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Actos Bladder Cancer Headlines

By admin | Published January 27, 2012

Actos Bladder Cancer : Keep your doctor informed if you are experiencing any of the above side effects. There are drugs that can help minimize these con”ditions and make your treatment more comfortable. Luckily, these side effects tend to disappear once you are no longer receiving chemotherapy, and you will gradually feel stronger and become less vulnerable to bleeding or infections.

For invasive bladder cancer, chemotherapy is sometimes given before you have a cystectomy. Sometimes it’s given afterwards. Sometimes it’s not given at all. It depends entirely on the type of tumor you have, where it may have spread, and whether you have another medical condition that might make it difficult for you to tol”erate chemotherapy. Very advanced age can also be a factor in decid”ing whether chemotherapy is appropriate.

The choice of drugs used to treat invasive bladder cancer is similar to the choice in advanced or metastatic disease. If you have invasive transitional cell carcinoma you will probably undergo chemotherapy, as this type of cancer is responsive to either radiotherapy or surgery with chemotherapy, and many stud”ies have examined this type of cancer treatment.

If you have been diagnosed with squamous cell cancer or adeno”carcinoma, the track record for chemotherapy is not so clearly defined. Most physicians don’t recommend chemotherapy as standard treatment in conjunction with cystectomy for these types of cancer. It is, however, quite reasonable for your team to suggest that you look into a clinical trial (for example, one that is exploring the use of chemotherapy) if you have been diagnosed with squamous cell or adenocarcinoma.

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Most of the reported trials indicate that the use of single chemother”apy drugs does not have an extensive beneficial effect, but that the use of combinations of three or four chemotherapy drugs can shrink the bladder cancer in around 70 percent of cases and can also improve the cure rate and length of survival. For you as a patient, the information gleaned from these clinical trials means that if you have TCC, your doctors are likely to recom”mend treatment that includes a “cocktail” of several carefully targeted chemotherapy drugs as well as cystectomy or radiotherapy.

In some cancers, such as breast cancer, it is pretty standard practice to give several doses of chemotherapy after surgery, especially for tumors with high-risk pathological features, such as lymph-node involvement. We know of six studies that have looked at this question in bladder cancer, but the results are somewhat inconclusive as to whether chemotherapy is most effective given before or after surgery.

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When radiation is used alone or with chemotherapy there is an increased likelihood that your other organs, such as the prostate and uterus, will remain functional, as does your ability to void urine normally and have sex. The intention when chemotherapy and radio”therapy are given is usually to improve the chances of curing the cancer while preserving the bladder and avoiding the need to remove it surgically. This area is still somewhat controversial; while some physicians believe that this approach is nearly as effective as surgical removal of the bladder, others feel that cystectomy is the best treat”ment The decision depends in part upon the physical fitness of the patient as well as upon the patient’s personal preferences.

The use of radiotherapy doesn’t mean that it is without side effects. There can be scarring of the bladder tissue, and that can reduce the amount of urine your bladder can hold. The result would be an increase in the number of times you have to urinate, which can be irritating, especially at night. You also may experience an increase in bouts of cystitis.

There has been much discussion about whether the results achieved by radiotherapy are the same as those from cystectomy with, respect to achieving cure. We think that when one considers all types of bladder cancer, in the hands of a highly experienced urologist who specializes in this operation, cystectomy gives better results than radiotherapy. However, there are some patients, particularly those with other significant medical conditions, who will benefit from radiotherapy despite the possibility of a lower chance of permanent cure. In some centers, such as Massachusetts General Hospital, where the techniques of chemoradiotherapy and bladder preservation have been piloted, a urologist wall perform a cystoscopy about halfway through the planned course of radiotherapy. If the tumor is shrinking well, radiotherapy will be completed. However, if it appears that the cancer is not responding to radiotherapy, the plan wall be abandoned and replaced with a radical cystectomy.

