Bladder Cancer and Treatment - Essay Example

CANCER INTRODUCTION -Topic of review and rationale for choice: Age, gender, smoking, chemicals, bladder stone and repeated urinary track infections can cause bladder cancer to which men are more susceptible than women. Frequent urination, blood in the urine, and pain while passing urine, any of these symptoms should raise enough concern to go for a screening. Medical screening and tests, cytoscopy and scans will be able to establish the fact. Surgery, cytoscopy, chemotherapy and radiotherapy should be able to treat the cancer, depending on its stage. Currently there is no reliable screening test available for bladder cancer. Fifth most common cancer in the world today is bladder cancer. According to one study, 13,000 Americans might die from bladder cancer this year. If diagnosed early, the survival rate could be up to 95%. We reviewed the current data regarding the impact of various treatments of bladder cancer starting from understanding the difference between normal and cancer cells and how these cells can multiply. DNA changes and abnormalities have been recognised and efforts are continuously made to predict the prognosis of bladder cancer and its recurring, from these abnormalities. Usually originating in bladder lining, in the transitional epithelial cells or surface cells, this cancer mainly affects older men in industrialised areas. 90% of these are mainly transitional cell carcinomas. At present there exists a plethora of treatment options like surgery, radiotherapy, chemotherapy and various combinations of these treatments. METHOD The research methodology applied for this research is the accepted, simple one. Evidences and research results are searched manually in research books, journals and materials. Material available in books has been accumulated as primary sources. As Secondary sources, Electronic sources and databases are used. Extensive use of the electronic sources like Google search is done. Another separate search is done on Medline, which has proved to be very helpful. Medline yielded a lot of material. But nothing outdated has been chosen. Only current material with absolutely relevant topics is chosen. Concentration is on improved treatment outcome and only such material is reviewed. Method used for the research and collecting the material is Qualitative. Key words used throughout each stage of search: Bladder cancer, aetiology and risk factors, intravesical therapies, pathology, clinical staging, TUR, radiotherapy, chemotherapy, urinary diversion, recurrent bladder cancer, quality of life. The main purpose of reviewing the current data is how to apply the current available research results regarding the aetiology, incidence and prevalence to the treatment of cancer patients. Another reason is to assess the risk factors involved in different treatments. Management of bladder cancer patients is one more purpose of this study. In Asia, bladder cancer is at its lowest and the studies might be able to throw more light on this lower rate of incidence. It is much more common among men above 70 and is highest among Caucasians compared to African Americans and Hispanics, according to Urology Channel, 2005. This information might not have much consequence on the treatment and management of the disease; but could be of greater significance for further investigative causal research. Cigarette smoking causes 50% of the bladder cancer cases. Exposure to carcinogens and anti-neoplastic drugs could be another reason. Researches are still establishing the genuine causes and possible reasons. This material was chosen for review because of its relevance and importance. Bladder cancer is spreading in the industrialised nations and the treatment is not always successful. Quality of life and management sometimes are painful. Finding the best treatment would help not only cure, but also quality of life in advanced stages of the disease. It would be useful for fully and partially cured patients too. REVIEW There are many known causes for bladder cancer. Industrialised nations seem to be at a higher risk with the polluted atmosphere and harmful chemicals. "Those workers with recurrent and early exposure to hair dye, and exposure to dye containing aniline are at an increased risk. The following workers are at increased risk: hairdressers, machinists, printers, painters, truck drivers, workers in rubber, chemical, textile, metal, and leather industries. (medNews, 2005). There are also food habits involving the family history that could be equally harmful. "The other risk factors include age, chronic bladder inflammation, diet high in saturated fat, exposure to second-hand smoke, external beam radiation, family history of bladder cancer, and treatment with drugs like cyclophosphamide (urology channel, 2005.) All research does not accept the role of HPV in transitional cell carcinoma of the bladder. Schistosomiasis is the second most prevalent tropical disease in the world and the urinary tract schistosomiasis could lead to renal failure. Cellular Classification of bladder carcinomas 1. More than 90% - are transitional cell carcinomas derived from the uroepithelium. 2. 6% to 8% - are squamous cell carcinomas. 3. 