Actos Side Effects : Sometimes, in an alternative procedure/ lasers (high-energy light beams) are used to remove superficial TCC tumors. While this is slightly more comfortable than resection for you as a patient, the laser often destroys the tumor tissue, leaving nothing for pathologists to examine. The lack of pathology may limit your medical team’s ability to predict recurrence and target your follow-up plan.

If you have been diagnosed with a low-risk tumor, resection may be the only treatment recommended by your medical team. Or your team may recommend a course of intravesical therapy, too. Intravesical is a medical term meaning “within the bladder/’ Intravesical therapy, therefore, means that treatment – in this case a solution containing anti-cancer drugs – is placed directly in the blad­der instead of being given to you as a pill to swallow or as an injection.

The treatment is given as a liquid poured through an ordinary uri­nary catheter, the same device that is usually used to drain urine from the bladder. In this case, the flow of fluid is reversed, with the med­ication being injected gently up through the catheter into the inside of the bladder. Think of it this way: Remember when you were a kid and filled balloons with water? If you imagine the bladder as that bal­loon, filled not with water but with liquid medication sloshing around inside, you’ll ‘have a good idea of how intravesical therapy works.

Intravesical therapy has been used for about 30 years as a preven­tive treatment to reduce the recurrence rate for superficial bladder cancer. It is believed that intravesical therapy works because it destroys cancer cells that may remain “floating” in the bladder after resection, thereby reducing the possibility of a recurrence. It also may be absorbed directly into any remaining tumor tissue, causing destruction of the tumor. There are two types of intravesical therapy, chemotherapy and immunotherapy, with numerous treatment options within each therapy group.

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Your medical team will take a number of things into consideration when deciding which intravesical treatment option is best for you. Their goal is to balance the effectiveness of the treatment with possi­ble side effects and long-term risks based on the type and seriousness of your cancer. Aggressive treatment options with possibly serious side effects may well be the right choice if you’re dealing with a type of cancer that has a high recurrence rate and often comes back in a more life- threatening form. On the other hand, if your cancer is low risk and has a lesser chance of recurring, a more conservative approach might be taken.

Regardless of whether you’re advised to take chemotherapy or immunotherapy both are administered the same way The procedure can be performed either at the hospital about one to seven days after your resection or in your doctor’s office if a series of weekly treat­ments is recommended. The timing depends somewhat on how extensive the resection has been.

First your doctor will numb your urethra with a topical gel and insert a disposable catheter, which wall be used to fill the bladder with the solution. The catheter is removed after your bladder is full, and you’ll be asked to concentrate on not passing urine for a time, hold­ing the solution inside while you get up and move around. Walking, sitting, and standing while the solution is held in your bladder caus­es it to slosh around and completely coat inside the bladder walls. After an hour or so, you’ll void the solution just as you would pass urine. In most cases, you’ll be asked to minimize your fluid intake before the procedure so that your bladder won’t also be filling with urine that wall put additional pressure on your bladder.

The chemotherapy drugs that are used in this way include doxoru­bicin (brand name Adriamycin), epirubicin (Pharmorubidn), mitomycin C (Mutamydn), and occasionally thiotepa (Thioplex). Chemotherapy solutions have proved effective in reducing recurrence rates by about 30 percent. However, chemotherapy has little or no effect in prevent­ing superficial cancer from progressing to a more serious stage. What this means is that chemotherapy will often stop the superficial cancer

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Although BCG is highly effective, it also has some toxic side effects, and as such is used primarily as a treatment for patients with high-risk types of superficial bladder cancer and those who have had repeated recurrences or CIS. Side effects may include a burning sensation in the bladder as well as fatigue, chills, and fever. A prolonged high fever and general feel­ing of being ill may be a sign that the BCG bacteria have spread through the body. Because BCG is the bacterium that causes a type of tuberculosis, antibiotics used to treat tuberculosis are usually pre­scribed when an infection occurs shortly after BCG immunotherapy. Another type of immunotherapy is interferon.This is naturally pro­duced in your body’s cells and works much as BCG does in stimulat­ing your body to attack cancer cells in the bladder. Temporary side effects, which usually disappear once interferon therapy is stopped, include muscle and bone aches, fatigue, vomiting, and headaches.

In almost all cases, intravesical therapy (chemotherapy or immunotherapy) is most effective when the first dose is given 6 to 24 hours after resection. Sometimes a single dose is given as a prophy­lactic (preventative) measure and is not repeated. More commonly, you’ll have one dose immediately after resection and then five more treatments on a weekly basis in your doctor’s office. In some cases, if a large tumor has been resected, leaving a larger area of ulcerated bladder surface, intravesical chemotherapy will be delayed for a few days to prevent the drug’s being absorbed through the damaged sur­face lining of the bladder. Your doctor may recommend a follow-up cystoscopy after the intravesical treatments are completed.

Keep in mind that there are several types of superficial bladder cancer, some of which have a high risk of recurrence or progression to a more serious stage. Treatment options, including resection and intravesical therapy, are different for each person and depend upon each person’s circumstances, For example, you may start talking to someone in your urologist’s waiting room who has had great results and few side effects from a single dose of mitomycin C (MCC) chemotherapy. Even more impres­sive, he hasn’t had a recurrence since his diagnosis three years ago. You, on the other hand, are on your fourth BCG treatment, and each one leaves you feeling as if you have severe bladder irritation for several days afterwards. “No side effects and no recurrences” sounds like a better deal than what you’re experiencing. So why wasn’t MCC prescribed for you?

