved.

Our use of the term or terms Actos Bladder Cancer is for descriptive purposes only. There is no relationship between the owners of this website and the maker of the product discussed in this post. Our use of the words Recall, Class Action Lawsuit and other similar words related to an event do not necessarily mean that this event has occurred. Refer to the website of the United States Food and Drug Administration for information on drug or medical device recalls. If a Class Action Lawsuit is formed in relation to the product discussed in this post we will provide that information at the time the Class Action is formed. A Class Action Lawsuit is not required to exist for you to file a lawsuit if you have been injured by the product discussed in this post.

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Actos Bladder Cancer : In both cases, the first step is a cystoscopy and removal of the tumor. For smaller superficial tumors, removal can sometimes be accomplished with biopsy forceps alone. For larger tumors, a resectoscope is used. In the case of a large invasive cancer which clearly is growing deep into the bladder, the urologist may choose not to remove the entire tumor since further surgery will be required and there is little to be gained by resecting more (and possibly more to be lost with a greater chance of serious bleeding or a bladder perforation with a more extensive resection). If however, the individual will not be a candidate for open surgery (due to advanced age or other medical risk factors), a more thorough resection may be advisable to prevent recurrence of future hematuria, or perhaps to allow for an alternate form of therapy such as a “bladder sparing” regimen, consisting of transurethral .resection, radiation, and chemotherapy.

In a small percentage of individuals a partial cystectomy, removing just part of the bladder, is possible, and may be the preferred form of open surgery. This procedure can generally be accomplished if the cancer is located in an accessible area of the bladder such as the dome, is not multi-focal, or too large. Many tumors arc too large, are multi-focal, or are in an inaccessible area, and therefore are not treatable with partial cystectomy. Furthermore, even when an individual presents with a cancer which is treatable via partial cystectomy, removal of the entire bladder may be preferable since recurrent, invasive disease in the remaining bladder is probable. For the elderly or those in poor health, and others with a limited life expectancy, partial cystectomy may be ideal if doable.

Radical cystectomy is a major surgery with potential complications. You therefore, need to be in the best possible medical condition prior to surgery. Your health care history will be reviewed by your urologist. If you have specific medical conditions such as heart disease or respiratory disease, a referral to the specialist or primary care physician overseeing management of these conditions is usually warranted to make sure your risk factors have been corrected or improved, to allow for safe surgery. If you have a medical condition which places you at substantial risk of a major complication, it should be addressed prior to proceeding with a surgery of this extent. For example, if you have a heart condition, such as an irregular heart beat, medication may need to be adjusted. Some patients may need to go on lung medication to improve their lung function. On occasion, an individual may need to even have surgery for a blocked heart vessel prior to going ahead with a radical cystectomy. If you still are smoking, you should definitely stop at least two weeks prior to surgery.

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You will need to discontinue any medications that can affect your ability to clot during surgery. These may include coumadin and aspirin and other medications which keep your blood from readily clotting. Some vitamins such as Vitamin E can also affect clotting and should be stopped. Herbal remedies will also need to be reviewed with your urologist, as some may affect your ability to clot. Your urologist will go over the medications and let you know which will need to be discontinued prior to surgery. If you drink more than the equivalent of 2 ounces of alcohol per day, it is important to stop drinking alcohol preferably at least a week or more prior to surgery. If you are an alcoholic and drink large quantities of alcohol on a regular basis, you will face the possibility of delirium tremens (DTs) after surgery when you cannot drink alcohol. DTs is a serious medical complication with a high mortality rate. If you have any doubts regarding your consumption of alcohol, you should discuss this with your urologist.

You may wish to donate blood which will be held in the blood bank for you exclusively during or after surgery. These units of blood are called autologous units and may be transfused only into you. Your urologist will advise you if it is necessary for you to donate blood. If you do choose to donate blood, generally a unit can be given every 7-10 days. It is advisable to take iron supplements during donation so your body can quickly rebuild its blood supply prior to surgery.

