how is stage 1 bladder cancer treated

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Is Stage 1 bladder cancer curable?

Stage I bladder cancers have grown into the connective tissue layer of the bladder wall (T1), but have not reached the muscle layer. Transurethral resection (TURBT) with fulguration is usually the first treatment for these cancers. But it’s done to help determine the extent of the cancer rather than to try to cure it.

What is the best treatment for T1 bladder cancer?

Intravesical BCG therapy for high-grade T1 BCG instillation into bladder is the gold standard for conservative treatment for high-grade T1 disease.

What is the survival rate for stage 1 bladder cancer?

Stage 1. Around 80 out of 100 people (around 80%) survive their cancer for 5 years or more after they are diagnosed. Stage 1 means that the cancer has started to grow into the connective tissue beneath the bladder lining.

How is bladder cancer typically treated?

Surgery, alone or with other treatments, is used to treat most bladder cancers. Early-stage bladder tumors can often be removed.

Is T1 bladder cancer aggressive?

Non-muscle invasive bladder cancers exist on a continuum of risk in patients with T1 high-grade (T1Hg) bladder cancer at the aggressive end of the spectrum. Following transurethral resection alone, T1Hg bladder cancer has a 69% to 80% recurrence rate and a 33% to 48% chance of progression to muscle-invasive disease.

What are the symptoms of stage 1 bladder cancer?

SymptomsBlood in urine (hematuria), which may cause urine to appear bright red or cola colored, though sometimes the urine appears normal and blood is detected on a lab test.Frequent urination.Painful urination.Back pain.

Can you live 10 years with bladder cancer?

Bladder cancer survival rates by stage According to the American Cancer Society , the relative survival rates for all stages of bladder cancer are: 5 years: 77 percent. 10 years: 70 percent. 15 years: 65 percent.

Does bladder cancer spread quickly?

They tend to grow and spread slowly. High-grade bladder cancers look less like normal bladder cells. These cancers are more likely to grow and spread.

Are most bladder cancers caught early?

Bladder cancer can often be found early because it causes blood in the urine or other urinary symptoms that cause a person to see a health care provider. In most cases, blood in the urine (called hematuria) is the first sign of bladder cancer.

Do you lose your hair with chemo for bladder cancer?

But other cells in the body, such as those in the bone marrow (where new blood cells are made), the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells are also likely to be affected by chemo, which can lead to side effects.

How do they remove bladder cancer?

When bladder cancer is invasive, all or part of the bladder may need to be removed. This operation is called a cystectomy. Most of the time, chemotherapy is given before cystectomy is done. General anesthesia (where you are in a deep sleep) is used for either type of cystectomy.

How many rounds of chemo do you need for bladder cancer?

Chemotherapy before surgery or radiotherapy usually 3 cycles. Chemotherapy after surgery or radiotherapy, or alongside radiotherapy, can be 6 or more cycles.

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What is the best treatment for bladder cancer?

If there are traces of cancer cells, options are intravesical BCG or cystectomy (the removal of part or all of the bladder). If the cancer is high grade, or many tumors are present, or even if the tumor is very large at the initial occurrence, oncologists recommend a radical cystectomy.

Can you have a radical cystectomy?

If the cancer is high grade, or many tumors are present, or even if the tumor is very large at the initial occurrence, oncologists recommend a radical cystectomy. For people who aren’t healthy enough for a cystectomy, radiation therapy might be an option along with the chemo, but the chances for cure are not as favorable.

Does bladder cancer spread to muscle?

Stage I bladder cancers stay in situ upto mucosa and connective tissue layer of the bladder wall. However, they have not spread to the muscle layer. Usually, transurethral resection (TURBT) with cystoscopy is the first treatment for these cancers. However, it helps determine the extent of the cancer and is part of cure as well.

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What is the treatment for stage 0A bladder cancer?

People with low-grade noninvasive bladder cancer (stage 0a) are treated with TURBT first. Low-grade noninvasive bladder cancer rarely turns into aggressive, invasive, or metastatic disease, but patients are at risk for developing more low-grade cancers throughout their life. This requires long-term checkups, called surveillance, using cystoscopy and urine cytology (see Diagnosis ). To reduce the risk of future tumors developing, people may receive intravesical chemotherapy after TURBT.

What is the best treatment for bladder cancer?

In general, the main treatment options for bladder cancer are: Surgery. Chemotherapy. Immunotherapy (local and systemic) Targeted therapy. Radiation therapy. To learn more about the basics of each type of treatment, read this guide’s Types of Treatment section.

How to treat bladder cancer?