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

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Actos Warning Proclamation

By admin | Published January 26, 2012

Actos Warning : Tobacco smoking and occupational exposure have been the two major factors related to BC risk; however, not all smokers develop BC and not all cases of BC occurred in smokers or patients with chemical exposure. It has been proposed that there could be factors other than environmental that could affect the incidence on urothelial tumors. In fact, as for many other cancers, molecular researchers are trying to establish genetic alterations linked to carcinogenesis that could justify genetic predisposition.An important research has been conducted in patients with BC in relation to smoking and chemical exposure , trying to identify those patients with higher sus­ceptibility of being affected by environmental carcinogens. Aromatic amines were established carcinogens for urothelium.

 

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They could be inactivated by acetylation pathway, and it has been postulated that those patients with slow acetylation capability were more susceptible to BC than those that are rapid acetylators. NAT-1 and NAT-2 are N-acetyltransferase genes located on the short arm of human chromosome 8 and they are involved in amines inactivation. Reduction in NAT-2 activity has been suggested as mechanism for BC predisposition among patients exposed to environmental carcinogens such as aromatic amines.A number of SNPs have been reported in NAT-2 coding exon, as well as over 35 NAT-2 haplotypes have been identified (Hein 2006). Several of these haplotypes corresponded to NAT-2 slow acetylator phenotype and NAT-2 slow acetylation genotype has been related to higher risk of BC.

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The Spanish Bladder Cancer Study is a hospital-based case-control study on BC conducted in five different areas in Spain that included 1150 cases and 1149 controls. They evaluated in this great population the association of several polymorphisms in NAT and GST genes with BC risk and their interaction with cigarette smoking. In addition, they reported a metaanalysis of 29 studies of NAT-2 and BC including 5096 cases and 6519 controls. They demonstrated that NAT-2 slow acetylators had a 40% increase in BC risk compared to rapid/intermediate acetylators with an OR of 1.4 (95% CI, 1.2-1.7). They could also demonstrate a significant multiplication interaction between NAT-2 slow acetylation genotype and cigarette smoking, that is, NAT-2 slow acetylators were especially susceptible to the adverse effects of ciga­rette smoking on BC risk. On the other hand, the metaanalysis performed corrobo­rated their own data, being the summary on relative risk for NAT-2 slow acetylators compared to rapid/intermediate acetylators of 1.4 (Garcia-Closas et al. 2005).Other SNPs in different genes have been studied. Nucleotide excision repair (NER) pathway is a complex mechanism for repairing DNA damage and subse­quently for preventing carcinogenesis. NER pathway included several genes, and different SNPs on those genes have been related to an increase in BC risk. Twenty- two SNPs on seven NER genes were evaluated in 1150 cases and 1149 controls included in The Spanish Bladder Cancer Study. Four of these 22 SNPs in NER genes could be significantly related to a small increase in BC risk and interestingly it could be demonstrated as a stronger association between BC and polymorphism in ERCC2 gene (ERCC2 R156R) for never-smokers compared with ever-smokers (Garcia-Closas et al. 2006).

Other study including 696 patients with BC and 629 controls evaluated the asso­ciation with BC risk of a comprehensive panel of 44 SNPs in genes of NER path­way and genes involved in cell cycle control. They concluded that patients with higher numbers of variants in NER genes rather than single polymorphism are at increased risk for BC (Wu et al. 2006).

 

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 News Flash

By admin | Published January 26, 2012

Actos and Bladder Cancer : Traditionally, the surgery is performed through a lower abdominal incision in the midline from just below the umbilicus (i.e., “belly button”). Hospitalization for this procedure is generally between 5 and 10 days, and up to 6 weeks are needed for complete recovery. In recent years minimally invasive surgical approaches that replicate the technique of open radical cystectomy have been developed. Both laparoscopic and robotic-assisted radical cystectomies are currently being performed at highly specialized cen­ters. The principles of the surgery are the same, but the procedure is performed through smaller incisions using laparoscopic instruments. Using robotic assistance, your surgeon is able to perform complex operations with higher precision, under magnification. These approaches offer die potential advantage of a shorter recovery time, less blood loss, and less postoperative pain,