If you have experienced a recent illness which has weakened you, it is important to be fully recovered prior to proceeding with the operation. Illness may result in a state of malnutrition. If you have experienced recent weight loss, it may be important to take protein supplements to build up your body prior to surgery.

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Because your urologist will be using a piece of your bowel to create a new urinary drainage system, your small and large bowel will need to be thoroughly cleaned out prior to surgery. Your urologist will prescribe cleansing agents such as Golytely or Fleet Phospho-soda the day before surgery to rid the bowel of fecal contents. It is also standard to take a number of antibiotic pills the day before surgery to reduce the bacterial count in the bowel. You will be on “clear liquids” the day before with nothing to eat or drink after midnight. Your urologist will give you detailed instructions regarding the bowel prep and a prescription for the antibiotics.

Getting a good night’s sleep the evening before surgery will help you deal with the initial anxiety as you travel to the hospital. Ask your physician for a “sleeping pill” if you know you will be facing a sleepless night.

If you are very anxious about your upcoming surgery, talk to your urologist or primary care physician. A prescription for medication to reduce anxiety may be appropriate. For those individuals who wish to “go natural,” various techniques such as meditation, guided imagery, or Reiki can be practiced prior to and after surgery to reduce stress and anxiety and enhance your recovery. These modalities are generally available in most communities. If you need help in learning these techniques, ask your physician for a referral or call your hospital for resources in your community.

Our use of the term or terms Actos Bladder Cancer is for descriptive purposes only. There is no relationship between the owners of this website and the maker of the product discussed in this post. Our use of the words Recall, Class Action Lawsuit and other similar words related to an event do not necessarily mean that this event has occurred. Refer to the website of the United States Food and Drug Administration for information on drug or medical device recalls. If a Class Action Lawsuit is formed in relation to the product discussed in this post we will provide that information at the time the Class Action is formed. A Class Action Lawsuit is not required to exist for you to file a lawsuit if you have been injured by the product discussed in this post.

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Actos Bladder Cancer : As mentioned in the previous chapter, current practice is to blend chemotherapy drugs in order to get a head start in treating the can­cer before it becomes too extensive.The goal is increased effectiveness in fighting advanced bladder cancer. This practice has often resulted in a longer and more comfortable lifespan for many bladder-cancer patients and has made it possible to offer increased hope.

A quick review: Chemotherapy is a term that refers to drugs that fight cancer, usually by causing cancer cells to die or causing the process of their growth to stop. It is often a liquid medicine given by injection into the vein. Sometimes it can be administered as a tablet. Chemotherapy treatment is usually provided on an outpatient basis, although certain drugs, such as dsplatin, may be given during a short in-patient stay.

Chemotherapy treatments – which drugs are given and how often ~ vary from person to person, depending on the stage of disease, the patient’s age and overall health, and many other factors. Usually you will receive the drugs intravenously (by needle into the vein), and each treatment will take from one to several hours. You may receive several treatments over the course of a month, and treatments may be given for up to six months or occasionally a bit longer. (More infor­mation about chemotherapy is available in Chapter 5, including a detailed discussion of side effects and potential benefits.)

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Chemotherapy has many uses. It is given to reduce or eliminate cancer cells present in your body, as well as to prevent existing cancer cells from growing and flourishing. Chemotherapy can inhibit and sometimes prevent the formation of new cancer cells. It can shrink tumors so that they are safely operable. When chemotherapy is used to stop bladder cancer from coming back after treatment by cystecto­my or radiotherapy it is called adjuvant therapy. Chemotherapy is not yet able to cure all cancer, but it has certainly opened the door for many people to enjoy man)” months of extended life.

