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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Actos Bladder Cancer : 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 : 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.

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 :

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.

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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