 

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A pelvic lymph node dissection should be performed at the time of your surgery. This involves removal of the lymph node tissue in the most common areas of bladder cancer metastasis (spread of the cancer). The pelvic lymph node dissection has two important roles: to stage the cancer and to guide therapy. Individuals who are found to have cancer in the lymph nodes at the time of surgery generally require additional therapy such as chemotherapy. Studies have shown that up to 30 percent of patients with disease- positive lymph nodes who undergo a pelvic lymph node dissection will be free of disease at 5 years. Although there is debate among urologists as to exactiy how extensive ofapelvic lymph node dissection should be performed, there is no de­bate that one should be performed. Although a pelvic lymph node dissection can add an additional 30-90 minutes to your procedure time, there is little additional morbidity associ­ated when performed by an experienced surgeon.

 

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Regardless of the approach, anyone who undergoes a radical cystectomy will require a form of urinary diversion because the bladder will no longer be there to store urine. This can have a significant psychological and functional impact on an individual’s quality of life. Patients are often hesitant to undergo definitive surgery because of the anxiety associated with long-term urinary diversion. There are two main types of urinary diversion: continent and noncontinent. Both forms require surgically removing a segment of bowel (most commonly the small bowel) from your gastrointestinal (GI) tract and plugging the ureter from each kidney into this segment of bowel to provide drainage of urine. Noncontinent diversions (ileal conduit) are those in which the piece of bowel is brought up through the abdominal wall to a stoma and the urine drains contin­uously into a drainage bag. This is die most common type of urinary diversion performed in the United States. This procedure requires approximately 8 to 10 centimeters (3 to 4 inches) of small bowel, which is far less than that used for continent urinary diversions. Although the obvious dis­advantage of this procedure is its lack of continence and need for a continuous drainage bag, it has less short- and long-term complications than that of the continent diver­sion. An external urinary drainage appliance is very well tolerated and patients adapt to them very quickly.

 

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 Bladder Cancer Broadcast

By admin | Published January 26, 2012

Actos Bladder Cancer : Not resting on their laurels, the clinical research community has moved forward and is now testing a new combination that adds paclitaxel, another active drug mentioned above, to the gemcitabine- cisplatin regimen. A three-drug combination (gemcitabine-cisplatin- paclitaxel) has been compared to the two-drug standard, to see whether this produces better cancer shrinkage and improved survival. In June 2007, the first report of this trial was made public. It indicated that the three-drug combination offered no significant benefit compared to gemcitabine-cisplatin and was associated with more side effects.

Another new agent, pemetrexed, also targets the division and reproduction of cancer cells, and has a relatively gentle profile with regard to side effects. It is being tested in patients who have already been treated with gemcitabine and cisplatin to see whether it will cause tumor shrinkage. Early reports are promising, but its true use­fulness is not yet known, and it has not yet been assessed by the Food and Drug Administra tion, which must give formal approval for its use in the treatment of bladder cancer.

In addition to the use of chemotherapy, another class of anti-can- cer agents, the so-called growth inhibitors or targeted agents, is being tested in patients with advanced bladder cancer. It is known that pro­teins located on the surface of cancer cells can control the rate of DNA production and division and stimulate cancer-cell growth. An example is the epidermal growth factor receptor (EGFR), which sits on the surface of some bladder-cancer cells and helps to control the rate at which they grow and divide. Inhibitors of the function of EGFR (and of the genes that control its production) have been developed and are known to slow or stop the growth of some cancer cells.