Again, a reminder: Chemotherapy is powerful medicine. In addition to causing damage to cancerous cells, it can damage cells in the bone marrow that produce blood.This means that your blood count may be lower than usual. A shortage of white blood cells can leave you vulner­able to infections. A low platelet count may lead to bruising or even extensive bleeding from minor cuts and scrapes. Low red blood cell counts leave you feeling fatigued or exhausted (a condition called anemia). These side effects usually go away after the treatment is stopped. Temporary symptoms such as nausea and vomiting can be controlled to some extent by drugs, while other, more permanent side effects can occur, such as infertility or premature menopause.

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The problem was that it was really quite toxic, with side effects that included nausea, vomiting, a sore mouth, risk of infection, and occasionally problems with cardiac (heart) function. Despite the problems, around 60 percent to 70 percent of patients experienced shrinkage of their metastatic bladder cancers in response to this treatment, and there were patients who survived in good health for several years after such treatment (without recurrence).

Our use of the term or terms Actos Bladder Cancer is for descriptive purposes only. There is no relationship between the owners of this website and the maker of the product discussed in this post. Our use of the words Recall, Class Action Lawsuit and other similar words related to an event do not necessarily mean that this event has occurred. Refer to the website of the United States Food and Drug Administration for information on drug or medical device recalls. If a Class Action Lawsuit is formed in relation to the product discussed in this post we will provide that information at the time the Class Action is formed. A Class Action Lawsuit is not required to exist for you to file a lawsuit if you have been injured by the product discussed in this post.

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Actos Bladder Cancer : Radical cystectomy is one of the biggest and most complex procedures performed by urologists. In addition to its complexity from a technical standpoint, you will likely have many questions not only related to cancer control but also to quality of life after surgery. Cystectomy can affect your quality of life from both an emotional and physical standpoint. After surgery, you may face specific physical adjustments to die urinary diversion, possible changes in sexual function, and changes in bowel habits and function. Specific side effects and complications related to cystectomy and urinary diversion are discussed in Chapter 4. An essential aspect to enhanced quality of life after surgery is to be proactive in the decision-making process before surgery. Ask your surgeon many questions before surgery, because knowing what to expect after surgery will ease this transition. A cancer diagnosis is a difficult time for anyone, and thoughts and questions will race through your head faster than you can remember them. Write them down as you think of them, so you can have a complete discussion at the time of consultation with your physician.

As stated previously this is a big surgery, and your surgeon may have you see other specialists before your procedure to ensure you are in the best medical condition to undergo surgery. You may be admitted to the hospital the day before your scheduled surgery for any remaining tests and to prepare your bowel for surgery. In the last decade, however, medicine has become increasingly more outpatient based, and many surgeons have eliminated the preoperative admission and have you report to the hospital the morning of surgery. Your surgeon will most likely have you only consume clear liquid on the day before surgery to clear out your GI tract, which allows for a technically easier urinary diversion and may also decrease your risk of complications. Along this same line, most surgeons will have you do some form of bowel preparation the day or two leading up to surgery. This is also used to cleanse your GI tract before surgery.

Immediately after surgery you will generally stay in the hospital 5-10 days. Postoperative practice varies from surgeon to surgeon, but most leave a small drain in the abdomen to monitor for leakage of urine from the newly created diversion and intestinal contents from the reconnected bowel. If there is no evidence of an internal leak, the drain routinely is removed at the bedside (with minimal discomfort) before discharge from the hospital. Your surgeon may also leave a nasogastric tube in for the first day or so after surgery. This is a tube that goes from your nose to your stomach and keeps your stomach decompressed, which prevents abdominal bloating and vomiting.

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Generally, starting on the day after surgery you will be out of bed and with assistance from the hospital staff will start walking. It is very important to begin walking as soon as possible because it will make you feel better, will help with early return ofbowel function, and will decreasethe chances of developing blood clots in your legs and pelvic veins. You will also be instructed on breathing exercises while in bed and sitting to help expand your lungs after surgery and to prevent pneumonia. One of the major obstacles before discharge is return ofbowel function and resumption of a regular diet. Your GI tract can be slow to return to normal function, largely related to the bowel work required for the urinary diversion. This will take time, and it is important to not force your diet too soon after surgery because this will increase your chances of nausea and vomiting. In general, your body will tell you when you are ready to eat.

