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Bladder cancer is the ninth most common cancer worldwide, 11 and among the most expensive to manage. About 90% of bladder cancers diagnosed in developed countries are urothelial or transitional cell carcinomas i.e. NMIBC usually appears as papillary tumors (small growths that look like mushrooms) confined to the mucosa or sub-mucosa, but also includes flat lesions (i.e. Bladder cancer is the ninth most common cancer diagnosis worldwide, with more than 330,000 new cases each year and more than 130,000 deaths per year.
Although the incidence of bladder cancer is relatively high, the mortality is relatively low. Bladder cancer is one of the most expensive cancers to manage, accounting for around 7% of total cancer expenditure in the US and this burden is comparable in other developed countries. Women are diagnosed less often than men, but tend to have more advanced disease at diagnosis as a result of the fact that bladder cancer is less often suspected. Increasing evidence suggests that genetic predisposition has a significant influence on bladder cancer incidence.
Blood in the urine (hematuria) is the most common finding in non-muscle invasive bladder cancer. The diagram above shows the staging of bladder cancer, according to the current tumor, node, metastasis (TNM) classification.
It is important that bladder cancer is staged accurately as different management strategies are employed for non-muscle invasive bladder cancer compared with muscle invasive bladder cancer.
In 1998, a new classification of non-invasive urothelial tumors was proposed by the World Health Organization (WHO) and the International Society of Urological Pathology (ISUP) and published by WHO in 2004. The prognostic value of both grading systems (WHO 1973 and 2004) has been confirmed, but attempts to demonstrate better prognostic value of one system over another have yielded controversial results. As outlined in the overall classification section, accurate diagnosis between non-muscle invasive bladder cancer and muscle invasive bladder cancer is very important as they are treated differently. During initial assessment, use of voided urine cytology or urinary markers is advocated to predict high-grade tumor before TURBT. TURBT is the gold standard method to confirm diagnosis and treat non-muscle invasive bladder cancer with adjuvant chemotherapy or Bacillus Calmette-Guerin (BCG) in high-grade tumors. Early diagnosis of non-muscle invasive bladder cancer is essential to ensure timely treatment, which in turn minimizes the risk of recurrence or progression to muscle invasive disease. The prognosis for non-muscle invasive bladder cancer is excellent, providing the disease is diagnosed and managed early; 5-year survival rate of 97% for the earliest stage tumors. The EAU guidelines include key recommendations for the diagnosis of non-muscle invasive bladder cancer. At the time of the initial diagnosis of bladder cancer, computed tomography (CT) urography or IVU should be performed only in selected cases (e.g. Table footnote Evidence grade A = Based on clinical studies of good quality and consistency that addressed the specific recommendations, including at least one randomized trial. Blue-light cystoscopy allows more sensitive fluorescence-guided biopsy and resection than conventional procedures leading to an additional detection rate of 20% for all tumors and 23% for CIS.
TURBT is both a diagnostic and therapeutic technique and any suspicion of bladder cancer warrants this procedure. The goal of TURBT in Ta or T1 bladder tumors is to make the correct diagnosis and remove all visible lesions. As a result of inadequate diagnosis, patients require repeat procedures (cystoscopy and resection, with local or general anesthesia) to manage recurrent disease, further increasing the risk of surgical complications 62 and increased costs.
Compared to white light cystoscopy alone, Hexvix® blue-light cystoscopy improves detection of non-muscle invasive bladder cancer because more lesions are detected, and improves removal of tumors during resection due to better visualization.12, 13 This results in an improved surgical outcome, leading to fewer residual tumors, 13, 15 and fewer short- and long-term recurrences. Following TURBT, adjuvant treatment options include early instillation chemotherapy (defined as chemotherapy within 6 hours of TURBT), further instillation chemotherapy, instillation of BCG, and radical cystectomy. Table footnote: Evidence grade A = Based on clinical studies of good quality and consistency that addressed the specific recommendations, including at least one randomized trial.
Pile Banding : A rubber band is used to grip the pile mass at its base and constrict it like a noose. This slide was created under the auspices of KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a promotional interest.
This position statement was developed by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Although pharmacologic treatment options are discussed on the slide, it is important to remember that lifestyle interventions, including diet, exercise, and education, remain the foundation of any type 2 diabetes treatment program. Sleep apnoea is a dangerous sleep disorder characterized by frequent cessation of breathing during sleep.
Night Shift Sleep Positioner is a non-invasive device for those whose sleep apnoea is caused by sleep position that guards against sleeping on the back.
CPAP, or continuous positive airway pressure, devices pump air into the user’s throat, providing a regular airflow and preventing the airway from collapsing.
Notice: All medical and therapeutic information and advice contained in this website is necessarily general in nature and may not be appropriate to your particular condition. Eating disorders are complex problems in which both the physical and psychological health of a person are intricately linked.