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You may be alarmed if your doctor suggests the possibility of par­ticipating in a clinical trial Does it mean that you have no hope? What should you do? How should you respond? It’s important not to dismiss the idea out of hand. The words experimental, research, and human volunteer can be upsetting, particularly at a time when you are dealing with the emotional issues surrounding a diagnosis of advanced cancer. But treatments in clinical trials can often be highly beneficial to those who volunteer. You and your loved ones should talk with your medical team members about the kind of clinical trial they are recommending and why it may benefit you. In fact, several studies have shown that patients participating in clinical trials have better outcomes than those found in the community at large. However, this also may be due to the types of patients who agree to participate in trials.

Does referral to a clinical trial mean that there is no hope of your surviving this illness? Not at all! There is always hope of survival, and any doctor can tell you about people who have responded positively to treatment and not only survived, but thrived. Being in a clinical trial doesn’t mean that you won’t continue to receive medical treatment; you wall, and since it’s a voluntary process, you have the right to stop participating in the trial at any time.

As with any aspect of your treatment plan, you make the decision about whether to proceed. Don’t feel pressured to participate in a trial if it doesn’t feel right for you, but do give it objective thought and consideration. How do you begin thinking through the decision on whether to participate in a trial?

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Probably the first question that comes to your mind is whether clinical trials are safe. Scientists and medical investigators work hard to ensure that they are as safe as possible. The medical community and the U.S. Department of Health and Human Sendees have put rules in place ensuring that every clinical trial is highly regulated and reviewed by health-care professionals, who determine that the trial is designed and conducted in compliance with federal regulations gov­erning research on human volunteers. Everything about the trial, from the doctors involved to the people who volunteer and the treat­ment being tested, is subject to strict review and monitoring. However, it is important to understand that some clinical trials do carry increased risks.

As with any treatment, you’ll want to ask about possible risks, ben­efits, side effects, how the treatment works, and what results doctors expect from the study.You’ll want to know who is conducting the clin­ical trial and what kind of oversight is in place. Also ask what is expected of you. Where will you go for the treatments? How often will you go? Are there more tests or office visits than you might have with standard treatment? Who administers the treatments and how are the results measured? Do you have to report regularly to those running the trial? Who pays for it all? Will there be extra costs to you as a result of your participation? Will the team conducting the trial (or the doctors involved) stand to benefit personally from the results of the trial or its conduct?

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 Side Effects News

By admin | Published January 26, 2012

Actos Side Effects : CAN CYTOLOGY BE USED INSTEAD OF CYSTOSCOPY TO RULE OUT BLADDER CANCER?

Urinary cytology is the examination of urine using special stains to look for cancer cells. These cells would have been those that have broken off (exfoliated) from the lining of the urinary tract. Voided urine is sent for analysis. First voided morning urine should not be used as there is a higher rate of cellular degeneration. To enhance the yield of cells, the bladder can be barbotaged (flushed). Cytology is most useful for high grade or aggressive tumors and for those with carcinoma in situ (CIS). In low to intermediate grade tumors, cytology may not be positive because these tumors may not exfoliate cells into the urine. In addition, if low grade tumor cells are exfoliated, they may appear to the pathologist to be identical to normal bladder cells. Due to the limitations of sensitivity of cytology, it is not a very good screening test, but proves to be valuable in following some individuals who have already been diagnosed and treated for bladder cancer.

Because a positive cytology is very specific for cancer, it is highly predictive of transitional cell cancer even if no tumor is visible during cystoscopy. Additional information can be obtained with urine cytology. The DNA content and measurement of the amount of abnormal DNA can be determined. In general, as the amount of abnormal DNA is increased, the prognosis is worsened.

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ARE THERE ANY OTHER URINE TESTS THAT ARE HELPFUL IN MAKING THE DIAGNOSIS?

There has been continued research and a subsequent array of urine tests to screen for bladder cancer. Some of these newer tests include:

Bladder Tumor Antigen (BTA): measures basement membrane protein antigen released into the urine, a protein from the bladder wall.