Use your time in the hospital to learn as much as you can about your urinary diversion. Most centers in which cystectomies are performed have an enterostomal therapist with expertise in taking care of patients with urinary diversions. If you have a new ileal conduit, they will go over the general maintenance of the abdominal stoma and urinary appliance bags. This will make you more comfortable and confident in dealing with your diversion at the time of discharge from the hospital. Upon discharge from the hospital, your surgeon will give you precise instructions regarding physical activity, exercise, and resumption of sexual intercourse. It is important to follow these instructions carefully to ensure a smooth postoperative recovery.

If you underwent a continent urinary diversion, you will likely be discharged from the hospital with a catheter in the newly created reservoir to temporarily drain the urine until the reservoir is completely healed. If you have a cutaneous catheterizable diversion, a catheter is left in the catheteriz- able channel and a separate catheter is often brought out through a separate incision in the abdominal wall. These are temporary and generally removed 2 to 3 weeks after surgery. If you have an orthotopic diversion, a Foley catheter is generally placed in the diversion through your urethra. It is extremely important that you are careful with these tubes at home because dislodgement requires replacement and occasionally can lead to damage of your newly constructed leservoir. Mucus is often secreted from the bowel used to create your new urinary reservoir, and the nurses in the hospital will teach you how to flush your tubes with sterile saline before discharge to avoid mucous obstruction, which can lead to inadequate drainage.

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Occasionally, a portion of the bladder involved with tumor can be removed while sparing the remainder of the bladder. In selected patients this allows for preservation of normal bladder function and continence and decreased complications because no urinary diversion is required. Unfortunately, only a small percentage of individuals will be candidates for such an approach—generally, patients with smaller, solitary tumors on the dome of the bladder. Individuals with multifocal tumors, large tumor, or carcinoma in situ are not candidates for this procedure. Recovery time for a partial cystectomy is generally quicker tiian that of a radical cystectomy, and hospital times tend to be shorter. A Foley catheter is left in place for 7-10 days to allow the bladder time to heal.

The basic function of the bladder is to store urine. By directly instilling medications into the bladder, physicians have capitalized on this property of the bladder. By placing these agents into the bladder, these agents come into direct contact with the cancer cells. Intravesical (within the bladder) therapy is often used for patients with non-muscle-invasive bladder cancer. It can be used immediately after TURBT, as a single dose, to prevent recurrence of noninvasive tumors and is also used in the form of weekly outpatient administrations (usually 6 weeks at a time) to prevent both the recurrence and progression of bladder cancer.

The two basic agents that are used as intravesical therapies are chemotherapy drugs and immunotherapy agents. The most commonly used therapy in the United States is bacillus Calmette-Guerin (B CG), which is a form of immunotherapy. BCG is actually a vaccine that was originally developed for protection from tuberculosis. In the 1970s and early 1980s, it was noted to have intravesical effectiveness for the treatment of non-muscle-invasive bladder cancer. Although the exact mechanism of BCG activity is unknown, it works through local stimulation of the immune system. A Foley catheter is placed in the bladder, and then BCG is administered through the catheter into the bladder for 1 to 2 hours. Traditionally, BCG has been given once a week for 6 weeks to patients with high-grade non-muscle- invasive bladder cancer or to those patients with carcinoma in situ. Some studies have shown that routine maintenance instillations in addition to die traditional 6-week course may be more effective in preventing disease recurrence. BCG has proven not only to prevent recurrence of bladder cancer, but also to prevent progression to muscle-invasive disease and therefore is the first-line intravesical agent used in the United States.