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Actos Side Effects:  When applied to TCC, the term “superficial” can be misleading, and some doctors would like to see the term discontinued. Many people equate the term “superficial” with “not very risky,” which isn’t always the case. In general, superficial TCC at the low or intermediate risk levels is a highly treatable form of bladder cancer with a good chance for an excellent outcome despite a moderate to high rate of recurrence (depending on the extent and nature of the tumor). But as we dis­cussed in Chapter 3, some superficial TCCs are considered high risk and cariy an elevated chance that the cancer will not onfy recur, but may have progressed to a more dangerous stage when it does recur.

Luckily, only about 20 percent of those who experience a recur­rence are diagnosed with a more advanced type of bladder cancer. What this means is that “superficial” bladder cancer, if and when if recurs, will usually come back again as a superficial cancer that can be managed by local means. However/ understanding your prognosis and being informed about the cancer’s possibility of recurrence are important parts of your overall treatment process.

Make sure that your multidisciplinary team – which may include your urologist, oncologist, pathologist, and radiation oncologist – welcomes your active involvement in your treatment plan and thoroughly explains each step of the process to you. It is worth mentioning that noninvasive bladder cancer is usually managed by a urologist with support from the pathologist and usually does not require a full multidisciplinary team unless it recurs repeatedly.

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Most likely at this point you’ve undergone some of the diagnostic tests discussed in Chapter 2.YouVe had tissue biopsied and classified as superficial TCC, and you probably underwent a flexible cystoscopy, during which your doctor thoroughly examined your bladder wall and made a “map” of the location of abnormal tissue or tumors that other diagnostic tests have confirmed. Sometimes more than one tumor will be present in the bladder, so your urologist will be veiy careful to look at the whole organ from the inside. The next step for you is likely to be resection (removal of the tumor), unless youVe already had a surgical biopsy or rigid cystoscopy. In that case, your doctor may have done a resection to avoid your hav­ing to undergo a second surgical procedure under anesthesia.

Undergoing a resection sounds more intimidating than it actually is. Think of it as the removal of the piece of the bladder where the tumor or abnormal cells are growing. This may effectively clear the bladder of tumor, bringing it to a state where only healthy tissue remains. When you have a bladder resection by means of a cystoscopy, as opposed to invasive surgery, you won’t have an incision or stitches, as no external cutting or incision is required.

Resecting (sometimes called endoscopic resection) is performed under general anesthesia in a hospital setting. Your doctor will use a resectoscope, which resembles a somewhat larger cystoscope. Like a cystoscope, it has a lighted lens and is introduced into your bladder through your urethra. (Don’t worry; you’ll be asleep under anesthesia and receiving pain medication while this is happening.)

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Your doctor will fill your bladder with water or a nonirritating clear liquid such as glycine, which expands the bladder walls and makes it easier to see tumors and abnormalities. Guided by the map made during the initial cystoscopy your doctor will use a small wire loop (through which a high-energy electrical current runs) to remove the cancer, a margin of healthy tissue, and a small amount of muscle. Any remaining cells are removed with an electric current or sometimes a high-powered laser. Sometimes your doctor will also take a few ran­dom tissue samples from other areas of your bladder to make sure that abnormal cells aren’t developing elsewhere. The tumor, healthy tissue, and muscle are then sent to your pathologist for examination. A small amount of muscle tissue is included in the tissue sample so that the pathologist can make sure the tumor hasn’t spread into the muscle wall. A margin of healthy tissue is taken to help decrease the chances that abnormal cells remain in the bladder.

Resection is usually carried out as outpatient surgery. This means that you probably will be able to go home the same day. (You’ll need to bring a driver with you as you’ll still be recovering from anesthesia and won’t be sufficiently alert to drive a car.) You may have some blood in your urine for a few days after a resection, and you may expe­rience pain or stinging upon urination. The stinging urination can be eased by drinking lots of fluids and by taking simple pain medications prescribed by your urologist. If either condition lingers longer than two or three days, if other painful conditions occur, or if the bleeding becomes extensive, call your doctor right away.

In some circumstances, your doctor may choose to insert a catheter into your bladder for a short time (usually only one to two days) after the surgery, to prevent blood clots from obstructing the flow of urine and causing discomfort. The catheter allows blood and urine to gen­tly drain out of the bladder and also allows your doctor to irrigate your bladder to promote complete healing of the resected area. On rare occasions, doctors will recommend another resection pro­cedure. Sometimes the pathologist wants to biopsy muscle tissue from deeper in the bladder wall. And sometimes the tumor is too large to be safely removed all at once.

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Actos Side Effects : The MRI machine is a big metal box with a tunnel through its middle and a narrow sliding table. You’ll lie on the sliding table, which will move you slowly through the electromagnetic field or “tunnel” of the MRI machine. An MRI can take anywhere from 15 to 45 minutes. Some MRI machines are closed cylinders; others have wider tunnels and open sides to reduce the claustrophobic feelings that some peo­ple experience. If you suffer from claustrophobia – the fear of close or enclosed spaces – you should warn your doctor that you might not be comfortable having an MRI scan.