Sometimes, people with muscle-invasive bladder cancer receive systemic chemotherapy first, before surgery. Then they may have a radical cystectomy and urinary diversion or may be given a combination of chemotherapy and radiation therapy . Giving neoadjuvant chemotherapy may shrink the tumor in the bladder, destroy microscopic cancer cells that have spread beyond the bladder, and ultimately help people live longer. An important clinical trial showed that a specific combination of systemic chemotherapy called MVAC given before radical cystectomy helped people with muscle-invasive bladder cancer live longer. This approach is now a standard treatment for people whose overall health allows it. The combination of 2 chemotherapy drugs, cisplatin and gemcitabine, is also considered a standard regimen for neoadjuvant therapy in muscle-invasive disease.

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What is the first line of treatment for urothelial cancer?

The first treatment a person is given for advanced urothelial cancer is called first-line therapy . If that treatment stops working, then a person receives second-line therapy.

Can pembrolizumab be used for bladder cancer?

Pembrolizumab is approved by the FDA to treat bladder cancer that has not been stopped by, or responded to, BCG treatment (also called “BCG-unresponsive”) and radical cystectomy to remove the bladder cannot be done because of other medical reasons or the patient chooses not to have that surgery.

What is the name of the team that works together to create a treatment plan for a patient?

This is called a multidisciplinary team .

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Can bladder cancer be removed?

Surgery is often among the first treatments, and the standard treatment is a radical cystectomy (see “Surgery” in Types of Treatment ). Lymph nodes near the bladder are usually removed as well. A TURBT may still be done, but it usually is used to help the doctor figure out the extent of the cancer rather than as a treatment.

What is stage 1 bladder cancer?

Patients with Stage I bladder cancer have a cancer that invades the subepithelial connective tissue, but does not invade the muscle of the bladder and has not spread to lymph nodes. Stage I disease is classified as a “superficial” bladder cancer. A variety of factors ultimately influence a patient’s decision to receive treatment of cancer. The purpose of receiving cancer treatment may be to improve symptoms through local control of the cancer, increase a patient’s chance of cure, or prolong a patient’s survival. The potential benefits of receiving cancer treatment must be carefully balanced with the potential risks of receiving cancer treatment.

When to administer chemo for bladder cancer?

The optimal time to administer chemotherapy is immediately after TUR as the drugs might prevent reseeding of cancer cells disrupted with surgery.

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How effective is TUR surgery?

Surgery (TUR) alone is effective in preventing recurrences in approximately 50% of patients with superficial bladder cancer. Failure of treatment is usually due to the appearance of new superficial cancers, which can be retreated with TUR and cautery or laser therapies.

What is a TUR in urology?

A TUR is an operation that is performed for both the diagnosis and management of bladder cancer. During a TUR, a urologist inserts a thin, lighted tube called a cystoscope into the bladder through the urethra to examine the lining of the bladder.

What is adjuvant therapy for bladder cancer?

Adjuvant therapy is additional treatment that increases the effectiveness of a primary therapy. The goal of adjuvant therapy is to improve the chance of cure, prevent cancer from recurring or progressing to a worse stage, …

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Why is it important to have a follow up on bladder cancer?

Because the risk of developing invasive bladder cancer never goes away, it is important to have frequent follow-up examinations (cystoscopy) no matter what form of therapy is selected. It is extremely important to detect early progression because there are effective treatments for small advanced bladder cancers.

How many people die from bladder cancer?

Because this is a cancer of older individuals, many patients will die of other causes before progression of bladder cancer. However, approximately 25% of patients treated for superficial bladder cancer will ultimately die of bladder cancer.

What are the symptoms of bladder cancer?

The most common symptom of bladder cancer is reddish or brownish-colored urine from blood in the urine. Other symptoms include the frequent urge to urinate, pain while urinating, and pain in the back or pelvis. 4

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Where does bladder cancer start?

Bladder cancer is a growth that starts in the inner wall of the bladder, the organ that collects and expels urine created by the kidneys. The bladder has three layers of muscular walls that make up its structure. 1 A cancerous growth in the bladder can grow uncontrollably and start spreading to other parts of the body.

What is radical cystectomy?

Cases this may be used for include those in which the tumors in the bladder take over a large part of the organ. This surgery removes the bladder and any nearby cancerous lymph nodes or tissues.

What tests are used to diagnose bladder cancer?

These include blood tests, imaging tests that look inside the body, and samples of the tumors called a bladder biopsy, usually taken during surgery.

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How do doctors diagnose cancer?

When doctors first diagnose a cancerous tumor of any kind, they assess how much it has grown, how far it has spread in the body, and how abnormal, or wild, the cancerous cells in the tumor look. These assessments are used to determine cancer’s stage (0 to IV) and grade. 2

How does cancer spread?

The cancer spreads from the original location through a process called metastasis. When cancer spreads, it’s called metastatic cancer or a metastatic tumor. This spreading can happen between tissues, or through the fluids of the blood or lymphatic systems. 3

How is cancer stage determined?

