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Bladder Maintenance Theraphy

All discussions relating to bladder cancer symptoms, diagnosis, treatment and prognosis

Bladder Maintenance Theraphy

Postby Nulty » Sun Apr 17, 2016 5:38 am

What is Maintenance theraphy?

How often it is given?

Cystscope every 3 months, Will there be always Maintenance theraphy in Superficial Non-Invasive Bladder cancer(Carcinoma in site)

ANSWER: Has, I assume from you question that either you or someone you know has had a superficial bladder tumor.  These are prone to recur and sometimes in a more malignant and invasive form.   The usual routine is to periodically cystoscope such patients.  (This is more accurately termed ongoing "surveillance" and not "maintenance").  The whole purpose cystoscopy is to detect recurrences at an early stage where the are more curable by minimal surgery.  Cystoscopy is generally done every 3 months for the first 2 years.  If the patient has no recurrence, it is performed every 6 months until 5 years after diagnosis and then yearly thereafter.  If there is ever a recurrence, the cycle of 3 quarterly cystoscopies starts over.  To follow is a "macro" I have written on bladder cancer that might be useful for you.

Bladder cancer is the 4th most common cancer in men and the 8th highest in females.  The incidence of this neoplasm increases with age and is 2-3 times more common in men than in women.  This cancer originates in the lining of the urinary bladder and accounts for 90% of cancers that occur in the lining the entire urinary tract.  The patient will typically present with the gross passage of blood in the urine or with irritative urinary symptoms.  The diagnosis is generally made by cystoscopic examination of the bladder which shows the typical cauliflower like tumor(s) on a pedicle of varying thickness.  Some tumors may be more solid and broad based.  These tend to be more aggressive and have a worse prognosis.  Although the gross appearance is characteristic, biopsy is needed to confirm the diagnosis and to evaluate the grade and stage of the tumor.  The grade is based on microscopic examination of the cancer cells and varies from one for the least to 4 for the most malignant.  The stage measures the depth of penetration into the balder wall and is classified similarly.  After the diagnosis is established, and depending on the grade and stage, other test may be needed to evaluate the extent of the tumor such as CT or MRI scans of the abdomen and pelvis.  Low grade noninvasive tumor are usually cured by TUR(transurethral resection) of the tumor.  High grade or stage tumors may require more intensive therapy such as radiation, chemotherapy or radical surgical removal of the bladder.  Even low grade tumor have a tendancy to recur so life long periodic evaluation is necessary to try and detect recurrences early.  Sometimes, especially in a patient with multiple tumors on presentation or many recurrences, instillation of medication into the bladder is used to try and prevent such episodes.  Some of the agents used for this include BCG, mithramycin, thiotepa, etc.  Good luck.

---------- FOLLOW-UP ----------

Thanks . This is to do with me. If 2 surgery done TURBt.

1 st one Turbt done July . Then 6 BCG .2nd surgery done November. Now check up in February. What are the chances of having another treatments or surgery?  What should be done  not to have this Tumours again?

Thanks
Nulty
 
Posts: 51
Joined: Fri Feb 07, 2014 11:48 pm

Bladder Maintenance Theraphy

Postby Haley » Sun Apr 17, 2016 11:51 am

What is Maintenance theraphy?

How often it is given?

Cystscope every 3 months, Will there be always Maintenance theraphy in Superficial Non-Invasive Bladder cancer(Carcinoma in site)

ANSWER: Has, I assume from you question that either you or someone you know has had a superficial bladder tumor.  These are prone to recur and sometimes in a more malignant and invasive form.   The usual routine is to periodically cystoscope such patients.  (This is more accurately termed ongoing "surveillance" and not "maintenance").  The whole purpose cystoscopy is to detect recurrences at an early stage where the are more curable by minimal surgery.  Cystoscopy is generally done every 3 months for the first 2 years.  If the patient has no recurrence, it is performed every 6 months until 5 years after diagnosis and then yearly thereafter.  If there is ever a recurrence, the cycle of 3 quarterly cystoscopies starts over.  To follow is a "macro" I have written on bladder cancer that might be useful for you.

