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Actos Bladder Cancer : Despite prompt and appropriate medical treatment if you have mus­cle-invasive TCC, there is about a 50 percent chance that your cancer will metastasize (spread), either to another organ in the body or with­in the bladder area itself. The most common sites of “distant metastasis” (not in the imme­diate area of the bladder) are the para-aortic lymph nodes and the liver, lungs, and bone. Occasionally, bladder cancer can send deposits through the bloodstream to the brain, but usually this happens only after prolonged and repeated treatment. Most recurrences, both dis­tant and local, occur within the first two years after treatment.

One point worth emphasizing is that cancer cells in a distant metastasis still have the characteristics of the bladder cancer (i.e., they behave in the pattern of those bladder-cancer cells and don’t really constitute ” bone cancer”or “liver cancer”as such).Thus the drugs that may work against bladder-cancer cells also have a chance of working against these metastases located at other sites in the body.

As you might expect, the metastasis of your cancer is a dangerous situation that reduces your chance of a permanent cure. That doesn’t mean that cure is impossible or that you no longer have options. Some established chemotherapy approaches can sometimes achieve cure if the metastases are not too extensive. In addition, new and promising therapies, including novel chemotherapy drugs, are under­going clinical trials as this book goes to print, and many of those may well be available to you.

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When metastasis occurs, the direction of your treatment shifts somewhat from a totally focused attempt to achieve cure. In this situ­ation/ while we attempt to cure the metastatic cancer if possible/ we also tty to palliate (reduce) the symptoms and we place a greater emphasis on comfort and pain control This type of treatment is called palliative care. At this point, not only you but your family and loved ones should be involved with your medical team in understanding the progression of your disease and making decisions about your care.

This is a very important point and it can be confusing. On the one hand, your medical team is still trying very actively to cure the cancer, if possible, and to prolong your life and improve its quality to the maximum extent. However, as the chance of cure is somewhat small­er, you and your medical team must also give thought to the benefits and drawbacks of treatment, to quality-of-Hfe issues, and to making the decisions that make the most sense. You and they will want to weigh the chance that treatment might be successful against the possible side effects, the time spent in treatment, and the possible limitations on your quality of life.Your doctor may discover the metastasis during a routine check­up, although sometimes a patient will experience symptoms.

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might be bone pain, abdominal discomfort severe headache, or tin­gling in the legs. (The latter may occur if a metastasis is pressing on nerves in the spine.) Perhaps weight has been lost without changing exercise or diet habits. One might develop a cough or abdominal pain, or experience hematuria (blood in the urine) or other symp­toms of bladder irritation. Any of these symptoms should send you to the phone to make an appointment with your doctors to figure out whether something sin­ister is beginning to occur. As you read this you might be thinking that if the cancer is so advanced – if it has spread to the lungs or bones what’s the point of treating symptoms like tingling in your legs or vague abdominal pain?

The point is that even though the cancer has advanced and metas­tasized, you are likely to live for an extensive period of time – months or years – and it makes good sense to make sure that you are able to live that time comfortably and as fully as possible. If you allow symp­toms to go untreated, your ability to participate in everyday life with your family and friends may be greatly diminished, and the time you have left with them may be cut short. On the other hand, occasionally a specialist may decide to watch and wait. For example, when a change is seen on an x-ray but there are no symptoms. Or when a patient is unwell from other medical problems or is just keen to avoid treatment at that time. In such situ­ations, sometimes the decision will be made to observe closely and start treatment when symptoms occur.

What kind of treatment can one expect if the cancer metastasizes? Surgery to remove the bladder is occasionally a possibility if the only site of recurrence is the bladder and surrounding tissues. It usually doesn’t make sense to operate if the cancer has spread to distant sites. Sometimes radiotherapy will be used to reduce the symptoms of recurrence in the bladder if the recurrence is too extensive to permit surgery or if distant metastases have also occurred.

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 : For those individuals whose bladder tumors are at high risk for recurrence or progression, instillation of agents directly into the bladder can be worthwhile. The forms of therapeutic agents come in two groups: chemotherapy or immunotherapy. It is fortunate the bladder is readily accessible to these agents, allowing for direct action with minimal systemic side effects.

Those individuals at high risk for recurrence and or progression should be considered for this therapy. Individuals with multiple or diffuse superficial tumors, large tumors, high grade tumors, superficially invasive tumors, those with recurrence within one year, or individuals with CIS all should be considered for this treatment. In addition, those with positive cytology after resection or patients with persistent superficial tumors which could not be removed should also be considered.