Cancer staging specifics are determined by guidelines set by the American Joint Committee on Cancer’s system, named the TNM staging system. 2

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What is the treatment for T1Hg bladder cancer?

Counselling patients with T1Hg bladder cancer on their treatment options (bladder-sparing intravesical therapy versus cystectomy) is an extensive and delicate process. Factoring in risk of recurrence and progression, patient age and medical comorbidities that predict life expectancy and quality of life is one of the most daunting clinical challenges facing urologists.22Patients should be thoroughly informed about the risks of progression to muscle-invasive disease or development of metastases. Patients must be instructed that vigilant surveillance of symptoms is imperative when receiving conservative therapy.

What is the worst stage of bladder cancer?

The worst scenario for patients with T1Hg bladder cancer is progression to an unresectable or metastatic stage during intravesical therapy. T1Hg bladder cancer progresses to muscle-invasive or metastatic disease at a rate of 30% to 50% after 5 years.2,23As a result, some studies advocate initial cystectomy based on the perceived acceptable morbidity and a 5-year disease-specific survival rate of 80% to 90%.24–28

What is a T1 bladder cancer?

T1 bladder cancer represents 5% to 20% of NMIBC3,8,9and is defined as an invasion into the lamina propria without invasion into the muscularis propria. The 2004 World Health Organization pathology guidelines recommend a conversion from the previous classification of grade G1, G2 or G3 to that of low- or high-grade papillary urothelial carcinoma.10Pathology reports should identify whether muscle tissue is present in the resected specimen. One study described that a pathology report of a repeat resection of T1 disease found the incidence of understaging was only 14% when muscle tissue was present compared to 49% when muscle tissue was absent in the initial specimen.11It is recommended that pathologists report the extensiveness of T1 disease since some studies have reported that focal lamina propria invasion may present fewer risks than extensive involvement.12While understaging remains problematic, overstaging of T1 disease in pathology reports has been described; about 25% to 35% of cases were found to be stage Ta disease when reviewed by a second pathologist.6,13,14This is significant to the discussion of cystectomy for treatment of stage T1 disease.

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Can T1Hg be treated with BCG?

However, the paucity of effective conservative treatment alternatives for stage T1 disease may be misinterpreted as an immediate mortality risk in patients who continue to exhibit organ-confined disease. As we will discuss later, an initial trial of BCG rather than immediate cystectomy appears justified in almost all initial T1Hg cases without undue risk, since progression within the first six months is rare (less than 4%).9As previously discussed, a pathology report that over-stages T1 disease could result in some patients undergoing cystectomy for stage Ta disease. Furthermore, the unconvincing results associated with delayed cystectomy do not account for the successful patients who avoided surgery. The risks associated with over-treatment of 50% to 70% of patients with unnecessary cystectomy appear too great to warrant cystectomy as standard practice; however, the issue remains heavily debated. There are no prospective studies that demonstrate that early cystectomy has a survival benefit29and there are obvious quality-of-life issues associated with performing unnecessary cystectomies.

Is bladder cancer stage T1Hg lethal?

Stage T1Hg bladder cancer should be considered an aggressive and potentially lethal disease. The importance of initial re-resection to identify unrecognized muscle-invasive disease is significant. Most patients with high-risk disease are candidates for initial bladder salvage with intravesical BCG, a procedure with a high survival rate; however, failure of the procedure may result in a guarded prognosis. Even with apparent success, patients must be informed of the risks of disease progression to muscle-invasive or metastatic disease and the necessity of vigorous monitoring. Despite optimal management, a significant number of patients will relapse or progress to invasive disease and require cystectomy.

Does mitomycin C work for bladder cancer?

Initial results on the administration of electromotive mitomycin C, which applies an intravesical electrical current, have been reported . A randomized study of BCG alone versus sequential BCG plus electromotive mitomycin C in patients with T1 bladder cancer found lower recurrence, progression and disease-specific mortality in patients who received electromotive mitomycin C.35However, further data are required before electromotive mitomycin C can be fully endorsed.

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Is bladder cancer a non-muscle invasive cancer?

Approximately 70% of all newly diagnosed bladder tumours are non-muscle invasive bladder cancers ( NMIBC), including stage Ta, stage T1 and carcinoma in situ (CIS). Non-muscle invasive bladder cancers exist on a continuum of risk in patients with T1 high-grade (T1Hg) bladder cancer at the aggressive end of the spectrum. Following transurethral resection alone, T1Hg bladder cancer has a 69% to 80% recurrence rate and a 33% to 48% chance of progression to muscle-invasive disease.1–4This review provides insight into the optimal management of T1Hg bladder cancer.

