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Actos and Bladder Cancer : Bladder cancer treatment can include surgery, chemotherapy, radiation therapy, and immunotherapy. Although some of these treatments are used alone, often a combination of several treatments (i.e., both chemotherapy and surgery) is used for the most success. Selection of the most appropriate treatment is based on clinical staging, including pathological and ra­diographic information, and individual preference in close consultation with your physician. When choosing a blad­der cancer treatment, it is important that you consider not only the potential for cancer cure but also the side effects and quality of life impact of various treatments.

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SURGICAL TREATMENT

Surgery plays an important role in both the staging and subsequent treatment of bladder cancer. Transurethral resection of a bladder tumor (TURBT) is the initial treat­ment step in the vast majority of patients with bladder cancer. TURBT provides valuable staging information, and pathological results from these procedures are used to make further decisions regarding what, if any, addi­tional therapy is needed. The gold standard treatment for muscle-invasive bladder cancer is radical cystectomy (removal of the bladder). Advances in surgical technique and anesthesia have reduced the complications associated with this procedure in the last two decades. The develop­ment of continent urinary diversion, which allows one to empty the bladder through the urethra, is an option for certain patients. Minimally invasive procedures such as laparoscopic or robotic-assisted radical cystectomy may also be treatment options. In addition, bladder-sparing procedures (either with partial removal of the bladder or aggressive TURBT frequently in combination with che­motherapy and/or radiation therapy) have allowed some patients to treat their cancer while leaving their blad­ders intact. Advances in surgical techniques continue to this day with the development of minimally invasive approaches to cystectomy. Both robotic-assisted and lapa­roscopic radical cystectomy have been performed safely in highly specialized centers and have the potential for decreased morbidity and a shorter period of recovery, but longer term follow-up is needed to determine if these pro­cedures are equivalent to open surgical techniques.

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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.

Our use of the term or terms Actos and 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 and Bladder Cancer

Actos and Bladder Cancer : Bladder cancer is a common cancer of the urinary tract. It is the fourth leading cause of cancer-related death among men and the seventh among women. Clinical management of bladder cancer is challenging because of the heterogeneity among bladder tumors with respect to invasion and metastasis and frequent occurrence of new tumors in the bladder among patients treated with bladder preservation treat­ments. Due to these factors it has been said that the cost per patient of bladder cancer from diagnosis to death is the highest of all cancers. In addition to it being a significant health problem, bladder cancer is an interesting cancer to study in many ways than one. For example, environmental factors such as cigarette smoking and other carcinogens play a major role in the development of transitional carci­noma of the bladder, whereas schistosomiasis, a protozoan infection, results in squamous cell carcinoma of the bladder. Different molecular pathways with distinct molecular signatures appear to be involved in the development of low-grade versus high-grade bladder tumors. Currently being monitored by an invasive endoscopic procedure, cystectomy, with urine cytology as an adjunct, bladder cancer is at the forefront of developing cancer biomarkers for noninvasive detection. Due to the differences in the invasive and metastatic potential of bladder tumors, treatment options differ depending upon the grade and stage of the tumor. New advances are being made in treatment options to improve the outcome and quality of life for patients with bladder cancer. Similarly, new molecular nomograms are being dis­covered to predict treatment outcome so that individualized treatment options can be offered to patients.

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This new text book on bladder cancer is organized to give both the clinicians and laboratory investigators state-of-the art information on basic science and clinical aspects of bladder cancer. Organizing this book that includes both the molecular basis as well as clinical practices in the management of bladder cancer would not have been possible without the invaluable contributions of the authors of each chap­ter. These authors who are experts in various aspects of bladder cancer were assembled from institutions in different parts of the world. All of these authors were generous with their time and commitment for bringing the readers up-to-date infor­mation on current advances in each area of bladder cancer. In addition, these experts have provided critical evaluation of the material presented in each chapter. Therefore, as editors of this book it has been our privilege to work with each contributor and we believe that this book will serve as a comprehensive reference on bladder cancer.

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Although, the readers are encouraged to read the entire book, we would like to present the highlight of each chapter in order to guide the readers to select the mate­rial of interest. Chapters 1-9 focus on molecular basis of bladder cancer, translational research into the areas of tumor markers, and standard mode of bladder diagnosis and detection. Chapters 10-22 focus on clinical aspects of bladder cancer.Smoking is well known; however, in Chap. 1 on epidemiology of bladder cancer, Dr. Ribal reminds us that other causes like occupational exposure, genetic predis­position, and infection are also linked to the development of bladder cancer. Bladder cancer is a carcinogenesis-driven cancer, with polycyclic aromatic hydro­carbons (PAH) and aromatic amines having causal links. Chapter 2 by Escudero, Shirodkar, and Lokeshwar focuses on xenobiotic metabolisms that convert PAH and aromatic amines into active carcinogens and on genetic polymorphisms that increase the risk for bladder cancer development. The chapter discusses theories of bladder cancer development (field cancerization versus clonal origin) and chromo­somal aberrations associated with bladder cancer.

Our use of the term or terms Actos and 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 and Bladder Cancer : In most populations the incidence of BC is three to four times higher in men than in women (Pelucchi et al. 2006). The excess of BC in men is not fully explained by differences in smoking habits and occupation.BC is a disease of the environment and age . Populations are increasing in number, but , they are growing older as well. Since more people are living longer, more are at potential risk. Furthermore, the changing environments in developed and devel­oping countries are causing more carcinogen concentration than can be associated to genesis of BC.

Several risk factors have been proposed for BC.