You’ll wear a gown, and as with the CT scan, the radiology techni­cians leave the room during the scanning process, but you’ll be able to communicate with them through an intercom. Sometimes a friend or relative is permitted to sit in the room with you, particularly if you are claustrophobic. Sometimes if you are claustrophobic a gentle sedative is used to help you to feel comfortable in the machine. Sometimes a contrast medium is used, usually intravenous, in which case you might experience a cool sensation. YouTl be asked to remain very still for short periods while the images are being taken, usually anywhere from a few seconds to a few minutes at a time. You’ll be able to move slightly between “takes” or images.

Other than what many patients describe as a “closed-in” feeling, the single most uncomfortable part of an MRI is not being able to move about. Sometimes you’ll also hear a banging sound as the scans are being taken. This can be surprisingly noisy. Many physicians feel that the MRI scanner is a useful alternative to the CT scanner, but results can be more difficult to interpret when the MRI scan is focused on the back of the abdomen, the pelvis, and bladder, so generally CT scans are more frequently used.

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Usually performed under general anesthesia in a hospital, a biopsy via a rigid cystoscope allows the physician to examine your bladder manually for any abnormalities (again, by inserting a finger into the rectum and feeling the local tissues) and then to remove small amounts of tissue. These can then be examined microscopically and used to confirm the presence of cancer and the invasiveness of the disease, as well as to help determine the appropriate treatment.

Sometimes, in the case of small or superficial tumors, the physician will remove the entire tumor and surrounding tissue for biopsy. As with all surgeries or invasive procedures, a biopsy may involve some pain as well as a brief recovery time that might call for some limita­tions on physical activities for a day or two. The urologist will pre­scribe pain-relieving medication to reduce the severity of discomfort.

A chest x-ray is a type of x-ray process that takes about 10 min­utes. You’ll wear a gown and remain standing during the x-ray. The radiology technician will ask you to stand in several positions and will take x-rays of the chest area. It’s a painless process and doesn’t require that you inject or drink any contrast medium. This test can indicate whether the cancer has spread to the lungs and also can reveal other, unrelated medical conditions, such as a chest infection. A bone scan uses a very small amount of a radioactive tracer injected into the bloodstream. Bone absorbs the tracer, which gives off gamma rays; these are then scanned to identify areas of abnormality. The purpose of this test is to monitor for the presence of cancer metastases in the bones, but it can also detect infection or arthritis sometimes.

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It’s a time-consuming test. It takes about three hours for the bone to absorb the tracer after it’s injected into your vein (usually in an arm). What usually happens is that after the tracer is injected, you’ll leave for a few hours or wait in the waiting room. (Bring a book.) The scan itself will take about an hour. For the scan, you’ll lie on a stationary table while a big cylinder ~ actually a gamma camera – moves up and down the table taking pictures. The cylinder doesn’t enclose you to the extent that an MRI machine does and usually doesn’t provoke a claustrophobic feeling. As with a CT or MRI scan, you’ll lie on a table, wearing a gown, and will have to remain still when the gamma camera is clicking away, sometimes for several minutes at a time. You’ll be asked to change positions several times during the scan, a welcome relief after you’ve had to remain motionless.

Sometimes tests on the urine are done to determine the presence of biomarkers. These are proteins that may be liberated by bladder-cancer cells into the urine. One example is the NMP22 or Bladder Check test For this, a few drops of voided urine are tested chemically on a glass slide. Some physicians believe that the NMP22 is more sensitive and more accurate than the more conventional cytology test, in which urine is examined for cancer cells under a microscope.

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Actos Side Effects atients sometimes describe feeling some abdominal pressure or discomfort, but not pain, during the flexible cystoscopy procedure. You will be awake, wearing a gown and lying on an examining table, with your knees draped and held apart. As noted above, your doctor will use anesthetic gel to numb the area where the flexible tube is inserted and then gently guide the cystoscope into the urethral open­ing (the eye of the penis in a man; the vaginal outlet of the urethra in a woman). Some men experience brief pressure and discomfort as the cystoscope passes over the area where the prostate is located. In most cases, the entire process, including preparation, will take about 15 to 20 minutes, and your doctor will be able to discuss the results of the flexible cystoscopy with you immediately.

The rigid cystoscopy is sometimes done when the tumor is in an inac­cessible part of the bladder as well as when a more complicated biopsy is needed. It is performed in a hospital setting and can be either an inpatient or outpatient procedure. While the process is similar to flex­ible cystoscopy, you will be given general anesthesia and a more rigid tube will be used. Your doctor will give you specific instructions about how to prepare for the anesthesia (you will need to have someone drive you to and from the hospital) and what to expect during the brief recuperation after the procedure. You may be asked to remain overnight if you have other medical problems, such as severe heart disease.

During the IVP, you’ll be lying on a flat table, wearing a hospital gown, with the x-ray machine positioned above you on a movable jointed arm. The radiologist will take some basic x-rays and then will inject a contrast substance (usually iodine) through a vein, usually in your arm. The iodine is carried by the blood system to the kidneys, where it is removed (excreted into the urine). The iodine shows up when exposed in an x-ray. You might feel a sense of heat or burning from the iodine or have a metallic taste in your mouth. However, these sensations usually dis­appear after a few minutes. If you know that you are allergic to iodine, let the radiologist know and a different contrast material can be used.

