Refined Cancer Treatment and Quality of Life

What do I need to know about my bladder cancer? 

First let us say that we apologize that you are seeking out information regarding bladder cancer likely due to your recent diagnosis. Bladder cancer is most common in men age 60-70 and in those who smoke, however anyone, men and women, regardless of lifestyle choices can receive bladder cancer at any time. In our experience, it is not important to focus on how you got the cancer but rather how we can help you get rid of it.

 

There are 3 classifications of the most common type of bladder cancer

 

1. The first class of bladder cancer is a superficial low-grade disease meaning the tumor isn’t deep into the bladder and is developing slowly. Patients with low-grade bladder cancer can take a relatively noninvasive approach and have the small lesions scraped out (going through the urethra, no incisions) and see a great recovery. Some studies find the specific survival rate with superficial low-grade cancer to be 100% however cancerous lesions have about a 30% chance of recurring. The chance of lesion reoccurrence typically decreases if Mitomycin chemotherapy is used in the bladder during tumor removal and routine cystoscopy (looking in the bladder) is done periodically

 

Here is a guide from the NCCN (National Comprehensive Cancer Network) that suggests how often patients with superficial bladder cancer should get follow up. Click to open the NCCN guide

 

2. The second class is invasive bladder cancer, which is more serious than superficial low-grade bladder cancer, and is the topic for the majority of the content on this website. Patients with invasive bladder cancer have a tumor that invades the lining or wall of their bladder, which means the tumor has gone into the muscle of the bladder. The technical term for this stage of cancer is T2, however the stage may change with additional scans or surgery. Other stages include T3 bladder cancer, which means the tumor is invading the fat around the bladder, and T4 which means the tumor has invaded a nearby organ.

 

Being diagnosed with T2 stage bladder cancer should be taken very seriously, as patients with invasive bladder cancer that do not have their bladder removed (or chemotherapy and radiation if they cannot tolerate surgery) have an average survival or 1-2 years with a slow and painful death. The best survival rate is seen in patients who have their tumor aggressively scraped out followed by chemotherapy, and eventually have their bladder removed. By maximizing the scraping of the tumor internally and receiving chemotherapy before the bladder is removed, the survival of invasive bladder cancer is increase by 6-10%. Chemotherapy is generally given over a 6 to 12-week period and consists of 2-4 IV drugs in 3-4 cycles. This aggressive treatment approach yields an average survival rate of above 80%, and in some cases up to 90% in patients that have their bladder removed and have very little tumor remaining.

 

Patients only receiving chemotherapy without bladder removal have a 70% chance of seeing a tumor reoccurrence often in the liver, bones, lungs, or brain, and for these reasons we do not recommend that approach.

 

3. The third class of bladder cancer falls in between the first two classes discussed and is known as non-muscle invasive bladder cancer (NMI). Patients with NMI bladder cancer neither have the non-aggressive low-grade superficial lesions nor do they have invasive disease requiring bladder removal, but instead have high grade tumors that invade just under the surface of the bladder and are categorized as stage T1.

Patients with high grade stage T1 cancer should be treated with a live attenuated vaccine protecting against tuberculosis (Bacille Calmette Guerin (BCG)) that when instilled into the bladder elicits an immune response making it less likely for a bladder cancer reoccurrence. NMI tumors have about a 50-70% chance of recurring making this form of treatment important for recovery. All patients with NMI bladder cancer should have a CT scan at the time of diagnosis and additionally should have the tumor resected twice to ensure the correct diagnosis.

 

Dr. Wilson thanks you for considering seeking your urologic care with her. She enjoys getting to know each of her patients and looks forward to working with you.

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