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Actos Bladder Cancer : Sometimes an internal bladder connected to the urethra (the tube that carries urine to the outside of the body) isn’t possible and you will instead have a continent urinary diversion system. This means that you’ll have a pouch or reservoir, either external or more commonly internal, that collects your urine, and you’ll have to empty the pouch. This is also known as an ostomy or ileal conduit system.

The more common continent urinary diversion system is an internal reservoir, or pouch, made from a piece of intestine. The pouch is inside your body, but you must manually empty and flush the reservoir by inserting a syringe or catheter into a permanent ”hole” or stoma in your abdomen. Often the stoma is located unobtrusively in your navel, where it is not likely to be detected by a casual glance.

Your doctor, may, however, recommend an external pouch that is situated outside your body and attaches to your abdomen through a “hole” or stoma. You must manually empty the external pouch and cleanse the stoma. Either alternative sounds unpleasant, but having a pouch (particularly an internal reservoir) won’t interfere with your life or self-image as much as you might expect, if at all. You can still snorkel and swim. You can dance in a clingy, swingy dress or bike in Spandex shorts. You can do your job, whether it’s manning a drill press or managing a Fortune 500 company. And you can still look and feel sexy and enjoy a satisfying intimate relationship with your partner.

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One of the difficult issues for you and your medical team is to work out exactly what to do about the treatment of invasive bladder cancer. It is clear that cystectomy can be a life-saving procedure, yet many patients with invasive bladder cancer still eventually die of the disease, especially if it has penetrated the surrounding organs.

Your team will make a recommendation about treatment after carefully evaluating such very important factors as the extent of invasion by tumor cells (the stage), the normal or disorganized/abnormal appearance of die cancer cells under the microscope (grade), whether the cancer cells have invaded lymphatic channels or blood vessels, whether cancer cells are growing within the lymph nodes, and whether a specific cell control gene called P53 is normal.

If your cancer is organ-confined (i.e., if the cancer cells have not spread beyond the boundaries of the bladder and its immediate surrounding tissues), if it has not penetrated beyond the first layers of surrounding muscle, if there is no lymphatic or vascular invasion, and if lymph nodes are negative (i.e., they contain no cancer cells), the chance of permanent cure by cystectomy alone is around 80 percent.

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Since the 1950s it has been known that cancer-killing drugs (chemotherapy) can sometimes shrink bladder cancer that has spread through the body, and sometimes they can completely eliminate the deposits of cancer in different parts of the body. In the past 25 years, several studies have looked at the impact of combining chemotherapy with cystectomy or with radiotherapy in an attempt to improve survival figures. Before that discussion, let’s talk a bit about chemotherapy.

Chemotherapy is a term that refers to the use of drugs to kill cancer cells. Chemotherapy is usually given by intravenous injection (injection by needle directly into the vein), but sometimes it can be administered as a tablet or even through a urinary catheter (intravesical) for a patient with superficial bladder cancer. (See Chapter 4.) There are many different types of chemotherapy, and a detailed discussion is beyond the scope of this book. Your medical team will talk with, you about what type of chemotherapy is best for you and why.

In brief, chemotherapy drugs mostly act to interfere with the ability of cancer cells to divide and multiply, often by inhibiting the function of enzymes within the cells or by blocking cell division and the formation of RNA and DNA, the substances of life. Because these drugs act on cells that are dividing and multiplying, they can also affect some normal tissues and thus can cause a range of side effects.

Our use of the term or terms Actos 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 Bladder Cancer : Bladder tumor “seeding” may occur during the procedure. As the tumors are resected, cancer cells are released into the irrigant which fills the bladder. These cells may implant in other areas of the bladder traumatized during the procedure. It should be understood that the bladder is generally filled with urine, and tumor cells can naturally implant at other locations even without surgery. Implantation can be lessened during surgery by avoiding injury to other bladder areas and by the use of adjuvant intravesical chemotherapy. There have been numerous studies over the past decade showing a number of chemotherapy agents can be effective in decreasing initial tumor recurrence, possibly by preventing seeding. Reduction in recurrence may however be short lived.

Previously, it was common practice to obtain multiple random bladder biopsies at the time of initial tumor resection. This was recommended to rule out the possibility of hidden CIS. Understanding these biopsy sites may increase the possibilities of tumor recurrence by tumor seeding, biopsies are now often limited to areas adjacent to the tumors removed and suspicious appearing areas only. CIS can be ruled out by using cytology, or by obtaining biopsies during future cystoscopy after the tumor has already been removed. When dealing with low grade tumors, random biopsies of the bladder will rarely show cancer.