As the iodine travels through your urinary tract system, a quick series of x-rays is snapped. Sometimes the radiologist will apply a gentle compression elastic band around your body to help the visual­ization process. You may be asked to turn over and might even be asked to empty your bladder. (The iodine should not cause any discoloration of your urine or any pain or burning during urination.) The x-rays taken before the iodine was injected and those taken after provide images for your doctor that give a visual picture of the ureters (the tubes between the kidneys and bladder) and the bladder’s anatomy and function.

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The technologist then moves a transducer (an imaging gadget shaped somewhat like an oversized electric shaver with a flat head) over the area where the bladder is located. You probably will be asked to change positions or even to hold your breath for a few seconds during the process. The technologist watches on a screen to make sure that clear images are being recorded.

If any of the tests suggest the presence of a bladder tumor, your doc­tor will schedule other tests; they might include an MRI or a CT scan, and if a biopsy was not obtained during the flexible cystoscopy process, a surgical biopsy as well. These tests help your doctor deter­mine where the tumors are, what type of cancer you have, and whether the cancer has invaded the muscle wall of the bladder. Depending on the results of those tests, your doctor may order a chest x-ray or even a bone scan to determine whether the cancer has spread to other areas of the body.

A CT scan is a painless, noninvasive test during which low intensity x-rays are repeatedly passed through the body’s soft tissue at differ­ent angles. A computer then processes the x-rays to show a detailed cross-section of the tissues and organs – in your case, of the bladder, liver, spleen, abdominal lymph nodes, and surrounding tissues. Sometimes the scanner will be focused on the chest and lungs to see whether cancer has spread there. From the CT scan, your doctor not only can confirm the presence of a tumor in the bladder, but can also measure its size and location, and determine whether it has spread to other nearby tissue.

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The CT scanner can snap about 32 cross-section pictures or “slices” in approximately 10 seconds as the machine moves over your body. This means that you can easily hold your breath as the images are taken. For the CT scan, you’ll be lying on a table, dressed in a gown, and while you’ll be able to talk with the radiology technicians at all times over an intercom, you’ll be alone in the room and asked to lie still and hold your breath while the actual x-rays are being taken.

Like the IVP, a contrast medium is used to help the radiologist see your bladder and urinary tract. Sometimes it may be injected into the veins, as in IVP, or it may be swallowed or sometimes administered as an enema to distinguish bowel tissue from the bladder structure. Usually when diagnosing bladder cancer, doctors will want all three – intravenous, oral, and rectal scans – to help determine how deeply tumors may have invaded the bladder tissue and whether there is any spread to the abdominal lymph nodes or liver.

Some people find the taste of the contrast medium unpleasant, and if an enema is required, you’re likely to feel a brief, uncomfortable fullness while the scans are being taken. However, because of the speed of the process, the feeling that you need to expel the contrast medium doesn’t last long. You might also feel a brief flush or hot sensation when the contrast medium is injected. A CT scan takes anywhere from 5 to 30 minutes. Other than mild discomfort, there are few side effects.

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Actos Side Effects : The most significant factors that put you at high risk of developing bladder cancer are age, sex, history of exposure to cigarette smoke, and occupation. Men are at much higher risk for bladder cancer than women, although it’s not known why; it strikes men three to four times as often as it does women. However, recent statistics show that the disease appears to be rising among women.

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If you were raised by smokers or live in a house with smokers, you may be at risk, as are those who are current or former smokers. To a lesser extent, smoking pipes or cigars also carries a risk. Snuff and chewing tobacco have not been linked to bladder cancer. The risk of bladder cancer quickly drops when you quit smoking. However, as an ex-smoker you remain at risk because it can take 20 or 30 years for bladder cancer to manifest itself. Certain variables, such as how deeply you inhaled cigarette smoke and how long you smoked, can elevate or reduce your risk.

Occupational exposure to certain chemicals accounts for up to 20 percent of bladder cancers. Some of those chemicals, such as the benzidine used in the textile dye and rubber-tire industries, have been banned in the workplace. Other suspected carcinogens (cancer- causing substances), such as 4-nitrobiphenyl, 2 -naphthylamine, and 4-aminobiphenyl, are still in use, however, and have led to some occupations being earmarked as high or moderate risk for bladder cancer. Workers at risk among those occupations include;

•   Laborers in textile dye, rubber, and chemical industries with exposure to aromatic amines

•    Some pharmaceutical or pesticide manufacturers

•   Workers employed in coal or gas production

•   Painters

•   Truck drivers

•   Hairdressers

•    Sewage workers

•   Metalworkers in the aluminum, iron, and steel industries

Other risk factors include chronic urinary tract infections, exposure to cyclophosphamide or ifosfamide (chemotherapy drugs used for certain cancers), and pelvic radiation for cervical cancer. Also, there is a somewhat elevated chance of your developing bladder cancer if a member of your family has had the disease. Although there is evi­dence that saccharin consumption is a risk factor, various studies have failed to find a strong link between caffeine and modem artificial sweeteners. People who consume lots of fluids have been reported to

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After taking a history and performing a physical examination, among the first steps most physicians take in diagnosing bladder cancer are a urinalysis and some or all of the following tests: intravenous pyelography (IVP), an ultrasound, and x-rays, followed by a flexible cystoscopy.  Typically the IVP and ultrasound are the first steps in the diagnos­tic process. However, in some circumstances, doctors prefer to perform the flexible cystoscopy first. Sometimes your family doctor will schedule these tests (although it is the urologist who performs a cystoscopy, if needed); sometimes your doctor will refer you to a urologist for all the tests. It’s not impor­tant from your standpoint whether the urologist or family doctor does the tests, so long as the tests are completed

When you are referred to a urologist, he, too, will take a history and perform a careful physical examination. He may then suggest a flexible cystoscopy. This is a procedure that allows the urologist to look around inside your bladder for the presence of small tumors or abnormalities without doing an invasive, or surgical, procedure. Hexible cystoscopy is usually performed in your physician’s office under local anesthetic, although in some cases, it’s preferable to conduct a similar procedure, called a rigid cystoscopy, under general anesthesia in a hospital setting.