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Epidemiological evidence of the association between cigarette smoking and cancer began to be considered from the 1920s, and in 1950s, its relationship with lung cancer was perfectly established (Gandini et al. 2008). Tobacco smoking is cur­rently responsible for 30% of all cancer deaths in developed countries. If the current pattern of tobacco smoking continues, there will be more than one billion deaths attributable to tobacco in the twenty-first century compared with 100 million deaths in the twentieth century (Vineis et al. 2004). In the IARC Monographs of the Evaluation of Carcinogenic Risks to Humans, it is reported that there is sufficient evidence in humans that tobacco smoking causes cancer of lung, oral cavity, naso-, oro-, and hypopharynx, nasal cavity and paranasal sinuses, larynx, esophagus, stomach, pancreas, liver, kidney, ureter, urinary bladder, uterine cervix, and bone marrow (myeloid leukemia). (Sufficient evidence means that the Working group considers that a casual relationship has been established between exposure to the agent and cancer in studies in which chance, bias, and confounding could be ruled out with reasonable confidence) (International Agency for Research on Cancer 2002). Putative carcinogenic constituents of tobacco smoke include arylamines, in particular, the potent carcinogen 4-aminobiphenyl, polycyclic aromatic hydrocar­bons (PAHs), N-nitroso compounds, heterocyclic amines, and various epoxides.

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Tobacco smoking is the most well-established risk factor for BC, causing around 50%-65% of male cases and 20%-30% of female cases. The lower cases in women than in men is explained by the earlier stage of the tobacco-related epidemic among European women, and it is likely to increase in the future (Boffetta 2008). In addi­tion, it has been estimated that smoking is responsible for about 34% of deaths from BC in males worldwide and for 13% of BC deaths in females. Time trends in BC incidence and mortality are consistent with those of other tobacco-related cancers, with mortality rates being highest in birth cohorts with the maximum exposure to tobacco (Maxwell 2008).

Our use of the term or terms Actos and 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 and Bladder Cancer : Another option would be to use a laser. Laser fibers are flexible and may be able to reach a difficult tumor. The tumor may be effectively destroyed with laser energy; a disadvantage is no specimen is obtained.

Photodynamic therapy may afford additional results. With this novel technique, a chemical is instilled into the bladder, sensitizing the cancer cells to light energy. The entire bladder is then illuminated with laser light via a cystoscope. This treatment is not widely available at the present time and it is most effective for small tumors.

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There are potential risks and complications of any surgical technique. Bladder tumor removal via resectoscope is usually safe and complication free. However, potential problems may arise:

Bleeding is usually present, but rarely severe. Some tumors are more vascular than others and will bleed more. In addition, the resection will involve the bladder wall and vascularity varies here as well. Transfusions are not generally required unless an individual starts with a low blood count from previous bleeding or medical condition. Bleeding can be an on going concern until the bladder completely heals weeks later. Catheterization and irrigation may be required. Just a small amount of blood will change the color of urine red. Urine that is punch colored or the color of rosé wine generally is not serious and will clear on its own. When the urine has large amounts of blood in it, the appearance generally looks like tomato juice, indicating serious bleeding requiring medical attention.

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Bladder perforation may occur, especially with large tumors or those located on the lateral bladder walls. During resection of tumors on the lateral walls, the obturator nerve, which runs alongside the outside of the lateral bladder wall, may cause a strong muscle contraction. This contraction can abruptly move the bladder during a resection, resulting in a perforation. During resection of a large tumor with solid base, the urologist proceeds with deep resection of the tumor to remove the entire tumor and also determine whether or not it is a high stage tumor with muscle invasion. Bladder walls differ in size and integrity, and sometimes a perforation may occur. In addition, bladders which have previously been subject to some form of stress such as radiation or chemotherapy may have extremely poor integrity and are subject to pulling apart during a resection, resulting in a perforation. Bladder perforation is usually detected during the resection when the urologist sees fat (perivesical fat is located on the outside of the bladder). Sometimes, during a particularly bloody resection, the perforation may not be visible intraoperatively, but discovered when the lower abdomen becomes firm and distended (indicating that a large volume of fluid has passed into the abdomen). Small perforations are usually handled by stopping the procedure and maintaining a catheter for a week or more. Large perforations, especially those that communicate with the peritoneal cavity (the cavity that encases the bowels) generally require open surgical repair. Perforations can potentially spread cancer beyond the bladder

Our use of the term or terms Actos and 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 Warning : 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.

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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?

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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.

WHAT SHOULD YOU DO BEFORE YOUR FIRST APPOINTMENT?

Before visiting your bladder cancer specialist for the first time, you should gather all of your medical records. It is important to obtain copies of your biopsy and cytology reports, radiology studies, operative reports and any other test reports related to your diagnosis of bladder cancer. In addition to written reports, you should request your actual pathology slides for review by the urological pathologist who works with your urologist. It is also important to obtain actual copies of any radiological exams performed. Often, you can obtain a CD with your exams on it or actual films.

Our use of the term or terms Actos Warning 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 and Bladder Cancer: Receiving a diagnosis of bladder cancer is overwhelming. Bladder cancer is a complex disease that can range from a nonaggressive form to a much more serious problem. Depending on the type of bladder cancer that may affect you or your loved one, there are many treatment options. Trying to determine your next steps following the diagnosis is challenging.

Remember that you are not alone. Over 70,000 people were diagnosed with bladder cancer in the United States in 2009. Empowering yourself with information is an important step to making informed decisions and finding out which treatment option is best for you.

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You will receive a great deal of information from your healthcare team. You will also probably seek out some information on the Internet or in bookstores. No doubt friends and family members, meaning well, will probably offer you advice on what to do and when to do it, and will try to steer you in certain directions. Relax. Yes, you have heard words you wish you had never heard said about you, that you have bladder cancer. Despite that shocking phrase, you have time to make good decisions and to empower yourself with accurate information so that you can participate in the decision making about your care and treatment.

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Our use of the term or terms Actos and 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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