After your procedure, depending on the level of anesthesia and the extent of surgery, you will be brought either to the recovery room or back to the area where you were first prepared for your procedure. You will be released to home only when you have fully recovered from you anesthetic and are doing well. The recurrence rate for superficial bladder cancer can be as high as 60-90%. Recurrences can cause bleeding and other difficulties and are best handled sooner rather than later. In addition, depending on the initial tumor grade and stage, progression to a more serious form of bladder cancer is an ongoing concern. Surveillance cystoscopy is therefore recommended. Cystoscopy is still the best means to check for recurrent disease. It is however, an invasive procedure and should be accomplished only as often as required. For solitary, low grade, non invasive disease, follow up cystoscopy can be accomplished with the flexible cystoscope if available. If negative at three months, further cystoscopic exams can be done yearly and eventually lengthened even further. For those with multiple tumors, large tumors, high grade tumors or those who also have CIS, frequent cystoscopies, initially every three months are called for. As long as there are no recurrences, the time between cystoscopies can be lengthened. Cytology can also be utilized to reduce the number of cystoscopies. If recurrence or progression does occur, heightened scrutiny is again called for.

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Adverse reactions are side effects of treatment. Approximately 95% of individuals will tolerate treatments well. Adverse reactions may be mild. Common reactions include cystitis (inflammation of the bladder characterized by burning on urination), hematuria, mild fever, malaise, and nausea. These symptoms generally pass without any treatment. For bothersome symptoms, various medications may prove helpful. Your physician can prescribe medication for burning or urinary frequency. For those with persistent cystitis, antibiotics can be utilized. For individuals experiencing severe symptoms lasting more than 48 hours, isoniazid, an anti-tuberculous drug can be prescribed.

A short course of 3 days, starting the day before the next dose of BCG can be used to prevent severe side effects. Fortunately severe reactions resulting in sepsis, a life threatening condition characterized by high fever, chills and drop in blood pressure, is exceedingly rare. Sepsis would be treated in a hospital with triple anti-tuberculous drugs, steroids, and broad spectrum antibiotics. There are other serious adverse reactions which may require dose reduction or discontinuation. These are all rare and include: inflammation of the prostate, persistent hematuria, hepatitis, inflammation of the testicles and or epididymis, bladder contraction, ureteral obstruction, joint pain or inflammation of the lungs.

Recurrence of bladder cancer after the initial induction course, or relapse after complete response, would indicate failure of therapy. When two or more courses result in recurrence or when recurrence develops during the first six to twelve months after induction and maintenance therapy, patients generally are felt to have disease which is at higher risk for progression. A high percentage of patients who are complete responders remain tumor free for up to five years. However, with the passage of more time, additional patients will have late recurrences. For those with late recurrences (two to three years after therapy), most will respond to repeat BCG therapy.

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Invasive bladder cancer is often recognizable to the urologist by its appearance during cystoscopy. These cancers are generally large, sometimes multi-focal, and solid in appearance as compared to the fine papillary appearance of superficial bladder cancers. During the transurethral resection of the tumor, the urologist can generally tell the tumor is invading into the deeper portions of the bladder wall.

The pathologist’s report will then indicate the grade of the cancer and the depth of invasion. If the tumor invades into muscle, it is an invasive tumor. Further staging would then include a CT Scan or MRI to assess local contiguous spread, lymph node spread, or more distant spread of the cancer. A chest X ray is also routine. If there are any suspicious areas, a CT Scan of the chest is ordered. A bone scan is generally not required unless the individual has had a new onset of bony pain that is not explained by injury or arthritis.

Our use of the term or terms Actos 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 Bladder Cancer : A catheter is a plastic or rubber tube which is placed through the urethra into the bladder. It is kept in place by a fluid filled balloon, at the end of the catheter, which is inflated in the bladder. The tube allows for drainage of urine which may be mixed with blood after a TURBT. When small tumors are removed, a catheter is not usually required unless there is a concern that you may have difficulty urinating after the procedure because of an enlarged prostate, weak bladder or swelling of the urethra after instrumentation. After large tumors are resected, a catheter is often required. It serves the following purposes:

It allows one to monitor the amount of bleeding after surgery (although the urologist attempts to stop all bleeding, this is not always possible and bleeding may persist). It provides for bladder irrigation if required. If much bleeding is present after surgery, it is important to avoid the possibility of blood clots forming and blocking the flow of urine. Irrigation can be done intermittently with a syringe or continuously via a 3 way catheter, which has a port for inflow and outflow of irrigant. It keeps the bladder decompressed, which may be important if the resection was deep and bladder integrity is in question. The bladder may have been thinned markedly in the area of resection or biopsies. Decompression provides for reduced risk of leakage through the wall of the thinned bladder.