Cancer has the potential to arise at any part of the urothelial tract (the lining of the bladder, ureters, etc.), so the urologist will carefully examine the whole of the bladder and will sometimes use a different scope – one with a smaller gauge – called a ureteroscope to examine the upper urinary tracts (ureters).This is not a painful procedure and is simply an extension of the cystoscopy, using a slightly different gadget. If your doctor scheduled an IVP first and tumors were observed, the flexible cystoscopy test may be omitted and other tests may be recommended for you as the next step in the diagnostic process.

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Actos Side Effects: The bladder is a balloon-shaped, muscular organ tucked into the pelvis and held in place by fibrous bands and muscle. The bladder is part of a system that includes the kidneys, ureters, and urethra. These work to process the waste products left behind after your body has taken out the nutrients it needs from the food you eat.

The bladder is lined on the inside by a tissue known as “urotheli- um,” the smooth layer that stretches as the bladder fills and prevents excreted material from being reabsorbed into the body. Underneath the urothelium is a mix of fibrous or supporting tissue and muscle, both of which help the bladder to expand (when full) and to contract and excrete urine at the appropriate time.

Not only does the urothelium line the bladder; it also is found as the lining tissue elsewhere in the urinary tract system, including in the ureters (the tubes that drain the kidneys), the urethra (the tube that drains urine from the bladder to the exterior of the body), and parts of the male prostate. Urothelial tissue, too, can sometimes develop cancer­ous changes known as urothelial malignancy. The most common type of urothelial malignancy is “transitional cell carcinoma.” (See Chapter 3.)

It’s important to note that when the urothelial tissue is exposed to cancer-causing substances, such as the breakdown products of ciga­rette smoke, the potential exists for cancerous changes to occur in multiple areas. That’s why when bladder cancer is suspected or con­firmed, the whole urinary tract is screened for the possible presence of other cancerous deposits. Other organs, such as the lungs, liver, skin, and intestinal tract, also process waste. These systems work together to balance the chemicals and water that your body needs to function properly.

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Noticeable blood in the urine is a tricky symptom. It appears in varying colors and at irregular intervals, and as a result, you might overlook its significance or decide to wait and see whether it happens again before checking it out. For example, you may notice blood in your urine or drops of blood in your underwear two or three times in as many days, or you may see it on one occasion but after that your urine appears normal for days or weeks. The same thing can happen with a laboratory urinalysis, where red blood cells may be visible microscopically only intermittently.

You might experience a gush of With the major symptoms bright red blood or notice pink or rusty of bladder cancer acting in brown urine or even little clots of such a variable fashion, blood. To complicate things even appearing in different ways more, foods you eat such as beets or and sometimes disappearing blackberries may produce colored altogether, it’s important to urine, as do a number of medicines, see your doctor immediately food additives, and vitamins.   If you notice blood or what

With the major symptoms of bladder you think might be blood in cancer acting in such a variable fash- your urine. ion, appearing in different ways and sometimes disappearing altogether, it’s important to see your doctor immediately if you notice blood or what you think might be blood in your urine. As with most cancers, the key to successfully managing bladder cancer is detecting it early and starting treatment as soon as possible.

Bladder cancer does not have a long list of symptoms, and many of the symptoms are typical of other, less severe conditions such as infections or benign tumors. Besides blood in the urine, your symp­toms can include pain or burning during urination, a feeling of having to urinate because of an uncomfortable fullness, or the need to get up frequently at night to urinate. You may also have symptoms such as backache, abdominal pain, and unplanned weight loss, or you may feel more tired and achy than usual.

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Actos Side Effects: Saridon (phenacetin) and Cytoxan (cyclophosphamide) are two other substances that can increase your risk of bladder cancer. Phenacetin is a pain medicine that is no longer used that was previously shown to be associated with bladder cancer. Cytoxan is a drug used for chemotherapy that has been associated with bladder cancer. This may sound puzzling as you wonder, “how does one drug used to treat cancer cause another cancer?” Cytoxan itself is not the problem. Most medications are broken down by our bodies into components before being eliminated in our stool or urine. One of the byproducts of cyclophosphamide, called acrolein, can irritate the wall of your bladder, causing a lot of blood in your urine. Over time, this can increase the risk of developing bladder cancer.

A history of radiation therapy for a pelvic cancer may increase your risk of bladder cancer. Radiation has a role in the treatment of prostate, cervical, and ovarian cancers. Although the radiation is focused on the involved organ, the bladder and other surrounding structures also absorb radiation that sometimes damages the urothelium and leads to cancer.