NMP22: measures nuclear matrix protein 22

Aura Teck FDP: measures fibrin, fibrinogen degradation

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Telomerase: measures the enzyme used to preserve telomeres (the ends of chromosomes required to continue cell division) Hyaluronic Acid, Hyaluronidase: substances which have a role in blood vessel growth in bladder tumors and tumor progression. [1] Research goes on and newer tests may prove to be both more sensitive (positive if cancer is present) and more specific (not positive for other reasons). At this time, none of the urine tests are sensitive enough to take the place of cystoscopy in the initial evaluation of an individual suspected to have bladder cancer. In general, cytology as an adjunct to cystoscopy is more helpful than any of the urine bladder cancer tests to date.

AS PART OF MY INITIAL WORK UP, MY PHYSICIAN HAS ORDERED A CAT SCAN. WHAT’S THE PURPOSE AND ARE THERE ANY ALTERNATIVES?

When an individual has gross hematuria or persistent microscopic hematuria, a complete assessment of the urinary tract is required. Although cystoscopy is the test of choice for examination of the bladder, imaging studies are required to make sure there is no disease in the upper tracts (kidneys and ureters). Bleeding can be caused from many different disorders including transitional cell carcinoma of the upper tracts, kidney or ureteral stones, or renal cell carcinoma (cancer of the parenchyma or fleshy part of the kidneys). Your urologist has a number of options to choose from. There are advantages and disadvantages of each.

Intravenous pyelogram (IVP) is accomplished by injecting a contrast agent into your vein and then obtaining X ray images. The contrast is excreted by your kidneys, subsequently filling the lumen of the kidneys, ureters and the bladder. The contrast allows one to see subtle filling defects within chambers of the urinary tract, possibly representing tumor, stone or blood clot. Tumors of the fleshy part of the kidneys can also be seen. The study also allows for an assessment of renal function. It is a sensitive test for renal obstruction, which can occur because of cancer. Disadvantages of the study include the possibility of an IV contrast agent allergy, which occasionally may be serious.

You will be asked whether you have a sea food allergy, a known allergy to iodine or to IV contrast. If this is the case, you may need to be premedicated prior to the exam to avoid a reaction. Although the study is quite useful at visualizing the upper tracts, it is not very good at picking up subtle tumors on the bladder surface. If your kidneys do not function well (you have renal insufficiency), the contrast may cause harm to your kidneys and the imaging will not be as good. For pregnant women, any X ray exam could be potentially damaging to the fetus and therefore, will not be performed.

 

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Ultrasonography can check for a kidney tumor, stone, or obstruction. Bladders filled with urine can be scanned. There is no contrast or X rays involved, and therefore the study can be accomplished in those with renal disease, contrast allergies or for women who are pregnant. Although larger tumors of the bladder are often visible, it is not a good study to rule out urothelial cancer (transitional cell cancer of the urinary tract lining) since smaller tumors or flat tumors in the lining are not visible. Also, other conditions such as enlarged folds in the bladder or enlarged prostates can be confused with bladder tumors. Ultrasound exams are generally fast, painless, and relatively inexpensive. An ultrasound combined with cystoscopy plus cytology (to rule out cancer cells) is a reasonable assessment for those with a low likelihood of having upper tract disease.

CT Scan or CAT (computerized axial tomography) provides a computerized cross sectional visualization of the abdomen and pelvis. X ray images are synthesized into exquisitely detailed images. The CT scan can be done with or without IV contrast, and therefore has the same limitations as IVP in those with allergies to contrast or renal insufficiency. These studies are excellent for finding renal cell cancers and stones within the kidneys and ureter, but not very good at delineating cancers of the lining. CT scan is often an important part of staging bladder cancer, determining whether the cancer has spread.

Magnetic Resonance Imaging (MRI) is a technology which uses strong magnets to provide detailed images of your internal organs. Like ultrasound, this study has no known harmful effects on the body. It does not require contrast injection like CT scan and can be done safely in patients with renal insufficiency. It is not generally used for initial screening. Many individuals find the test uncomfortable due to a loud noise heard throughout the test, in addition to the close quarters the machine requires, leading to feelings of claustrophobia. A mild sedative may be required if the test is necessary and the individual experiences these uncomfortable feelings.