1% - are adenocarcinomas. (They maybe of urachal or nonurachal origin). The nonurachal type might arise from metaplasia of chronically irritated transitional epithelium. (medNews, 2005 ) 4. The rest is undifferentiated carcinomas. Naturally every patient wants to get cured and receive the best treatment possible. Research sometimes reaches an unfortunate state of confusion, not knowing the best treatment until it is proved. Some of the established treatmental theories get demolished with further research. Research trials, clinical research for comparison of methods of treatment (Randomised Controlled Clinical Trial, for example), are being continuously conducted, side effects and effectiveness are being assessed, so that the best treatment could be standardised. New methods of treatments are always tested for efficiency. Patients would be asked for their consent and if they do not like to do so, they are given the best available conventional treatment. Mostly patients do participate, trying to help themselves, as well as the future patients. "The cure for bladder cancer will come with a thorough understanding of how the disease affects the human body, as well as a complete map of the body's defences against disease invasion. Intense focus on the cellular changes that occur with the introduction of various forms of therapy is crucial to understanding the disease process, and, ultimately, conquering it," http://blcwebcafe.org/nbcrc.asp Efforts are being made for Early Detecting Screening and one such research is attempting to isolate and identify of tumor-specific proteins in urine as bladder acts as a reservoir of exfoliated cells and proteins. Drs. Getzenberg and Dhir are trying to establish the utility of bladder cancer specific protein, BLCA-4 that had been previously identified by Dr.Getzenberg's research group. http://www.upci.upmc.edu/report/Clinical/pucp/bladder.html Bladder cancer always carries the risk of recurrence and research is continuing to reduce or stop the risk. "Researchers are currently studying some vitamins, such as vitamin C and vitamin A-like drugs such as nonsteroidal anti-inflammatory drugs such as celecoxib (Celebrex) that may be useful in preventing these new cancers from developing," http://www.cancer.org/docroot/CRI/content/CRI_2_4_6X_Whats_new_in_bladder_cancer_research_and_treatment_44.aspsitearea In December 2005, Wu, Li, Chen, Cao, Li, Wang, Yang, Qian, Liu, Li, Zhou conducted a case control study: "The case-control study was aimed to detect the single nucleotide polymorphisms (SNPs) in JWA promoter region, to assess the effect of SNP on transcriptional activity, and to probe the relationship between SNP and the risk of bladder cancer," http://www.psychiatry24x7.com/medline/details.jhtmlid=16331563&product=none Turyn, Matuszewski and Schlichtholz are conducting a study in January 2006, on microsatellite alterations that are a common feature of neoplastic cells. "Our study aimed to compare the profile of microsatellite DNA alterations in tumour tissue and urine sediment at 12 selected microsatellite loci in transitional cell carcinoma of the bladder, and to determine which of the 12 markers or combination of markers has potential for the non-invasive diagnosis of bladder cancer. DNA alterations were examined using microsatellite markers on chromosomes," abstract: http://www.psychiatry24x7.com/medline/details.jhtmlid=16328066&product=none Cancer research is going on all over the world and bladder cancer is given serious attention by researchers. Delayed surgery in bladder cancer is not harmful, says The Journal of Urology: "Contrary to several recent reports, delaying bladder cancer surgery for several weeks after diagnosis does not worsen a person's prognosis, Swedish investigators report in the Journal of Urology. The author of a related editorial, however, contends that the sooner the surgery is performed, the better," http://www.nlm.nih.gov/medlineplus/news/fullstory_28243.html There are recent news items like: 1. Florescence guiding reduces recurrence of early bladder cancer. (Journal of Urology, 30.11.2005) 2. Marker in urine may detect bladder cancer (Journal of American Medical Association, 26.10.2005) 3. Spread of bladder cancer to Lymph or blood vessels linked to worse prognosis; (Journal of Clinical Oncology, 22.9.2005) 4. Urine test promising for detection of Bladder cancer recurrence (The Journal of Urology, 12.9.2005) 5. Uncertain whether P53 predicts Bladder Cancer prognosis (The Lancelot Oncology, 6.9.2005) Based on http://www.researchforacure.com/cancernews.aspxsection=cancernews&display=summary&cid=11,12,152,13,14 Michael O'Donnell insists that combination therapy of interferon-alpha and BCG is the therapy of the future. His argument is that BCG used alone is not effective in treatment and the same goes to interferon-alpha used alone. But the combination, from the tests conducted till now, seems to be highly effective. O'Donnell's research trial is believed to be the first to indicate that the combination therapy of interferon-alpha and BCG works for people with aggressive forms of bladder cancer" http://www.uihealthcare.com/depts/med/urology/research/bladdercancer/uibladdercancer.html "Research has increasingly demonstrated that many of the factors responsible for the development of cancer are so interwoven with the fabric of our industrialized society that the removal or modification of all of the known etiologic