Much attention has been paid to the influence of diet on cancer risk and treatment. Thus far, some scientists have suggested that vegetables, fresh fruits, and some fermented milk products appear to decrease one’s risk of developing bladder cancer. A few foods thought to increase the risk of developing bladder cancer are foods rich in animal fat, diose containing a lot of cholesterol, fried foods, and pro­cessed meat with various additives. We are not sure of the exact influence of diet on bladder cancer at this point in time. Scientists around the world are working on uncover­ing potential links between diet and bladder cancer.

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As with other cancers that affect different body parts, there are multiple types of bladder cancer. To better understand them, let’s separate bladder cancer into two different groups: primary tumors that originate in the bladder and secondary tumors that spread to the bladder from other places. Primary bladder cancers form within the bladder. Over 90 percent of primary bladder cancers in the United States are of the urothelial or transitional subtype. These form along the inner lining of the bladder. The second most common type of primary bladder cancer in the United States is squa­mous cell carcinoma, making up approximately 5 percent of all cancers diagnosed. These are often diagnosed in indi­viduals whose bladder has been chronically irritated by an infection, stones, or an indwelling catheter. The third most common subtype of bladder cancer in the United States is adenocarcinoma, accounting for approximately 2 percent of all diagnosed cases. These typically form near the dome of the bladder. There are other types of primary bladder cancer, but these are very rare. If necessary, your urologist will speak to you about these rare types.

Secondary cancers form somewhere else in the body and spread to the bladder. Other tumors can get to the blad­der by using the bloodstream, your lymphatic system, or directly from an organ close to the bladder. Other cancers that spread to the bladder, in order of decreasing frequency, are melanoma, colon cancer, prostate cancer, lung cancer, and breast cancer. Now that we’ve discussed some of the basics concerning bladder cancer, let’s examine how you should go about choosing a medical team to treat your cancer.

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You want your team to be knowledgeable and experienced in the care of patients with bladder cancer. Don’t rely on self-promoting advertisements on television as your way to select a facility and doctor. While you may seek out a com­prehensive cancer center (look for one accredited by Amer­ican College of Surgeons or National Cancer Institute), the important thing is that you select a facility that has bladder cancer specialists. These include urologists that specialize in cancer surgeries (not general urologists or surgeons who rarely perform cancer-related surgery), medical oncologists who specialize in bladder cancer, radiation oncologists, urologic pathologists, radiologists, genetics counselors, oncology nurses, and psychosocial support staff for cancer patients. It’s a highly specialized group. Your doctors and their staffs can be some of your best resources.

When you see your urologist, ask questions:

•          How many bladder cancer surgeries do you do a year?

•          What other types of surgeries do you do, and therefore how much time do you spend doing bladder cancer treatment?

•          How often do your patients require additional treat­ment such as chemotherapy or radiation after surgery?

•          What is the best urinary diversion option for me (ileal conduit, catheterizable stoma, neobladder) and why?

•          Are you board certified? In what specialty?

•          How long have you been in practice?

•          Do you regularly attend urologic cancer tumor boards to present cases for team discussion?

•          Do you work with a multidisciplinary team of oncolo­gists who also specialize in bladder cancer so that con­tinuity of care can be maintained?

•          What is your philosophy on educating patients about their treatment options?

These are all questions that you have the right to have an­swered before deciding that this doctor is to be your uro- logic oncology surgeon. If he or she hesitates before an­swering, consider that this person may not be the doctor you want to have performing your surgery.

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Actos Side Effects: The urethra is a hollow tube lined with transitional cells at its beginning that connects the bladder to the outside world. The structure of the urethra is different in men and women. The urethra is short in women and is much longer in men due to the presence of the penis. The cells lining the urethra change along its length. The inner cells, closest to the bladder, are transitional cells, whereas the cells closest to the outside of the body are squamous cells resembling skin. Although the urethra has different lengths in men and women, it functions the same. In men, the urethra passes through the prostate gland near the bladder.

The prostate, a walnut-sized organ that lies at the base of the bladder in men, plays a role in male fertility. Along with the seminal vesicles, the prostate gland produces fluid that helps sperm after ejaculation. Although the urethra passes through the prostate, the gland itself does not add much, if anything, to the volume of urine that reaches the bladder. As the urethra passes through the prostate, it is lined by transitional cells comprising the urothelium. Therefore, tilings that affect the urothelium can affect the prostate as well. This is very important when it comes to staging bladder cancer.

Cancer is defined as a group of diseases characterized by uncontrolled growth and spread of abnormal cells. Cells are the small building blocks of our body and most other living organisms. If the spread of these abnormal cells is not controlled, it can result in organ dysfunction and death. There are several cancers, each affecting various portions of the body. Cancer can be caused by external factors like ciga­rette smoking, exposure to certain chemicals, radiation, or infectious organisms. Internal factors that can lead to can­cer include inherited mutations, hormones, and conditions affecting your immune system. Mutations are permanent changes in your hereditary material, and hormones are products of certain cells in our body that influence the function of other cells.

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Although scientists have been able to uncover the cause of some cancers, there is still a great deal to be learned. One may go through his or her entire life without exposure to any of the previously mentioned factors and develop can­cer. Men have a higher risk of developing cancer, with a slightly less than i in 2 lifetime risk in the United States compared with 1 in 3 for women. Although cancer is more common than you may think, doctors have figured out new ways to diagnose and treat cancer. By no means is cancer a death sentence; it can be managed and a lot of people diag­nosed go on to live healthy and productive lives for many years after treatment.