The experienced urologist uses several techniques to improve his chances of removing tumors that are difficult to reach. He will often keep the bladder under filled. Although this may reduce visibility, it will allow the tumor to be closer to the resectoscope. Another technique is to place manual pressure on the bladder from above. This is done by an assistant or by the urologist himself. By pushing down from above, tumors at the dome are displaced downwards. An additional technique, for the male patient, is operating through a perineal urethrostomy. The urologist makes a surgical opening into the urethra between the scrotum and rectum, allowing the resectoscope to move further into the bladder, bypassing much of the urethra.

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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.

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.

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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.

Ureteral injury may occur when a tumor covers the ureter in the bladder. The ureter may be obscured by a bladder tumor, and the urologist may inadvertently resect it along with the tumor. In general, cutting current to remove a bladder tumor does not usually lead to long lasting problems as compared to cauterization, which is more likely to cause permanent blockage or obstruction of the ureter. If the urologist is working in the area of the ureter, he should avoid cauterization as much as possible. He may ask the anesthetist to inject an intravenous coloring agent which will turn the urine blue and allow visualization of the ureter. If he knows a ureter may be in jeopardy, he may insert a stent (a small plastic tube that traverses the ureter) for several weeks to allow the ureter to heal in an open fashion.

Urethral injury is infrequent and is almost always in males. A stricture or narrowed area of the urethra may result from irritation or injury from the resectoscope pressing on the urethra. Individuals that develop strictures complain of difficulty urinating, experiencing a slow or split stream. Strictures are usually readily handled with a number of urologic procedures.

Our use of the term or terms Actos 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 Bladder Cancer : Magnetic resonance imaging, or MRI, is one of the new­est imaging modalities in use. Hie images that it provides are very detailed, and MRI has the added advantage of ob­taining these images without the use of radiation. How­ever, it does take a lot longer than the imaging modalities previously mentioned and is quite expensive. MRIs are performed when you lay on a small table and are passed through a small tube, which is actually a collection of very strong magnets. Because of this, it is very important to remove all metal objects and jewelry before this exam. If you have a fear of small spaces and become anxious at the thought of them, you may be given a small dose of an anti­anxiety medication before the exam. There are two types of MRI machines currently in use: open ones, which are more comfortable, and closed ones.

Although MRIs are wonderful tests that provide a great view of the urinary system, there are a few risks. If you have an aneurysm clip from a prior brain procedure, you must let your doctor know because this clip could become dislodged during the exam. No one with a cardiac pace­maker should have an MRI performed. If you have any type of implanted device such as an electrical stimulator or pump, you should not have an MRI performed. Pregnant women during the first trimester should not have an MRI; neither should metal or machine workers who may have a small fragment of metal in their eye. Contrast is sometimes given during MRI exams and patients rarely experience al­lergic reactions to it. MRI pros include detailed imaging and a lack of radiation. Its cons are its expense and patient discomfort due to claustrophobia.

Any of the previously mentioned exams may be ordered during your workup. As mentioned before, it is extremely important that you bring copies of the actual images with their accompanying reports to your first appointment with, members of your bladder cancer team.

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Cancer grade and stage are two terms you will most likely hear abotit during the course of treatment. Bladder cancer grade and stage are not the same and should not be used interchangeably to describe your cancer. Grade, expressed as a number, is used to describe the appearance of cells under the microscope and increases from i to 4 depending on how they look compared with normal cells. Grade of cancer refers to the aggressiveness of the disease. Grade 4 cancers are typically more aggressive than grade 1 cancers, and they recur more often. Cancer staging describes the extent or spread of the disease at the time of diagnosis. It is essential in determining the choice of therapy and in as­sessing prognosis. Cancer stage is based on the size and location of the primary tumor and whether it has spread to other areas of the body.

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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The first person you will meet with a new diagnosis of blad­der cancer is your urologic oncologist. When you call to make the appointment, you will be asked whether or not a surgeon (usually a urologist) has already performed a biopsy to confirm that you indeed have bladder cancer. If they have, you will be asked to bring with you (or have sent to the urologic oncologist’s office) the glass slides of the actual pathological material taken at the time of the biopsy for review by another pathologist. You will also be asked for the written report of the original pathologist’s interpreta­tion of your biopsy material, all images taken in evaluation of your bladder cancer (either on CD or printed film) along with the written report of then interpretation, and any sur­gical operative notes from procedures performed by sur­geons seen in the initial evaluation and diagnosis of your bladder cancer.

Be sure to obtain the address and clear directions, if neces­sary, of specifically where you are to go and what time you are to be at your initial appointment. If you haven’t been to the facility before, allow yourself extra drive time to find it, find parking, and get to the location where the doctor will be. Being late only frustrates and distracts you from your ultimate goal of determining the treatment to help you arrive at your desired outcome. Bring the information requested above to ensure that your visit is as productive and efficient as possible for you and the doctor who will be seeing you. Often, the urologic oncologist or his or her of­fice may have requested that the pathology slides be sent in advance with the goal that his or her urological pathologist can look at them before your arrival and render an opinion about the accuracy of the information provided in the typed report that you will bring from the outside evaluation. It is also helpful to know in advance if your insurance company requires you to get preauthorization for having additional tests done, such as a CT or MRI.