Our use of the term or terms Actos Bladder Cancer is for descriptive purposes only. There is no relationship between the owners of this website and the maker of the product discussed in this post. Our use of the words Recall, Class Action Lawsuit and other similar words related to an event do not necessarily mean that this event has occurred. Refer to the website of the United States Food and Drug Administration for information on drug or medical device recalls. If a Class Action Lawsuit is formed in relation to the product discussed in this post we will provide that information at the time the Class Action is formed. A Class Action Lawsuit is not required to exist for you to file a lawsuit if you have been injured by the product discussed in this post.

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Actos Bladder Cancer : There are currently many ongoing clinical trials in the field of bladder cancer that will hopefully improve not only the survival outcomes for patients with bladder cancer, but also the quality of life of those living with bladder cancer. Clinical trials are an extremely important aspect in the treat­ment of many medical illnesses. In fact, many treatments you undergo today, whether it is for bladder cancer or another medical condition, were likely at some point part of a clinical trial. Your physician may approach you regarding clinical trials that are ongoing at his or her institution or near you. Don’t interpret this to mean your condition is not treatable with the currently approved therapies; your physician may just happen to know of a trial that may be helpful to you.

There are many types of clinical trials; some deal with new medical or surgical treatments for bladder cancer, some with new imaging modalities for diagnosis and staging of bladder cancer, and some with the possible prevention of bladder cancer. If you are approached about a clinical trial it is important to know exactly what you are getting into before you enroll. Although there is generally a lengthy consent process, the best way to be informed is to ask questions of both your physician and the person running the trial.

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It is important to remember that any treatment for bladder cancer, both surgical and nonsurgical, may be associated with complications and side effects. Some side effects can be mild and self-limiting, whereas others can more signifkantiy impact your quality of life. The best way to plan for the side effects of treatment is to know about them ahead of time. Although this won’t prevent side effects or complications, prior knowledge and preparation may ease any difficulties during or after treatment. It is also important to remember that each individual is unique and responds to treatment differentiy. If you know somebody who has been treated for bladder cancer in the past and had a particularly good (or not so good) experience, this does not necessarily apply to your situation. In this chapter we discuss some of the more common side effects and
potential complications associated with the treatment of bladder cancer. The following discussion may seem overwhelming and a bit daunting, but its intent is not to cause you stress. For the most part, severe and significant complications with treatment are rare, but they do happen and you should consider your tolerance for such events when choosing the most appropriate treatment plan for you. The best preparation is knowledge; therefore being aware of potential side effects up front will allow you to make more informed treatment decisions.

Roughly 5-10 percent of patients experience a fever after a transurethral procedure. This is almost always due to a urinary tract infection. The most common symptoms of a urinary tract infection in this setting are fever, chills, side pain, and frequent or painftil urination. If you experience a fever postoperatively, you should contact your physician immediately. The vast majority of infections can be treated as an outpatient with oral antibiotics and resolve in several days. Most urologists give you antibiotics during your procedure and for a few days thereafter to prevent infection, but unfortunately a small percentage of patients will still experience an infection despite taking antibiotics. It is important to note that most patients have lower urinary tract symptoms after surgery. This is directly related to the manipulation from the cystoscope and any biopsies or resection that were performed. These procedures cause bladder and urethral inflammation, which may cause you to experience painful urination, urinary frequency, and urgency for several days after the procedure. These symp­toms are very similar to that of a urinary tract infection and can be confusing, but they do not cause fever like a urinary tract infection. If you are unsure whether your symptoms are a result of an infection or the procedure, the safest bet is to consult your urologist as soon as possible.

Urinary retention (inability to pass the urine) is another uncommon and generally self-limiting complication one can experience after surgery. In men, this is often caused by swelling of the prostate due to manipulation from the cystoscope. Excessive bleeding may also result in clot formation that can obstruct the flow of urine. Patients who experience this side effect urinate in small volumes or not at all, even though their bladder is uncomfortably full. The treatment for this is simple; a catheter is placed in your bladder for a few days to allow any edema (swelling) to resolve. The catheter can then be removed several days later and most patients void without difficulty at that point.