Epidemiology is essentially the study of factors affecting the health and illness of populations. Before moving on with our discussion about bladder cancer, it’s important to gain perspective on how many people live with bladder cancer.

There are over 1 million people throughout the world liv­ing with bladder cancer. Bladder cancer is the seventh or ninth most common cancer, depending on where you live. Most individuals with bladder cancer live in industrialized countries and geographical areas where infection with the parasite Schistosoma haematobium is common. In the United States bladder cancer is the fourth most common cancer in men and the ninth most frequently diagnosed cancer in women. The male-to-female ratio is 3 to 1. Two- thirds of cases are diagnosed in people over age So, but it can occur very early in life. Two times as many whites will be diagnosed with bladder cancer compared with African Americans. The reasons for this are unclear.

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Ludwig Rehn, a German surgeon during the 19th centu­ry, is credited with the first explanation of one of the root causes of bladder cancer. He established a link between exposure to chemicals used in the production of colored textiles and the development of bladder cancer in factory workers. Although his discovery was not initially accepted, bladder cancer was soon recognized as an occupational cancer in factory workers. This may help explain the higher incidence of bladder cancer in industrialized nations. Exposure to a number of chemicals has been associated with the development of bladder cancer. These include ani­line dyes and other members of the aromatic amine family. People who work in occupations where exposure to these chemicals is common include textile workers, dye workers, rubber workers, painters, and even hairdressers.

Smoking is the most common cause of bladder cancer today. It increases your risk of developing bladder cancer 2- to 4-fold compared with people who don’t smoke. The risk of bladder cancer increases with the frequency and duration of smoking. For example, someone who smokes one pack a day for 20 years has a higher risk of bladder cancer than someone who smokes a few cigarettes on week­ends. When you stop smoking you can slowly decrease the risk of bladder cancer, over the course of 20-30 years. If you currently smoke, it would be best to stop smoking.

Chronic inflammation of your bladder may also place you at an increased risk of developing a specific type of bladder cancer called squamous cell carcinoma. Inflammation occurs when one has an untreated urinary tract infection, bladder stones, an indwelling bladder catheter, or an infec­tion with a parasite called Schistosoma haematobium. Para­plegics or quadriplegics who require a catheter to drain their bladders and those who live in areas where S. haema­tobium is common are at greatest risk.

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

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

This can only be answered based on your individual history of cancer care, your health status, and the present state of your cancer. Experimental therapy is just that; it is still in the investigational stage and has not yet been determined whether or not it is completely safe and or effective. A patient may or may not qualify to be in a cancer trial depending on age and other risk factors, stage of cancer, or prior therapy.

During phase 1 of a cancer trial, the safety of the chemotherapy dose is being determined. During the early part of the trial, a lower dose may be used. The dose is gradually increased to determine the potential for side effects. Individuals entering the trial later may receive higher doses, more potentially serious side effects, and not necessarily more effective therapy. During phase 2, it is determined how often a particular cancer will respond to the chemotherapy at a fixed dose regimen. Lastly, during phase 3, the new drug which appears to be effective is compared to the current accepted chemotherapy for a particular cancer.

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This brief review undermines the uncertainty of receiving chemotherapy during an experimental protocol. If the individual needs chemotherapy, it is generally safer and wiser to receive the standard regimen already established as safe and possibly effective. If however, prior standard chemotherapy has proven to be ineffective, or if the patient cannot tolerate standard therapy and the patient’s health allows for additional chemo, enrollment in a chemotherapy trial may be appropriate if the individual qualifies. At times, there can be breakthroughs and new agents can be more effective in eradicating cancer than the established drugs.

Initial side effects experienced by almost all individuals will include nausea and vomiting, diarrhea, mouth ulcers, extreme fatigue, loss of appetite and weight loss, hair loss, and a drop in blood counts. Many of the side effects can be lessened by taking appropriate medication. Long term side effects include low blood count, nerve and kidney damage. Side effects can be severe and potentially life threatening. Death as the result of sepsis from MVAC treatment occurs in approximately 3% of patients. Even if side effects are not severe, chemotherapy may result in the individual rapidly becoming weak and tired, reducing markedly his quality of life. The side effects for the most part are not long lasting with a return to normalcy after chemotherapy has been completed. If you are not tolerating the chemotherapy regimen well, your oncologist can modify the dose, frequency of dosing, or alter the regimen entirely.

When facing the prospects of chemotherapy, it is essential to have an oncologist who can inform you fully of the potential probable effectiveness of the chemotherapy being offered. Just as importantly, the toxicities of the chemotherapy must be fully reviewed. Of course, there are no absolutes when reviewing the potential for success and failure. Each individual’s cancer is unique. Some respond better than others to chemotherapy. General statistics regarding disease regression and remission are available. Absolute numbers for the individual are not.

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After several courses of chemotherapy, an assessment of your clinical progress will be made. This will generally require a study such as a CAT scan, to check the response of the cancer to the chemotherapy. If progress is being made and the individual is tolerating the chemotherapy, a decision is then made to continue the chemotherapy to completion. If on the other hand, the cancer is not responding or the individual is not tolerating the therapy, a decision can be made to stop further chemotherapy, alter the present regimen, or try a different course of chemotherapy.