For treatment to be effective, a person with an eating disorder needs to really want to get better. No one form of treatment works for everyone Eating disorders are caused by many different factors.
The earlier treatment begins, the greater the chance of a successful outcome Delay in recognising the disorder and getting appropriate treatment can lead to long-term problems and result in the need for more intensive treatment. Many people with eating disorders find it difficult to ask for help and may feel very unsure about accepting it.

Treatment is available in a number of forms though access to services varies throughout the country. 10 The good news is that it has a relatively low mortality when compared with other cancers, particularly when it is detected and treated early.
11 It is more common in older people and affects approximately four times the number of men than women.
Because of long-term survival and the need for lifelong routine monitoring and treatment, the cost per patient of bladder cancer from diagnosis to death ranges from US$96,000 to US$187,000 (2001 values) in the USA. It is the arylamines (mainly 4-aminobiphenyl and other heterocyclic amines) in cigarette smoke that are the responsible carcinogens. Ta or T1 tumors do not cause bladder pain and rarely present with lower urinary tract symptoms. Its major contribution is a detailed histological description of the various grades, which uses specific cytological and architectural criteria. The majority of clinical trials published to date on Ta or T1 bladder tumors have been performed using the 1973 WHO classification, and therefore the current European Association of Urology (EAU) guidelines are based on this scheme. Cystoscopy is recommended in all patients with symptoms suggestive of bladder cancer and cannot be replaced by cytology or by any other non-invasive test. Evidence grade B = Based on well-conducted clinical studies, but without randomized clinical trials. Users place the disposable device over their nostrils before bed, and its MicroValve technology uses pressure from your own breath to keep your airway open. Consequently, we caution all our readers that the information and advice contained in this website (or in any publication) should be acted or relied upon only after consultation with your physician or sleep clinic.
For each individual there will be a different group of factors underlying and sustaining the disorder. They may be reluctant to admit to the seriousness of their problem and feel frightened of the consequences of seeking help. Access to public health services is usually by referral from a medical source (GP, paediatrician, Area Medical Health Officer, clinical psychologist). People accessing treatment should ask about confidentiality so that there is clarity from the beginning for all concerned. When hospitalisation is required, children and adolescents should not be treated on adult wards if this can be avoided. 44 It is important that bladder cancer is classified accurately as either non-muscle invasive or muscle invasive bladder cancer due to the fact that these stages of urothelial cancers are managed quite differently. 3 The US National Cancer Institute estimates that there will be 72,570 new cases of bladder cancer in the US in 2013 and 15,210 deaths.
Overall, bladder cancer is the fifth most expensive cancer in terms of total medical care expenditures, accounting for almost US$3.7 billion (2001 values) in direct costs. The risk is related to the metabolism of these carcinogens and a NAT2 (N-acetyltransferase 2) slow-acetylation genotype has been associated with increased risk of bladder cancer. Until the prognostic role of WHO 2004 is validated by more prospective trials, both classifications are currently used in practice.
Radical cystectomy is warranted in muscle invasive disease and systemic chemotherapy where there is evidence of metastases.
The most important risk factor for understaging T1 tumors is absence of muscle in the tissue which occurs in 30–50% of submitted specimens. It was popular in the past as an outpatient procedure until the advent of infrared Coagulator(IRC).
Ideally, all those involved in the treatment of a person with an eating disorder will work together as a team and treatment will be tailored to the individual's needs. They may also feel ashamed of the disorder, may try to disguise it and may be unforthcoming about important symptoms. Health Boards provide treatment via their Mental Health Services to those in their catchment area. This will help build trust, and disclosure of important information, whether physical, psychological or behavioural, will be made easier. Carers will also need to be aware of confidentiality agreements so that appropriate boundaries are respected. Serious adverse events are rare in TURBT, but can include occasional bleeding and perforation (greater than 5%). The Family Doctor or GP The GP plays a crucial role in the diagnosis of an eating disorder and in the referral of a person for treatment. In some cases, particularly when treatment is sought at an early stage, a GP with a good knowledge of eating disorders may be able to attend to all aspects of treatment.
In many cases the GP will make the decision to monitor medical aspects and refer a person on for other aspects of treatment.
The aim is to educate and to enable the person to begin to make the choices necessary to restore healthy eating habits and normal weight. However, where therapy is required, support groups should not be seen as an alternative but as an additional form of support. With the right support and a high level of commitment, some people will manage to recover from their eating disorder without professional help. Because mesothelioma is so rare and aggressive, patients and their families might find it difficult to address the issue of treatment.
The options for mesothelioma treatment are steadily increasing and giving patients more of a hope.
Since treatment is so readily available, it is extremely important that patients and their loved ones seek advice from their primary oncologists.Each case of mesothelioma is different and considered individual. Because there are several different types, there is no set roadmap for the management and treatment of mesothelioma.