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At the time of TURBT, perforation of the bladder can occur. This happens if the full thickness of the bladder wall is resected at the time of TURBT. This is often inadvertent, but it can also be done intentionally by your surgeon in the case of a tumor that grows deep into the wall of the muscle. Most perforations are small and will close on their own, without additional intervention. You may need to have a Foley catheter for several days to permit healing and minimize leakage of urine from the perforation. In rare circumstances a bladder perforation may be so large or in such a location that it is dangerous to allow it to heal on its own. Such cases require open surgery to suture the bladder closed. This is performed through a lower midline incision. A Foley catheter again would be left in the bladder for several days to permit healing. Open surgery for bladder perforation is a rare event (less than 1 percent).

Radical cystectomy and associated urinary diversion is a complex procedure. Even in the best of hands, the potential for side effects and complications is significant. The most common side effects and complications related to this procedure are discussed below. Although this will give you a good understanding of what to expect after surgery, it is very important that you discuss the risks of cystectomy with your urologist before surgery to be as fully informed and prepared as possible.

Our use of the term or terms Actos Bladder Cancer is for descriptive purposes only. There is no relationship between the owners of this website and the maker of the product discussed in this post. Our use of the words Recall, Class Action Lawsuit and other similar words related to an event do not necessarily mean that this event has occurred. Refer to the website of the United States Food and Drug Administration for information on drug or medical device recalls. If a Class Action Lawsuit is formed in relation to the product discussed in this post we will provide that information at the time the Class Action is formed. A Class Action Lawsuit is not required to exist for you to file a lawsuit if you have been injured by the product discussed in this post.

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Actos Bladder Cancer : Cell growth is closely regulated by genes which are composed of DNA located in the command center of the cell, the nucleus. When the genes become defective, cell growth can become unregulated, and tumors can develop. Oncogenes, also called cancer genes, can be activated, resulting in uncontrolled cell growth. Other genes which help prevent abnormal cell growth called tumor suppressor genes may be inactivated. Genes can be activated which enhance the tumor cell’s ability to spread throughout the body. The body’s immune system is a critical safeguard against the formation of cancerous tumors, often destroying the abnormal cells before they have a chance to grow and divide.

Cancer cells can spread throughout the body. They can spread through the lymphatic system, composed of lymph channels and lymph nodes, or distantly to other organs or the skeleton via the blood stream (hematogenous spread). In the case of bladder cancer, the cells can also spread by being carried in the urine and implanting in other locations in the urinary tract.

Larger tumors are more likely to spread than smaller tumors. Another critical concern is the grade of the tumor. Normal cells are specialized, differentiated to perform specific function, and have a typical structural arrangement with surrounding cells. As cancers worsen, the cells become less specialized, less differentiated, and lose their normal structural arrangement, resulting in a higher pathologic grade.

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For bladder cancer, another key indicator for likelihood to spread is the depth of penetration into the bladder wall. The bladder wall is composed of an inner lining called the urothelium (made up of transitional cells) which rests on a membrane layer called the basement membrane, below which is the connective tissue layer (support tissues) called the lamina propria. Within the lamina propria lies a small amount of muscle called the muscularis mucosa. Deep to the lamina propria is the deep muscle of the bladder arranged in three layers. This layer is called the muscularis propria. Tumors located in the inside, superficial layers of the bladder wall are unlikely to spread. Tumors that grow into the deeper layers (down into the muscle of the bladder wall) are much more likely to spread. Furthermore, there is a definite link between the grade of the tumor and its likelihood of invasion. Low grade tumors are almost always noninvasive, while high grade tumors are usually invasive. In general, papillary tumors, which are delicate and frond like in appearance are usually low grade and superficial. This is to be contrasted to sessile tumors which appear solid, are often high grade and invasive. Depth of invasion is critical in establishing prognosis. The tumor which invades into the lamina propria is a far more serious tumor than the superficial tumor which demonstrates no invasion. It has a much higher propensity to progress to the muscle invasive tumor, a much more dangerous cancer, with a high risk for spreading beyond the bladder.