There are situations in which the urologic oncologist, once he or she has reviewed the films, may find them inadequate. If this occurs, he or she may want to get additional imaging done while you are there for this visit. It is also likely the urologic oncolo­gist will want you to leave your imaging studies with them to be reviewed by a radiologist. The imaging studies per­formed on your behalf are your property, but your urologic oncologist may need to retain them for use during your surgical care. Once the surgery and associated care for your bladder cancer is completed, the imaging studies can be returned.

Our use of the term or terms Actos 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 Bladder Cancer :

Urothelial Cancer (UC)

A diagnosis of urothelial cancer (also known as transitional cell cancer) can mean many different things. Urothelial cancer is not a single type of cancer; it is classified by shape and whether it is restricted to the inner surface of the bladder (superficial to underlying tissues and muscle) or invasive, as well as by stage and grade of development.

The words transitional cells describe how the cells appear under the microscope. Transitional cells share features with various types of cells normally found near the bladder. Since 2009, pathologists have altered the common term to “urothelial cancer” to acknowledge the fact that all these cells arise from the lining of the ureters, bladder, and urethra, the urothelium.

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The human bladder is composed of several layers. On the innermost surface (which is next to where urine is stored) is a layer of cells known as the transitional cell epithelium. This layer varies in thickness from three to seven cells.

If your doctor described your tumor as being confined to the transitional cell epithelium, the tumor is a superficial tumor. About 74 percent of UCs are noninvasive and superficial when diagnosed, although superficial tumors may eventually progress to a more invasive stage. The word superficial has to be used carefully because it does not necessarily mean that the tumor is safe and doesn’t have a dangerous potential. In other words, some “superficial” tumors actually have a high malignant potential and the ability to spread elsewhere in the body.

A diagnosis of invasive UC means that the cancer has progressed into other layers of the bladder wall, such as the intermediate ceil layer or the muscle.

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Urothelial cancer is classified as either papillary or flat in shape, although and more than one kind of tumor may be present at the same time in the bladder.

Papillary tumors look like the fronds of a fern or a bunch of tiny berries or grapes. Papillary tumors can be superficial or invasive. Most papillary tumors are malignant; however, the papilloma tumor is a relatively benign type of papillary UC and is typically removed by surgery.

Other tumors appear to be flat and velvety and are more commonly called carcinoma in situ (CIS). These tumors are only one cell thick.

Our use of the term or terms Actos 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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Urothelial cancer, or UC (also referred to as transitional cell cancer or TCC). It can be localized on the surface or it may be invasive. (UC will be discussed in more detail later in this chapter.) UC is the most common type of bladder cancer, accounting for about 90 percent of all cases. In 2009, the American Cancer Society estimated that by the end of that year about 70,980 people would be diagnosed with bladder cancer—roughly 52,810 men and 18,170 women. About 63,882 of the cases would be urothelial cancer.

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Squamous cell cancer. This type of cancer accounts for about 4 percent of all bladder cancers and is usually an invasive cancer. Squamous means “resembling a scale” (which is flat and thin) or a scaly surface, and squamous cell cancer looks like skin cancer when viewed under a microscope. Among the causes of squamous cell development is the schistosomiasis parasite discussed in chapter 1.

Adenocarcinoma. ‘The appearance of this type of cancer closely resembles tumors of gland-forming cells in the intestinal tract. (,Adeno means “gland.”) It is often associated with the production of small amounts of mucus. Some adenocarcinomas occur in the urachus, a remnant of a fetal structure that connects the bladder to the umbilicus before birth. Adenocarcinomas, which are usually invasive, account for about 1 to 2 percent of bladder cancers.

In addition to the above types of bladder cancer, there are several extremely uncommon forms of the disease:

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*     Small cell anaplastic bladder cancer. Similar to small cell cancer, this rapidly growing cancer is usually found in the lung, and it shares a pattern of rapid growth and early spread to other parts of the body It is not really clear why small cell tumors arise in the bladder, although it is thought that they start from neuro-endocrine cells, isolated small, dark, round cells that arise during fetal development, of uncertain function, which are sometimes found in the bladder. These cells may play a part in the control of cellular growth.

• Sarcomas and choriocarcinoma. It is quite rare for these two forms of cancer to be found in the bladder. Sarcomas are found in the muscle layers of the bladder. Choriocarcinoma is most often diagnosed among Asians in the Far East. Found in the bladder wall, it is an extremely rare tumor that seems to arise from small clusters of cells that paradoxically resemble part of the placenta.

Our use of the term or terms Actos 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 Bladder Cancer 12/20/2011: 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%.^[1] 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.

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