What is best for each patient depends of many diagnostic procedures such as, x-rays, MRIs, CT scans and biopsies.
These tests will help your primary physician or oncologist decide what the best treatment option for the individual case is.Mesothelioma Treatment OptionsCancer treatment often varies by patient. However, all cancer treatments focus on destroying malignant cells and preserving healthy ones. One being surgery, another being chemotherapy, radiation, or a combination of all three.These three recommended treatments are considered the most effective for the treatment of malignant mesothelioma.
Once that is determined, doctors can then prescribe the best possible method of mesothelioma treatment.Surgery for Mesothelioma TreatmentOne option for the treatment of mesothelioma is surgery. Since mesothelioma is not usually diagnosed until the later stages, curative surgery is not usually an option.
Once a tumor has metastasized in the pleural cavity, palliative surgery just provides the patient with more comfort and better quality of life.
Curative surgery may become more of an option as tests are developed to detect mesothelioma in its early stages.In mesothelioma cases in the more severe stages, a removal of the pleura (the lining of the lung that controls fluid buildup) may be recommended.
One surgery doctors may opt for is called a pleurodesis, which injects talc into the lungs to prevent fluid from building up.
Another surgery called a thoracentesis, which removes fluid from the lungs using a thin needle, may be recommended.Radiation Therapy for Mesothelioma TreatmentFor patients whose health is too fragile for surgery, radiation therapy is often recommended. Although radiation is an aggressive treatment, it is associated with the least side effects. It is often used in conjunction with a different form of treatment such as surgery or chemotherapy. Your primary oncologist will decide depending on your individual case.External Beam RadiationComing from a machine outside of the body, this form of radiation is the most preferred type to treat mesothelioma. The machine targets affected areas and is administered up to 5 days a week for up to 5 weeks. This method of radiation is not very efficient as a curative mesothelioma treatment, but is often used as a palliative treatment to lessen breathing difficulties, pain, bleeding, or difficulty swallowing.
External beam radiation is in most mesothelioma cases paired in conjunction with surgery.BrachytherapyThis form of radiation is more aggressive than some.
Brachytherapy places radioactive materials directly inside the lung or area of the mesothelioma to treat it.Chemotherapy for Mesothelioma TreatmentChemotherapy is another effective form of treatment for mesothelioma. Although it does not provide a cure, it is extremely effective in providing relief from debilitating symptoms of mesothelioma. Researchers are continually studying the different combinations of chemotherapy drugs and procedures. In the future, doctors hope that chemotherapy drugs may go as far as to be a cure for mesothelioma, but for now the drugs simply improve quality of the life patients have.As an overview, chemotherapy drugs are either ingested orally or injected into the patient. Mesothelioma patients typically are administered the drugs intravenously, meaning through an IV.
One drug will serve as the primary cytotoxic and the other will serve as a stabilizing agent to surround healthy cells. Other drugs are used in combination only if deemed patient specific for those patients participating in a clinical trial. Most patients using chemotherapy treatments are too weak to withstand two drugs and can typically tolerate one.Heated chemotherapeutic treatment is a novel technique being integrated with surgical resections of mesothelioma tumors.
It has been shown that heating the effected cells decreased cancer cell size and in some cases eliminated them. However, using this kind of treatment can destroy healthy cells as well as cancer cells.There are several side effects patients may experience while going through chemo. Medication such as anti-nausea or vitamins might be prescribed to help patients combat side effects.Clinical Trials for Mesothelioma TreatmentClinical trials are the study of new treatments by skilled specialists of mesothelioma. Clinical trials are in constant need of patient willing to undergo experimental treatments not yet approved by the FDA.
Patients should speak to their primary oncologists about current clinical trials, benefits, and risks of participating in the available trials.
Those patients opting to participate should heavily consider the advantages versus the disadvantages, along with the total goals of the trial.Mesothelioma CureThe response the number of asbestos related illness has been overwhelming in recent years. Researchers and specialists have been working each day towards a cure for malignant mesothelioma. Right now, there is no absolute cure for the disease, but there are several successful mesothelioma treatment programs.Malignant mesothelioma treatments fall in line with the treatment of other lung cancers since they affect the same relative areas.
Currently there are no curative treatments for mesothelioma, but there are a number of treatments that have been partially curative by completely removing the cancer from the body. However, although the cancer is gone, it does not mean the cancer will not reappear.Curative treatments may not prevent the cancer from reappearing, but it is important to remember all the steps that are being taken towards the future of mesothelioma treatments. His physician had only given him a few months to live, but today he stands before thousands spreading awareness about mesothelioma. He currently works with others in developing treatment programs that have been as successful as his treatment has been.Medical researchers believe that once the right combination of treatments is found the road to curing mesothelioma will shorten. The growing technology such as the CT (Computer Topography) scans has been able to map several dimensional images of the body’s internal organs for targeted therapies.

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