factors could require the society to use a significant level of its resources for this purpose," says Connolly (1981, p.2). More research is being conducted on two rare varieties, Urachal Carcinoma (resembles colon cancer) and Small cell bladder cancer (resembles small cell lung cancer) and it is known that patient data leads to unusual conclusions. It is also established that removing urachus with belly button after chemotherapy helps. But chemo on its own does not help in urachal carcinoma (a very rare type, but on the increase at the moment). Four chemotherapy drugs have shown a response rate of 40%. These drugs are used in colon cancer too. Small cell bladder cancer responds to chemo on its own and combined with other therapies. There are more information about the vitamins and their benefits. "One form of vitamin E appears to offer protection against development of bladder cancer, while the second form has no beneficial effect, says a team of researchers led by M.D. Anderson," http://www.cancerwise.org/september_2005/display.cfmid=6d12d67c-7f56-4e51-a3dfc099c6431ce6&method=displayfull&color=red "This improvement in survival encourages the use of platinum based combination chemotherapy for patients with invasive bladder cancer" (Advanced Bladder Cancer overview collaboration, Neoadjuvent chemotherapy for invasive bladder cancer [review 37], Cochrane Database of Systematic Reviews (2), CD005246, 2005, Journal Article, Meta-Analysis Review). "Response rates to second-line therapy in phase II trials are similar to those seen for other cancers that are more commonly retreated. In addition, data suggest that patients who respond to second-line therapy consistently survive longer compared with non-responders, and, perhaps more importantly, symptomatic benefit may be obtained from second-line therapy, [Reference: 46] (review of second-line chemotherapy for advanced gastric adenocarcinoma [Review] [46 refs], Clinical Oncology, Royal College of Radiologists, 17(2); 81-90, 2005 Apr.) The following research abstract is collected from Ovid Medline : M.P. Porter, J.T. Wej and D.F. Penson, Department of Urology, University of Washington, 32(2); 207-16, 2005 May. They are conducting research regarding HRQOL outcomes in bladder cancer patients undergoing cystectomy. C.A. McBain CA and J.P. Logue, of Academic Department of Radiation Oncology, Christie Hospital NHS Trust, Manchester M20 4BX, UK, are conducting research on Radiation therapy for muscle-invasive bladder cancer Treatment planning and delivery in the 21st century [Review] [62 refs] Seminars in Radiation Oncology, 15(1); 42-8, 2005 Jan...." "we aim to present a practical overview of radiation protocols for bladder cancer, covering issues relating to patient selection, choice of target volumes, verification, dose, and fractionation. Alternative methods of improving treatment accuracy such as image-guided radiotherapy and intensity modulated radiotherapy are also discussed," [References: 62], Journal Article, Review, Review, Tutorial. Slama M. Pevromaure et al, Department of Urology, Cochin Hospital, Paris, France: Research on Concurrent chemoradiotherapy for clinical stage T2 bladder cancer, Urology, 63(1); 73-7, 2004 Jan. "Conclusions: In our experience, concurrent chemoradiotherapy is less effective than primary cystectomy for clinical Stage T2 bladder cancer. This treatment may be unwarranted in patients with concomitant carcinoma in situ at the first resection," [References: 19], Evaluation Studies Journal article Review. Review Tutorial. W. Sun and D.J. Vaughn, Dept. of Medicine, University of Pennsylvania School of Medicine, Philadephia. Title: Adjuvant chemotherapy for muscle-invasive bladder cancer. Source: Seminars in Urologic Oncology. 19(3); 186-93, 2001, Aug. "The curability of bladder cancer is directly related to the pathologic stage of the primary tumor. If extravesical extension or lymph-node metastases are present, the risk of metastitic progression is significant. Adjuvant chemotherapy has been proposed for these patients in an attempt to reduce the probability of relapse and to improve survival. Ongoing and future trials should further define the role of adjuvant chemotherapy in bladder cancer treatment," (Journal Article. Review. Review, Tutorial). A. Irie, Dept of Urology, Kitasato University School of Medicine, Kanagawa, Japan. Title: Advances in gene therapy for bladder cancer. Source: Current Gene Therapy. 3(1); 1-11, 2003 Feb. "Various strategies are applied for improving the transduction efficacy of the therapeutic genes into the bladder cancer cells. These strategies include the modification of adenoviral fibers, cotransduction of the materials for enhancing the viral infectivity, and disruption of the GAG layer," [references: 88]. (Journal article Revew. Review Tutorial). The most common and traditional way of treating the cancer, in spite of extensive research, still remains TUR and fulguration. Transurethral resection, over the years, had shown the best and durable way of managing all the superficial tumours. Bladder cancer treatment is plagued by high rate of recurrence and the results are seen as shortlived. Researchers and doctors still stand by the intravesical Bacille Calmette-Guerin (BCG) for eradication of recurrence, as this treatment has shown the least rate of