The agent is passed via a catheter into the bladder. The passage of the catheter generally takes just a few seconds in a woman, and perhaps ten seconds in a man. The urethral meatus (the outermost part of the urethra) is first cleansed with an antiseptic solution and then the catheter, which is made slippery with a sterile lubricant, is inserted up the urethra and into the bladder. On passage of the catheter, there is minor, short lived discomfort which may be reduced by an injection up the urethra with numbing medication. The various therapeutic agents are not painful during the infusion but may cause side effects afterwards. Depending on the agent instilled, the patient is asked not to void for a period of time afterwards to allow the agent to have its maximal effect on the bladder lining.

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BCG is a living but attenuated form of tuberculosis bacteria. Similar to other living vaccines, it is used to create a heightened immunity. There are a number of precautions which must be taken to make sure the BCG is infused safely. BCG should not be infused immediately or shortly after tumor resection. Several weeks should be allowed to pass so the BCG does not gain access into open blood vessels. In addition, BCG should not be infused if the individual has a urinary infection, has active bleeding, or if the catheterization is traumatic and causes bleeding. It should not be used in patients whose immune system is seriously compromised or for those on steroids, which can decrease the immune system.

The exact mechanism(s) of BCG is still not fully understood. It is known BCG actually attaches to and enters cancer cells. BCG is thought to trigger an increased immune reaction in the bladder, thereby killing off cancer cells.

BCG is held in the bladder for two hours. One should not hold it longer as adverse reactions are increased. The individual should then void into a toilet at home, preferably in a seated position to avoid splashing. After voiding, the toilet is disinfected with bleach. Since BCG can be shed from the urethra after treatment for several days, condoms should be used or one should abstain from sexual relations for at least 48 hours after treatment.

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Adverse reactions are side effects of treatment. Approximately 95% of individuals will tolerate treatments well. Adverse reactions may be mild. Common reactions include cystitis (inflammation of the bladder characterized by burning on urination), hematuria, mild fever, malaise, and nausea. These symptoms generally pass without any treatment. For bothersome symptoms, various medications may prove helpful. Your physician can prescribe medication for burning or urinary frequency. For those with persistent cystitis, antibiotics can be utilized. For individuals experiencing severe symptoms lasting more than 48 hours, isoniazid, an anti-tuberculous drug can be prescribed. A short course of 3 days, starting the day before the next dose of BCG can be used to prevent severe side effects. Fortunately severe reactions resulting in sepsis, a life threatening condition characterized by high fever, chills and drop in blood pressure, is exceedingly rare. Sepsis would be treated in a hospital with triple anti-tuberculous drugs, steroids, and broad spectrum antibiotics. There are other serious adverse reactions which may require dose reduction or discontinuation. These are all rare and include: inflammation of the prostate, persistent hematuria, hepatitis, inflammation of the testicles and or epididymis, bladder contraction, ureteral obstruction, joint pain or inflammation of the lungs.

Recurrence of bladder cancer after the initial induction course, or relapse after complete response, would indicate failure of therapy. When two or more courses result in recurrence or when recurrence develops during the first six to twelve months after induction and maintenance therapy, patients generally are felt to have disease which is at higher risk for progression. A high percentage of patients who are complete responders remain tumor free for up to five years. However, with the passage of more time, additional patients will have late recurrences. For those with late recurrences (two to three years after therapy), most will respond to repeat BCG therapy.

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 actual surgery to form the continent diversion may take several hours more to accomplish compared to an ilea) loop. This additional surgical time is not a problem as long as the individual is in good health, and the surgery has gone well. Not all urologists do continent diversions on a regular basis. If a urologist does not do this operation regularly, you will be better off finding a urologist that does, since complications related to this part of the surgery will be increased by inexperience. Because different techniques exist and the level of expertise and experience of each urologist is different, it is important to ask the urologist about the complications that may occur and the general frequency of occurrence he has seen in his patients. Complications unique to this diversion as compared to the ileal loop may occur, requiring reoperation in up to 20% of patients. If the complication rate is unacceptable, consider an ileal loop. The most common complications are:

Difficulty with catheterization: After the surgery the pouch may become increasingly difficult to empty. Surgical reconstruction is mandatory if a pouch cannot be readily emptied. Incontinence: During surgery, the continence mechanism is checked. However, at some time after surgery, incontinence may occur, necessitating the wearing of a collection device. In addition, the pouch may still need to be catheterized. Surgical reconstruction is required to reformat the continence mechanism. Pouch stones: Stones may form in the pouch. Removal may be accomplished with a scope either through the stoma or directly through the skin above the pouch.

