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Actos Bladder Cancer : Keep your doctor informed if you are experiencing any of the above side effects. There are drugs that can help minimize these con”ditions and make your treatment more comfortable. Luckily, these side effects tend to disappear once you are no longer receiving chemotherapy, and you will gradually feel stronger and become less vulnerable to bleeding or infections.

For invasive bladder cancer, chemotherapy is sometimes given before you have a cystectomy. Sometimes it’s given afterwards. Sometimes it’s not given at all. It depends entirely on the type of tumor you have, where it may have spread, and whether you have another medical condition that might make it difficult for you to tol”erate chemotherapy. Very advanced age can also be a factor in decid”ing whether chemotherapy is appropriate.

The choice of drugs used to treat invasive bladder cancer is similar to the choice in advanced or metastatic disease. If you have invasive transitional cell carcinoma you will probably undergo chemotherapy, as this type of cancer is responsive to either radiotherapy or surgery with chemotherapy, and many stud”ies have examined this type of cancer treatment.

If you have been diagnosed with squamous cell cancer or adeno”carcinoma, the track record for chemotherapy is not so clearly defined. Most physicians don’t recommend chemotherapy as standard treatment in conjunction with cystectomy for these types of cancer. It is, however, quite reasonable for your team to suggest that you look into a clinical trial (for example, one that is exploring the use of chemotherapy) if you have been diagnosed with squamous cell or adenocarcinoma.

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Most of the reported trials indicate that the use of single chemother”apy drugs does not have an extensive beneficial effect, but that the use of combinations of three or four chemotherapy drugs can shrink the bladder cancer in around 70 percent of cases and can also improve the cure rate and length of survival. For you as a patient, the information gleaned from these clinical trials means that if you have TCC, your doctors are likely to recom”mend treatment that includes a “cocktail” of several carefully targeted chemotherapy drugs as well as cystectomy or radiotherapy.

In some cancers, such as breast cancer, it is pretty standard practice to give several doses of chemotherapy after surgery, especially for tumors with high-risk pathological features, such as lymph-node involvement. We know of six studies that have looked at this question in bladder cancer, but the results are somewhat inconclusive as to whether chemotherapy is most effective given before or after surgery.

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When radiation is used alone or with chemotherapy there is an increased likelihood that your other organs, such as the prostate and uterus, will remain functional, as does your ability to void urine normally and have sex. The intention when chemotherapy and radio”therapy are given is usually to improve the chances of curing the cancer while preserving the bladder and avoiding the need to remove it surgically. This area is still somewhat controversial; while some physicians believe that this approach is nearly as effective as surgical removal of the bladder, others feel that cystectomy is the best treat”ment The decision depends in part upon the physical fitness of the patient as well as upon the patient’s personal preferences.

The use of radiotherapy doesn’t mean that it is without side effects. There can be scarring of the bladder tissue, and that can reduce the amount of urine your bladder can hold. The result would be an increase in the number of times you have to urinate, which can be irritating, especially at night. You also may experience an increase in bouts of cystitis.

There has been much discussion about whether the results achieved by radiotherapy are the same as those from cystectomy with, respect to achieving cure. We think that when one considers all types of bladder cancer, in the hands of a highly experienced urologist who specializes in this operation, cystectomy gives better results than radiotherapy. However, there are some patients, particularly those with other significant medical conditions, who will benefit from radiotherapy despite the possibility of a lower chance of permanent cure. In some centers, such as Massachusetts General Hospital, where the techniques of chemoradiotherapy and bladder preservation have been piloted, a urologist wall perform a cystoscopy about halfway through the planned course of radiotherapy. If the tumor is shrinking well, radiotherapy will be completed. However, if it appears that the cancer is not responding to radiotherapy, the plan wall be abandoned and replaced with a radical cystectomy.

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 : 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 : 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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Urothelial Cancer (UC)

A diagnosis of urothelial cancer (also known as transitional cell cancer) can mean many different things. Urothelial cancer is not a single type of cancer; it is classified by shape and whether it is restricted to the inner surface of the bladder (superficial to underlying tissues and muscle) or invasive, as well as by stage and grade of development.

The words transitional cells describe how the cells appear under the microscope. Transitional cells share features with various types of cells normally found near the bladder. Since 2009, pathologists have altered the common term to “urothelial cancer” to acknowledge the fact that all these cells arise from the lining of the ureters, bladder, and urethra, the urothelium.