What is the best treatment for bladder cancer?

Most bladder cancers are initially treated with TUR , and high-grade T1 disease is diagnosed from clinical specimens. Therefore, the role of urologists and pathologists is important for accurate diagnosis of high-grade T1. The outcome of TUR is highly variable depending on the skills of urologists [8]; thus an educational program is recommended for effective TUR. The extended TUR technique, which obtains additional specimens from the bottom of the tumor and grossly normal-appearing margin sites could improve the outcomes of TUR [9]. Bipolar equipment is an advantage of TUR because it appears to cause little tissue distortion and has the potential to facilitate the staging and grading of bladder tumors, although clinical outcomes are not different from those obtained with monopolar equipment [10,11]. Photodynamic diagnosis or narrow-band imaging increases the sensitivity of cystoscopy, but whether it lowers the tumor recurrence rate is under debate [12,13,14].

What is the most common type of bladder cancer?

The most common cell type of bladder cancer is urothelial cancer , and about 70%–80% of these are nonmuscle invasive bladder cancers (NMIBCs), while the other 20%–30% are muscle invasive bladder cancers (MIBCs). MIBC has a poor prognosis due to invasion or metastasis to other organs. NMIBC has a high recurrence rate (up to 50%) and progression (10%–30%), and thus is a great burden to patients [3]. Moreover, T1 disease, which invades the lamina propria, and poorly differentiated high-grade disease have a poor prognosis due to a higher incidence of recurrence and progression than other NMIBC; thus patients with high-grade T1 have to be carefully monitored or managed. Although bacillus Calmette-Guérin (BCG) followed by transurethral resection (TUR) is known as the gold standard treatment, controversies remain over whether BCG can reduce the progression rate of highgrade T1 [4,5]. One third of high-grade T1 patients who receive intravesical BCG therapy progress to MIBC [6] and are at risk of dying from bladder cancer because ineffective BCG therapy delays radical cystectomy [7]. Nevertheless, there is no consensus about how to predict progression and manage high-grade T1 disease. Herein, this review describes how to stratify high-grade T1 disease to predict progression and how to manage it properly by reducing over or under treatment.

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Can high grade T1 be treated with BCG?

In cases with low risk of progression, cystectomy may represent overtreatment and deteriorate quality of life irreversibly, while, in those with high risk, BCG therapy may worsen survival by delaying definitive therapy. There is currently no validated strategy to decide which treatment modality is optimal for each patient with high-grade T1. Current evidence suggests that clinico-pathological and molecular risk classifiers together may help select the optimal management course for each high-grade T1 patient.

Is T1 substaging prognostic?

1) [24,25,26]. These studies suggested that T1 substaging is associated with progression and survival, and thus could have prognostic value. However, substaging has inherent pitfalls: pathological reports from TUR specimens are inconsistent because tissues are easily affected by electrical cautery. In fact, a recent validation study comparing two substaging systems could not reach statistical significance, although a trend toward a difference in progression and survival was observed during a follow-up period of 10 years [27]. For this reason, these systems are not widely used in clinical practice.

Is cystectomy a good treatment for T1?

Considering the high risk of progression and cancer death of high-grade T1 disease, cystectomy would be the best answer for treatment. However, there are disadvantages. First, cystectomy may be overtreatment for high-grade T1 disease. Since at least 50% of high-grade T1 patients are not upstaged upon cystectomy [43,44,45], almost half undergo the surgery unnecessarily. Second, cystectomy deteriorates the quality of life. Although the incidence of continent orthotopic diversion has been increasing, many patients undergo incontinent diversion such as ileal conduit. Finally, cystectomy is a highly complicated surgery in the urological field, and almost 30%-50% of patients experience perioperative or long-term complications [46,47].

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How long do you live with bladder cancer?

Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain amount of time (usually 5 years) after they were diagnosed.

What is the relative survival rate of bladder cancer?

A relative survival rate compares people with the same type and stage of bladder cancer to people in the overall population. For example, if the 5-year relative survival rate for a specific stage of bladder cancer is 90%, it means that people who have that cancer are, on average, about 90% as likely as people who don’t have …

Where does bladder cancer spread?

Regional: The cancer has spread from the bladder to nearby structures or lymph nodes.

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Can you predict cancer survival?

Keep in mind that survival rates are estimates and are often based on previous outcomes of large numbers of people who had a specific cancer, but they can’t predict what will happen in any particular person’s case. These statistics can be confusing and may lead you to have more questions. Talk with your doctor about how these numbers may apply to you, as he or she is familiar with your situation.

Is bladder cancer better treated?

People now being diagnosed with bladder cancer may have a better outlook than these numbers show. Treatments improve over time, and these numbers are based on people who were diagnosed and treated at least five years earlier.

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