Neobladder means new bladder. In this surgery, the urologist uses a combination of small bowel, large bowel, or a combination of both to create anew bladder pouch which is attached to the remaining urethra. The individual can void by increasing abdominal pressure which is accomplished by holding one’s breath and bearing down. There are many surgical techniques to accomplish the formation of a neobladder.

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There are a number of issues which need to be reviewed. Cancer recurrence in the urethra after the formation of a neobladder would likely require surgery to remove the urethra and a new form of urinary diversion. After cystectomy, urethral recurrence of cancer can be expected in approximately 10% of patients. Those with multi­focal disease and especially with disease near the bladder neck will likely have a higher recurrence rate in the urethra. For those with a neobladder, the urethra must be carefully followed for possible cancer recurrence. Monitoring is accomplished by washings of the urethra for cytology or by visual inspection with a scope. if there is a concern for an increased risk of urethral recurrence given the nature of the individual’s bladder cancer, the formation of a neobladder should be avoided.

Urinary incontinence may occur after the formation of the neobladder because of damage to the continence mechanism of the urethra. The nerves to the urethral sphincter travel deep in the pelvis and generally are not injured during surgery. However, meticulous care must be taken in handling the urethra and the sphincter muscle around it. Complications resulting in scar tissue may also jeopardize the continence mechanism leading to leakage. Marked scarring between the neobladder and the urethra may occur, but is readily handled via an incision or dilation of the blockage accomplished through a cystoscope. Even in those with an intact sphincter, especially in females, leakage often occurs at night, necessitating the wearing of a pad.

For some individuals, the neobladder is not adequately emptied with increased abdominal pressure. The solution is intermittent self catheterization through the native urethra. This can be uncomfortable, especially for male patients. For many individuals continence is preserved and catheterization is not required, making this an excellent form of diversion.

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Creating a neobladder is technically more difficult and will require several more hours of surgery as compared to the simpler ileal loop diversion. Many urologists do not create neobladders on a regular basis. If your urologist does not do this part of the operation frequently, you are better off finding a urologist who does neobladder surgery regularly or you will face the prospect of a higher complication rate. It is important to question your urologist regarding the various complications and the frequency of occurrence he has seen in his patients. Ideally, the individual with a neobladder will empty without the need for catheterization and will remain continent between emptying. It is important to understand what percentage of individuals can expect this ideal outcome. If the probability for incontinence or need to catheterize is too high a risk for you, choose a continent diversion or an ileal loop diversion instead.

Chemotherapy uses drugs to kill cancer. There are many different types of chemotherapy. Some drugs work better than others for specific cancers. Some are given orally as pills. Many are given intravenously. Susceptibility to chemotherapy varies depending on the specific cancer. Some, like testicular cancer, are extremely sensitive to chemotherapy while others, like kidney cancer, are not. Bladder cancer is felt to be moderately sensitive to chemotherapy.

Chemotherapy drugs work systemically, throughout the body. These drugs work via various mechanisms to damage and hopefully kill rapidly dividing cells. Since cancer cells are for the most part rapidly dividing, they are generally sensitive to chemotherapy. Other rapidly dividing cells in the body may also suffer injury during chemotherapy, which is why people often experience hair loss, anemia, and diarrhea as a result of therapy. Chemotherapy also can lower the blood cells that fight infection, leading to a diminished immune system and an increased susceptibility for acquiring a potentially serious infection.

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 : When an individual has gross hematuria or persistent microscopic hematuria, a complete assessment of the urinary tract is required. Although cystoscopy is the test of choice for examination of the bladder, imaging studies are required to make sure there is no disease in the upper tracts (kidneys and ureters). Bleeding can be caused from many different disorders including transitional cell carcinoma of the upper tracts, kidney or ureteral stones, or renal cell carcinoma (cancer of the parenchyma or fleshy part of the kidneys). Your urologist has a number of options to choose from. There are advantages and disadvantages of each.

Intravenous pyelogram (IVP) is accomplished by injecting a contrast agent into your vein and then obtaining X ray images. The contrast is excreted by your kidneys, subsequently filling the lumen of the kidneys, ureters and the bladder. The contrast allows one to see subtle filling defects within chambers of the urinary tract, possibly representing tumor, stone or blood clot. Tumors of the fleshy part of the kidneys can also be seen. The study also allows for an assessment of renal function. It is a sensitive test for renal obstruction, which can occur because of cancer. Disadvantages of the study include the possibility of an IV contrast agent allergy, which occasionally may be serious.