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The human bladder is composed of several layers. On the innermost surface (which is next to where urine is stored) is a layer of cells known as the transitional cell epithelium. This layer varies in thickness from three to seven cells.

If your doctor described your tumor as being confined to the transitional cell epithelium, the tumor is a superficial tumor. About 74 percent of UCs are noninvasive and superficial when diagnosed, although superficial tumors may eventually progress to a more invasive stage. The word superficial has to be used carefully because it does not necessarily mean that the tumor is safe and doesn’t have a dangerous potential. In other words, some “superficial” tumors actually have a high malignant potential and the ability to spread elsewhere in the body.

A diagnosis of invasive UC means that the cancer has progressed into other layers of the bladder wall, such as the intermediate ceil layer or the muscle.

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Urothelial cancer is classified as either papillary or flat in shape, although and more than one kind of tumor may be present at the same time in the bladder.

Papillary tumors look like the fronds of a fern or a bunch of tiny berries or grapes. Papillary tumors can be superficial or invasive. Most papillary tumors are malignant; however, the papilloma tumor is a relatively benign type of papillary UC and is typically removed by surgery.

Other tumors appear to be flat and velvety and are more commonly called carcinoma in situ (CIS). These tumors are only one cell thick.

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Urothelial cancer, or UC (also referred to as transitional cell cancer or TCC). It can be localized on the surface or it may be invasive. (UC will be discussed in more detail later in this chapter.) UC is the most common type of bladder cancer, accounting for about 90 percent of all cases. In 2009, the American Cancer Society estimated that by the end of that year about 70,980 people would be diagnosed with bladder cancer—roughly 52,810 men and 18,170 women. About 63,882 of the cases would be urothelial cancer.

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Squamous cell cancer. This type of cancer accounts for about 4 percent of all bladder cancers and is usually an invasive cancer. Squamous means “resembling a scale” (which is flat and thin) or a scaly surface, and squamous cell cancer looks like skin cancer when viewed under a microscope. Among the causes of squamous cell development is the schistosomiasis parasite discussed in chapter 1.

Adenocarcinoma. ‘The appearance of this type of cancer closely resembles tumors of gland-forming cells in the intestinal tract. (,Adeno means “gland.”) It is often associated with the production of small amounts of mucus. Some adenocarcinomas occur in the urachus, a remnant of a fetal structure that connects the bladder to the umbilicus before birth. Adenocarcinomas, which are usually invasive, account for about 1 to 2 percent of bladder cancers.

In addition to the above types of bladder cancer, there are several extremely uncommon forms of the disease:

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*     Small cell anaplastic bladder cancer. Similar to small cell cancer, this rapidly growing cancer is usually found in the lung, and it shares a pattern of rapid growth and early spread to other parts of the body It is not really clear why small cell tumors arise in the bladder, although it is thought that they start from neuro-endocrine cells, isolated small, dark, round cells that arise during fetal development, of uncertain function, which are sometimes found in the bladder. These cells may play a part in the control of cellular growth.

• Sarcomas and choriocarcinoma. It is quite rare for these two forms of cancer to be found in the bladder. Sarcomas are found in the muscle layers of the bladder. Choriocarcinoma is most often diagnosed among Asians in the Far East. Found in the bladder wall, it is an extremely rare tumor that seems to arise from small clusters of cells that paradoxically resemble part of the placenta.

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 12/20/2011: The elderly, frail individuals with multiple coexisting chronic illnesses, individuals that are weakened through mahiutrition or who have compromised immunity all would face substantially increased risk of complications from standard chemotherapy regimens for bladder cancer. Unfortunately, cisplatin is toxic to kidneys, and many individuals with bladder cancer have compromised kidney function which effectively rules out the use of platinum based chemotherapy. Other treatment regimens exist and are being worked on for these individuals, but none show the efficacy of the standard therapy which includes cisplatin.

Most individuals treated with standard chemotherapy regimens with metastatic bladder cancer will have recurrence and progression of their disease. Multiple treatment regimens have been utilized with overall response rates of 10-40%.^[1] To date, regimens have generally used taxanes, both docetaxel and paclitaxel. Ifosfamide has been shown to have significant single agent activity as well, but is extremely toxic. Combination therapy with taxanes and ifosfamide are presently being tested.

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