recurrence. Radiotheraphy remains the highly accepted mode of reduction of discomfort and vastly aclaimed treatment in the non-surgical segment. No doubt, invasive and uncontrollable tumours do require cystectomy till some other extensively proven alternative surfaces. For patients suffering from bladder cancer of highly advanced stage chemotherapy combinations have been recently proving more effective. There are clear indications that survival rates are higher from adjuvant chemotherapy. Research data is still insufficient on this matter, so that a definite conclusion could not be drawn. APPLICATION TO CLINICAL PRACTICE As mentioned earlier, there is inadequate data about a best definite treatment, as compared to other modes of treatment. There is a deplorable lack of data about other areas of bladder cancer too. National Cancer Institute gives very important information on causes, symptoms, screening, diagnosis, treatment and rehabilitation and further suggestions to lead a normal life, to people with Bladder cancer and those around them. This is the fourth most common cancer and is widely rampant. "Research is increasing what we know about bladder cancer. Scientists are learning more about its causes. They are exploring new ways to prevent, detect, diagnose and treat this disease. Because of research, people with bladder cancer have an improved quality of life and less chance of dying from this disease," http://www.cancer.gov/cancertopics/wyntk/bladder As TUR surgery seems to be one of the best treatments, many patients are made to undergo this surgery by passing cystoscope through the urethra into the bladder. The cancerous part could be removed completely by resectoscope and fulguration method is applied for burning remaining cancer cells that could cause a recurrence. In spite of this method, nearly 68% recurrences occur and could be treated by repeating the procedure. Catheter has to be used for stopping bleeding and also to stop urethra being blocked till these after effects are left behind. "Like many other sites of cancer, there has been a development of regimens that allow for a higher quality of life after the treatment is completed. The exact method of treatment should be chosen individually by the patient, after discussing it with a team of physicians adept at treating bladder cancer, to maximize chance of cure and function," http://www.oncolink.com/types/article.cfmc=21&s=66&ss=768&id=9464 Several trials are now going on testing these new agents alone or in combination with chemotherapy in bladder cancer patients. The integration of these newer biologic agents probably to supplement rather than to supplant chemotherapeutic drugs, should be a primary direction of research with the objective to interfere with multiple aspects of bladder cancer progression. However, the value of integration of biologically targeted agents into combined modality treatment for patients with bladder cancer has still to be proven. Journal Article, Review. Review, Tutorial. The best approach to cancer care is multidisciplinary. Results have not been highly encouraging. The most conservative treatment of tumours still remains transurethral resection and fulguration. Tumour recurrence seems to be reducing after treatment with intravesical Bacille Calmette-Guerin (BCG). Cystectomy and Radiotherapy both are being conducted as part of the accepted treatment. Adjuvant chemotherapy after surgery/chemotherapy has been quite successful and has given a lot of hope. Combination chemotherapy seems to be effective; but a lot has to be done in this direction to prove it effectively. Most of the studies show contradictory information and there has not been much advance in the quality of life. BIBLIOGRAPHY: 1. Arrand, J.R. and Harper, D.R. (1998), ed., Viruses and Human Cancer, Bios Scientific Publishers, Oxford. 2. Beyers, Marjorie, Werner, June and Durburg, Suzanne (1984), ed., Complete Guide to Cancer Nursing, Edward Arnold, London. 3. Capen, C.C., Dybing, E., Rice, J.M. and Wilbourn, J.D. (1999), ed., Species Differences in Thyroid, Kidney and Urinary Bladder Carcinogenesis, International Agency for Research on Cancer, Lyon. 4. Cooper, E.H. and Williams, R.E. (1975), ed., The Biology and Clinical Management of Bladder Cancer, Blackwell Scientific Publications, Oxford. 5. Connolly, John G. (1981), Progress in Cancer Research and Therapy, Vol. 18, Carcinoma of the Bladder, Raven Press, New York. 6. Greaves, Mel (2000), Cancer, The Evolutionary Legacy, Oxford University Press. 7. Grant, Marcia M. and Padilla, Geraldine V. (1990), Cancer Nursing Research, A Practical Approach, Appleton & Lance, Norwalk, Connecticut. ONLINE SOURCES: 1. http://www.cancer.org/docroot/CRI/content/CRI_2_4_6X_Whats_new_in_bladder_cancer_research_and_treatment_44.aspsitearea= 2. http://www.psychiatry24x7.com/medline/details.jhtmlid=16331563&product=none 3. http://www.nlm.nih.gov/medlineplus/news/fullstory_28243.html 4. http://www.researchforacure.com/cancernews.aspxsection=cancernews&display=summary&cid=11,12,152,13,14 5. http://blcwebcafe.org/nbcrc.asp 6. http://www.upci.upmc.edu/report/Clinical/pucp/bladder.html 7. http://www.cancerwise.org/september_2005/display.cfmid=6d12d67c-7f56-4e51-a3dfc099c6431ce6&method=displayfull&color=red 8. http://www.oncolink.com/types/article.cfmc=21&s=66&ss=768&id=9464 9. , Read More