The pathologist studies the prepared slides and makes a determination of the grade of cancer. There are a number of criterions that are used: degree of cellularity, nuclear crowding, loss of polarity and differentiation, nuclear pleomorphism, chromatin pattern and mitotic activity. In layman’s terms, the pathologist looks at the size, shape and relationship of the cancer cells. The nucleus is often abnormal since it contains damaged or mutated DNA. Cancer cells look different than normal cells. The greater the difference from normal, the higher the grade will be. These parameters are utilized to reduce the subjective nature of pathology. In the end, the pathologist assigns a grade.

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The medical history of those with bladder cancer varies. For many patients, the first clue is blood in the urine, while in others, it may be an alteration in urination. Sometimes a tumor is found inadvertently on an X ray or ultrasound exam. In all cases, an initial assessment is implemented by the urologist. In this chapter, we will review the presenting findings of those with bladder cancer and how they are initially “worked up.”

A sign is a physical finding from an underlying disease or disorder which can be noted by the individual or the physician. A symptom is something the individual feels or experiences from a disease. A clinical sign is a physical finding, while a symptom is something the individual experiences.

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Actos Bladder Cancer :

Some tumors, including carcinoma in situ (CIS) tumors, are considered a high-grade bladder cancer because they characteristically have a high rate of progression to muscle- invasive tumors and also because they don’t have any differentiated features. The paradox is that they are only one cell thick, which usually correlates with lack of invasion. About 50 percent of the people diagnosed with CIS who have no other types of tumor present in the bladder will eventually have the CIS invade the muscle.

Recently, an extensive body of research work has suggested that abnormalities (known as “mutations”) of the genes that control the growth of bladder cancer may be important in helping to determine the prognosis of bladder cancer. While this is not yet routinely applied to clinical practice, preliminary studies have suggested that mutation of such genes as the P53 gene may be associated with more aggressive behavior of the tumor, with a greater tendency to spread. The P53 gene, which is part of the genetic makeup of the tumor, normally acts to suppress tumor growth; in some cancers, when an abnormality or mutation occurs, that tumor suppressive role is lost.

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Other genes may also be involved in this process, including those known as the Rb gene, Pi6 gene, and a gene that controls the epidermal growth factor receptor (EGFR). As this book is being written, a major clinical trial is studying whether these preliminary observations are true, and the final results are not known. We mention this to encourage you to discuss with your own physician the current state of the art of measuring genes and comparing the results with the outcomes of treatment of bladder cancer.

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Physicians and researchers can draw some general conclusions about bladder cancer and its diagnosis and treatment, but it is not always easy to predict how it will behave in a given individual.

Your physician and oncologist work with the pathologist to get an idea of your likely prognosis that is a5 accurate as possible, but the reality is that tumors of the same type don t always develop or progress in the same way. Nor do vthey always respond to treatment in the same way, and they don’t always follow a predictable pattern of recurrence.

Generally, one can say that the more deeply into the bladder layers cancer has spread, the more likely it is to recur. But some superficial cancers become invasive. And some don’t. Doctors and researchers don’t yet have all the key indicators to predict which superficial cancers will become invasive and recur and which ones wont.

In general, if you have been diagnosed with superficial urothelial cancer, you can expect a 40 percent chance that the cancer won’t recur, especially if you have a low-grade tumor where the cancer cells closely resemble normal bladder cells.

Our use of the term or terms Actos Bladder Cancer is for descriptive purposes only. There is no relationship between the owners of this website and the maker of the product discussed in this post. Our use of the words Recall, Class Action Lawsuit and other similar words related to an event do not necessarily mean that this event has occurred. Refer to the website of the United States Food and Drug Administration for information on drug or medical device recalls. If a Class Action Lawsuit is formed in relation to the product discussed in this post we will provide that information at the time the Class Action is formed. A Class Action Lawsuit is not required to exist for you to file a lawsuit if you have been injured by the product discussed in this post.

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