You will be asked whether you have a sea food allergy, a known allergy to iodine or to IV contrast. If this is the case, you may need to be premedicated prior to the exam to avoid a reaction. Although the study is quite useful at visualizing the upper tracts, it is not very good at picking up subtle tumors on the bladder surface. If your kidneys do not function well (you have renal insufficiency), the contrast may cause harm to your kidneys and the imaging will not be as good. For pregnant women, any X ray exam could be potentially damaging to the fetus and therefore, will not be performed.

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Ultrasonography can check for a kidney tumor, stone, or obstruction. Bladders filled with urine can be scanned. There is no contrast or X rays involved, and therefore the study can be accomplished in those with renal disease, contrast allergies or for women who are pregnant. Although larger tumors of the bladder are often visible, it is not a good study to rule out urothelial cancer (transitional cell cancer of the urinary tract lining) since smaller tumors or flat tumors in the lining are not visible. Also, other conditions such as enlarged folds in the bladder or enlarged prostates can be confused with bladder tumors. Ultrasound exams are generally fast, painless, and relatively inexpensive. An ultrasound combined with cystoscopy plus cytology (to rule out cancer cells) is a reasonable assessment for those with a low likelihood of having upper tract disease.

CT Scan or CAT (computerized axial tomography) provides a computerized cross sectional visualization of the abdomen and pelvis. X ray images are synthesized into exquisitely detailed images. The CT scan can be done with or without IV contrast, and therefore has the same limitations as IVP in those with allergies to contrast or renal insufficiency. These studies are excellent for finding renal cell cancers and stones within the kidneys and ureter, but not very good at delineating cancers of the lining. CT scan is often an important part of staging bladder cancer, determining whether the cancer has spread.

Magnetic Resonance Imaging (MRI) is a technology which uses strong magnets to provide detailed images of your internal organs. Like ultrasound, this study has no known harmful effects on the body. It does not require contrast injection like CT scan and can be done safely in patients with renal insufficiency. It is not generally used for initial screening. Many individuals find the test uncomfortable due to a loud noise heard throughout the test, in addition to the close quarters the machine requires, leading to feelings of claustrophobia. A mild sedative may be required if the test is necessary and the individual experiences these uncomfortable feelings.

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Initial treatment may eradicate an individual’s bladder cancer, however, for many, recurrent tumors may develop. Up to 70% of individuals will have recurrent bladder cancer after initial therapy. In approximately one third of patients, not only will tumors recur, but they will become more serious over time, developing a higher grade or stage. This chapter will review the importance of staging bladder cancer, the single most important predictor of future problems. In addition, we will review other important indicators that impact the prognosis.

After the diagnosis of cancer is made, it is critical to establish the stage of the cancer. Cancer stage quantifies the extent of cancer in the individual. The number of tumors, their size, whether or not they have grown into the wall of the organ or spread beyond, all fit into the various stages of a particular cancer. Most cancers can be found at an early, nonlethal stage. As they grow and worsen, they can invade the wall of the organ they lodge in, spread locally through the organ into surrounding tissue, or spread throughout the body via the lymphatic or blood system.

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 : 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.

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 : Hernia: After surgery, there is an increased risk of developing an incisional hernia (a hernia through the original incision) or an inguinal hernia (a hernia in the groin). A hernia represents a weakening of the thick outer layer of tissue which holds the abdominal contents in place. With a hernia, there is an abnormal protrusion of peritoneal sac and possibly bowel. Herniation of bowel may lead to a lack of blood flow to the herniated intestine which can be serious if left untreated. Surgical correction of the hernia is usually recommended to avoid this possibility and to eliminate discomfort.

Prolonged ileus: For some individuals return of bowel function may be delayed by several days or longer. Your urologist will be following you carefully to make sure a bowel obstruction or bowel leak is not present. Ileus may require leaving the nasogastric tube in to suction off excessive fluid. In addition, hyperalimentation (complete nutrition delivered intravenously) may be initiated if the ileus is prolonged.

Urine leak: The ureters are sewn to the ileal loop in a watertight fashion. In addition, small tubes, called stents, are placed through the ileal loop, through the anastomosis of the ureter to the loop, up the ureter into each kidney. These tubes are placed to allow the ureteral-ileal anastomosis to heal and to prevent leakage. They are generally removed weeks after surgery. Besides these stents, a drain or drains are placed to siphon off any urine which may still leak from the anastomosis. Prolonged urine leakage into the abdomen will generally result in ileus and possibly secondary infection. Persistent urine leak may result from the lack of good blood supply to the ends of the ureters. Leakage is also increased in those who have had pelvic radiation in the past for other malignancies. Prolonged leakage may require repeat surgery.