As new drugs are introduced and new combinations of drugs are tested, statistics regarding effectiveness are constantly changing. Side effects too can vary, depending on the individual. However, most patients will experience the side effects to various degrees, and these need to be fully understood prior to proceeding. In the end, it is the individual’s decision as to whether to begin or end chemotherapy. For many, trying chemo and seeing the effect on the cancer is a sound decision. If the cancer does not respond or if the patient finds the side effects unacceptable, chemotherapy can be stopped. It is extremely important for you to have an oncologist who will work with you closely. Your oncologist should understand your feelings regarding cancer treatment fully.

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Actos Side Effects:Your procedure will likely be scheduled at the hospital surgicenter as an outpatient. Depending 011 the extent of surgery and your general health, you may be required to stay in the hospital afterwards. There will be numerous forms to fill out, including consents for surgery and anesthesia. You will be asked whether or not you have a living will or power of attorney. Both the expected surgery and anesthesia planned will be fully discussed with you, including potential risks and alternatives. Your urologist will perform a history and physical exam to make sure you are fit for surgery. If you have multiple potentially serious medical problems, you probably have already had a pre operative visit with your internist, cardiologist or appropriate primary care physician.

You will be asked whether or not you have any drug allergies, artificial joints, or other medical devices implanted, such as a pacemaker. An IV (intravenous line) will be inserted into a vein in your hand or arm. You will be wheeled on your stretcher to the cystoscopy room and then positioned on the cystoscopy table. Small paste on leads will be placed to monitor your heart and a small device will be clipped over your finger to monitor the level of oxygen in your blood. You will then be given your appropriate level of anesthesia. Depending on the size and location of the tumor(s) and the difficulty of the procedure, your urologist will likely make a recommendation to you regarding the level of anesthesia required. He may give more than one choice. Risks of each will be reviewed with you by the anesthesiologist or nurse anesthetist (a nurse specialized in giving anesthesia).

Local with sedation: a numbing gel is squirted into your urethra and you are given intravenous sedation. Advantages include the lowest level of anesthesia, potentially with the least side effects and risks and quickest post op recovery from anesthesia. Many individuals are concerned they will experience pain. For small tumors and relatively minor surgery, this is an excellent form of anesthesia with very few patients experiencing pain or adverse reactions. If you do experience significant discomfort, your level of anesthesia can be changed to spinal or general.

Spinal anesthesia: accomplished by passing a fine needle into the lower spinal canal and injecting an anesthetic. Advantages include the ability to provide almost complete blockage of all pain and sensation during the surgery. The patient can continue to breathe on his own (a possible advantage for those with lung disease). Disadvantages include the occasional difficulty in giving the spinal (usually done rapidly with minimal pain, but sometimes difficult with pain), slower recovery from anesthesia (the length of spinal anesthetic is based on the amount and type of agent used and can generally be timed to match fairly closely the anticipated length of your procedure) and the possibility of a post spinal headache (not very common, but can last a day or more and be moderate to severe).

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General anesthesia: delivered through IV medications and anesthesia in a gaseous mixture via a mask or endotracheal tube (a tube inserted down your throat into your trachea, your main airway). The choice of mask or endotracheal tube is generally decided by the anesthetist. This decision is based on the length of the anticipated procedure, your general health, and how easy it is to “ventilate” or provide oxygen to you with a mask alone. The advantage of general anesthesia is total blockade of all pain and sensation (you are unconscious). For healthy individuals with large tumors or with expected difficult surgery, this method is often the best form of anesthesia. For those in whom spinal anesthesia is not possible and a large tumor is present, general anesthesia is the best option.

For many years, hospitals required indiscriminate preoperative testing, often including numerous lab studies, chest X ray and EKG. Today, the medical industry is more cost sensitive. Most centers will require only necessary tests based on your age, medical history, and medications. An EKG is often requested for those with heart disease and for individuals over the age of 50. Specific labs are required if you have a chronic illness or are taking medication which can change the bodies normal chemical balance. Reserving blood from the blood bank is rarely required unless you present with a low blood count from hematuria or from another illness.

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The urologist will often start by introducing a rigid cystoscope to examine the urethra and bladder. During the exam, your bladder will be filled with sterile water which travels through the scope. This is necessary to expand the bladder lumen fully, allowing a complete examination. Patients often are concerned too much fluid will be instilled, resulting in possible injury to the bladder or worse, a rupture. Because the water is instilled with only minimal pressure, bladder injury should not be a concern. The urologist can shut off the irrigation readily when the bladder is full and can empty the bladder at any time. After the cystoscopy is completed, the urologist then removes the bladder tumor(s).

If the tumors are small, he may simply use a biopsy forceps through the cystoscope (an instrument which has a small cup like end to remove pieces of tissue). Deep biopsies at the base of the tumor (especially when one is dealing with solid tumors as opposed to papillary variety) may be obtained using the same biopsy forceps. The tumors and deep biopsies are sent to the pathologist for examination. Additional biopsies from any suspicious areas or possibly the prostatic urethra may be done. After the tumor removal and biopsies are completed, electric current is used to stop any bleeding. The urologist steps on a pedal to turn the electric current on when the cable is touching the bleeding blood vessel.

Our use of the term or terms Actos Side Effects 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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