Bladder cancer is the 4th most common cancer in men and the 8th highest in females.  The incidence of this neoplasm increases with age and is 2-3 times more common in men than in women.  This cancer originates in the lining of the urinary bladder and accounts for 90% of cancers that occur in the lining the entire urinary tract.  The patient will typically present with the gross passage of blood in the urine or with irritative urinary symptoms.  The diagnosis is generally made by cystoscopic examination of the bladder which shows the typical cauliflower like tumor(s) on a pedicle of varying thickness.  Some tumors may be more solid and broad based.  These tend to be more aggressive and have a worse prognosis.  Although the gross appearance is characteristic, biopsy is needed to confirm the diagnosis and to evaluate the grade and stage of the tumor.  The grade is based on microscopic examination of the cancer cells and varies from one for the least to 4 for the most malignant.  The stage measures the depth of penetration into the balder wall and is classified similarly.  After the diagnosis is established, and depending on the grade and stage, other test may be needed to evaluate the extent of the tumor such as CT or MRI scans of the abdomen and pelvis.  Low grade noninvasive tumor are usually cured by TUR(transurethral resection) of the tumor.  High grade or stage tumors may require more intensive therapy such as radiation, chemotherapy or radical surgical removal of the bladder.  Even low grade tumor have a tendancy to recur so life long periodic evaluation is necessary to try and detect recurrences early.  Sometimes, especially in a patient with multiple tumors on presentation or many recurrences, instillation of medication into the bladder is used to try and prevent such episodes.  Some of the agents used for this include BCG, mithramycin, thiotepa, etc.  Good luck.

---------- FOLLOW-UP ----------

Thanks . This is to do with me. If 2 surgery done TURBt.

1 st one Turbt done July . Then 6 BCG .2nd surgery done November. Now check up in February. What are the chances of having another treatments or surgery?  What should be done  not to have this Tumours again?

Thanks
Haley
 
Posts: 58
Joined: Thu Jan 02, 2014 8:56 pm

Bladder Maintenance Theraphy

Postby Sherlock » Sun Apr 17, 2016 5:42 pm

Has, as you already have had one recurrence, it is most important to having ongoing surveillance cystoscopies as outlined in my initial note to you.  The purpose, of course, is to detect recurrences early so they can be removed transurethrally.  

The periodic instillation of BCG(Bacillus Calmette-Guerin) into the bladder is the most form of preventative treatment.  BCG was initially developed as a vaccine for tuberculosis and is actually an altered form of the bovine TB bacteria.  Although it did not work successfully in preventing TB, the vaccine was found to have anti-tumor properties against a variety of neoplasms, most prominently bladder cancer.  This is a type of "immunotherapy".  There is a specific bladder condition termed CIS(carcinoma-in-situ).  This is a diffuse flat spreading type of cancer of the bladder lining that has a tendency to become invasive. BCG is the specific first line of treatment for this condition.  BCG is also used to  prevent recurrences and invasion of bladder tumors in general.  It is 60-80% effective.  There are many different types of treatment schedules for using BCG none but has proven overall superiority.   Most urologists use a 6 week priming course of treatment followed by monthly maintenance instillations for 6-12 months or longer.  Of course, re-evaluation of tumor status by periodic cystoscopic evaluation is essential.  An initial poor response to intravesical BCG therapy, does not rule out future attempts at re-treatment as many patients respond to subsequent courses of this therapy.  If these fails, the intra-vesical instillation of other anti-tumor agents such as Mitomycin C, Thioitepa, Adriamycin & Epirubicin may be of benefit.

As previously mentioned, if you ever develop high grade and/or invasive tumors, radiation therapy or radical removal of the bladder have to be considered.  However, most patients have low grade non-invasive tumors that can be handled conservatively in the manner described above.  Good luck.  
Sherlock
 
Posts: 56
Joined: Sun Feb 09, 2014 3:38 am


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