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Wound infection: The rate of wound infection is low. Rates are increased in diabetics, obese individuals, prolonged surgery, and in those individuals whose body temperature drops excessively during surgery. Excellent surgical technique and the use of antibiotics can lower the rate. Wound infections generally will require opening the area to allow drainage. Wound infection can result in weakening of the abdominal closure, which can cause a hernia or more rarely an evisceration (a disruption of the abdominal closure), requiring immediate surgical closure.

Cardiovascular complications: Major surgery can result in significant physical stress to the body and its physiology. Cardiac arrhythmias (abnormal heart beats) may occur and warrant medical therapy to correct. If serious, a cardiologist may be consulted. Life threatening arrhythmias may require cardioversion to correct or even the possibility of a pacemaker. A heart attack (a vascular blockage to the heart) or a cerebrovascular accident also referred to as a stroke, are fortunately rare, but sometimes devastating complications which can prove to be fatal. It is essential an individual facing major surgery with cardiac or vascular disease be properly screened prior to surgery to rule out and correct any serious underlying abnormalities. One should not face surgery with an unstable major underlying condition without correction or improvement when this can be reasonably achieved.

Pulmonary problems: After surgery, it is essential to do deep breathing exercises usually with a device called a spirometer. Bed rest, pain from surgery, and the sedative effects of pain medication can all lead to inadequate aeration of the lungs, which can lead to atelectasis (a collapsed area of the lung). Left untreated, atelectasis can lead to infection (pneumonitis or pneumonia), a potentially serious complication. For those with preceding lung disease, a respiratory therapist will likely be requested to work with the patient to clear lung secretions and increase aeration to prevent infection.

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Another potential serious pulmonary problem is called pulmonary embolus. A pulmonary embolus causes damage to the lung by a blood clot which forms in another area of the body, travels through the veins of the body and ends in the lungs. Blood clots can form in the pelvic veins as a result of surgery. They can also form in the lower extremities because of prolonged bed rest and immobility after surgery. Compression stockings used during and after surgery until mobility resumes help to prevent clots in the legs. Getting the individual out of bed and ambulating as soon as possible after surgery are important to prevent clots from forming. In addition, subcutaneous heparin (a medication that stops clotting) can be given during the post-operative period to lessen the possibility of pulmonary embolus without a substantial increase in post-operative bleeding. The symptoms of a pulmonary embolus are shortness of breath and pain in the chest with breathing.

Clinical signs include a rapid heart beat and poor oxygenation of the blood. Diagnosis is confirmed with a ventilation-perfusion scan. This study will demonstrate a lack of blood flow in various parts of the lung which have good air flow (a finding consistent with a vascular blockage by a clot). In many institutions, a CT angiogram of the lungs has become the preferred study because of the speed of the study and its enhanced accuracy. An individual must not be allergic to IV contrast, nor have significant renal insufficiency if this test is to be ordered. Pulmonary emboli are usually treated with supportive measures such as supplemental oxygen and anti-coagulation of the blood to prevent further clots from forming and migrating. If a large clot has formed and continues to embolize to the lung, a small filter device may be placed in the main vein of the abdomen (the inferior vena cava) to prevent further clots from traveling to the lungs.

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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If the results of your tests-—-either scans or biopsies-—- show that cancer has spread to other tissue or organs, your doctor will want to confirm that. Clarification of the stage of your cancer comes through looking at the cancer cells from those organs under the microscope. Tissue samples may be taken at the time of your biopsy, or sometimes a needle biopsy is done, bypassing the need for additional surgery.

Pathologists stage bladder-cancer tissue by using a standardized system known as TNM, which stands for tumor- nodes-metastases. A typical TNM might be “T2aNlM0” (T-two-a-N-one-M-zero). Looks like mumbo jumbo, doesn’t it? Try thinking of it as medical shorthand, with each letter and numeral having a defined value that gives doctors and pathologists a specific, consistent way to describe how deeply a cancer has invaded the body’s tissue and organs.

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The TNM system uses the letters T, N, and M followed by numerals to describe the stage of invasiveness of your cancer.

The letter T followed by a numeral from one to four (1 to 4) describes the depth of invasiveness of your tumor. The lower the number, the less invasive the cancer.

The T scale has additional, more detailed levels as well. These levels add the lowercase letters a and b to the T score to delineate more precisely how far into the bladder your cancer has spread and whether it has moved into other areas of your body. It fine-tunes the pathology information to help your doctor make treatment recommendations.

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.

To keep up to date on Actos Bladder Cancer visit our site often.

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