Our use of the term or terms Actos Side Effects 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 Side Effects Information

By admin | Published January 25, 2012

Actos Side Effects : More information on Actos Side Effects

MY FAMILY WANTS ME TO GO FOR TREATMENT OF MY BLADDER CANCER TO THE “TEACHING HOSPITAL” IN THE CITY MY LOCAL UROLOGIST IS COMPETENT AND CARING AND I TRUST HIS JUDGEMENT SHOULD I LISTEN TO MY FAMILY AND SWITCH UROLOGISTS?

As we have discussed in the preceding questions, finding an excellent urologist to partner with is a must. A physician established at a “teaching hospital” (a hospital where physicians are trained in their respective fields of specialty) is at the minimum, competent. A large teaching or academic center would not risk its reputation on an individual who is sub par. Some individuals may be world class surgeons, but not all will be. An individual may be an average surgeon, but a gifted teacher or researcher, making them invaluable to their academic center. Your local community urologist will likely be an individual trained at one of these academic teaching hospitals. In addition, community hospitals also have credentialing and quality review programs to weed out incompetent physicians. In general, it is true the academic center will have more stringent standards and review of their staff. Nevertheless, excellent physicians can be found at the community hospital as well.

ISN’T IT TRUE THAT ACADEMIC OR TEACHING HOSPITALS WILL HAVE THE BEST TECHNOLOGY OR MOST UP TO DATE INFORMATION TO TREAT MY CANCER?

These hospitals generally are at the forefront of innovation regarding technological advances, testing and implementation of new surgical techniques and chemotherapeutic regimens. However, no one center can be excellent in all spheres of medicine. Each will have particular strengths and weaknesses. We are however, fortunate medical knowledge and innovation are shared openly via medical journals and conferences and other means of information exchange. New information and proven effective techniques are rapidly disseminated throughout the medical community. Some teaching hospitals may be “centers of excellence” for a particular procedure or innovative approach that is available at only a few sites in the country. There is naturally a lag time for some procedures to spread to the local level, and if in fact a new procedure carries substantial benefits compared to the standard, and is not available locally, then a referral may be appropriate.

Medical information is scrutinized in journals and reviewed at conferences. The newest treatment regimens for advanced cancer are explored in clinical trials to determine their efficacy and safety. It is only after they are proven that they become adopted as standard practice by most physicians. For the vast majority of individuals with bladder cancer, excellent, comprehensive treatment can be obtained at the local level. For those requiring more specialized care or for those unfortunate individuals with advanced cancer who desire experimental therapy via a clinical trial for their cancer, a referral to the appropriate center may be appropriate.

IF I HAVE MY MAJOR SURGERY PERFORMED AT A TEACHING HOSPITAL, WILL THE ATTENDING PHYSICIAN PERFORM MY SURGERY AND TAKE CARE OF ME AFTERWARDS?

At a teaching hospital, physicians are in training to master their skills before going out into “practice” in their respective fields. Interns are fresh out of medical school with limited practical training. Often they are referred to as PGY 1 (post graduate year 1). Years of training follow (PGY2, PGY3 etc.). Urology residents are required to generally have at least two years of training in a surgical program followed by four years in urology residency. It is the responsibility of the residency director to provide adequate training for these future urologists while assuring patient safety. Practically speaking, there are usually one or more attending physicians who supervise the work of the physicians in training. The attending physicians are board certified, experienced physicians who treat patients while simultaneously training physicians. The residents will be a key component in your care. They will be assessing you both pre- and post-operatively and will be writing orders directing your care. How much of the surgery they get to do is dependent on their years of training and their skills. They will be under the direct supervision of the attending physician. If you have concerns, you should address them with your attending physician.

MY UROLOGIST ALWAYS KEEPS ME WAITING, DOES THIS MEAN HE DOESN’T CARE?

Given the monetary pressures in today’s medical practice, some physicians are over booked and cannot see the allotted number of patients scheduled without delays. The theory behind this schedule is the expectation that a number of patients will not show for their appointment, allowing the physician to stay true to the schedule and not fall behind.

However, sometimes all of the patients do show, and the physician is delayed. Even with a carefully thought out schedule, emergencies may arise and some visits unexpectedly take longer than scheduled. The physician wants to devote the time and attention required for each individual. After all, you also expect the same time and attention during your visit. Even the most conscientious physician may find himself running behind in a busy medical practice. This lateness should be recognized by the physician who will often acknowledge it with an apology. If you find it distressing to wait more than fifteen minutes (a reasonable time to wait), you should discuss your feelings with your physician, who often can arrange an appointment at the beginning of the schedule when he will almost be guaranteed to be on time.

WILL THERE BE OTHER PHYSICIANS INVOLVED IN MY TREATMENT OF BLADDER CANCER?

You may need to be referred to an oncologist, a physician specialist in the medical therapy of cancer. At times, a referral to a radiation oncologist, a specialist who treats cancer with radiation, may be required. Other individuals may need to be consulted as well. It is important for your urologist to keep your primary care physician up to date so that he can coordinate your care and if required by your insurance plan, make the appropriate referrals.

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On a regular basis, magazine articles, books, and television shows implore those with major illnesses to seek out a second opinion. The general consensus is there is much to be gained and little to be lost, so why not seek out a second opinion? The issue certainly is more complicated than generally addressed, and deserves a review. The following chapter provides a second opinion on second opinions.

WHAT ABOUT SECOND OPINIONS?

In general, a competent physician will recommend a second opinion if there is uncertainty regarding your care. This uncertainty could involve the pathology report or debate regarding the most appropriate treatment options. Certainly if the pathology report is in question, a second opinion is mandatory! Your urologist should be able to spell out his treatment plans for you, what to expect and what alternatives may be required, depending on the seriousness of your disease. The plan may change over time as your disease improves or worsens.

You may need a second opinion if you are not doing well and your physician is unable to provide satisfactory explanations and solutions. Occasionally, your urologist may recommend a second opinion if your problem is unusual or particularly complicated. Having a physician you can trust is mandatory when dealing with cancer. Don’t let anyone pressure you into a second opinion if you feel confident in your physician’s abilities. On the other hand, if you are uncomfortable with your progress or a treatment recommendation, if you are not satisfied with the explanations given to you, don’t hesitate to seek out a second opinion. Your urologist should not feel threatened by this request as he wants you to feel comfortable with the plan of action. Only by partnering with your physician can he be most effective.

WILL MY UROLOGIST BE UPSET WHEN I REQUEST A SECOND OPINION?

Many physicians may feel slighted when a patient requests a second opinion. Your urologist may feel somehow you don’t trust his explanations, skill, or judgment. On the other hand, when a new patient faces a difficult or unexpected diagnosis, the urologist may find the request not at all unusual. It is important you explain to your urologist why you feel a second opinion is warranted. Urologists are professionals and will graciously facilitate your request. The experienced urologist comes to realize that despite his best efforts, some patients will seek a second opinion. If a patient is particularly concerned or nervous about a proposed treatment regimen, your urologist may welcome your request. Your urologist should facilitate your second opinion by sending appropriate records and telling you whether or not it is necessary for you to bring X rays or pathology slides with you. Your primary care physician may need to be contacted for the referral if your insurance requires it.

WHY DOESN’T MY UROLOGIST WANT ME TO GO FOR A SECOND OPINION?

Often, the urologist may believe the second opinion is unnecessary and will delay treatment. He may be concerned you will not only have a second opinion, but transfer your future care to the urologist providing the second opinion. He may believe that you may get bad advice. It is possible he may feel threatened the next urologist will not agree with his work up or care of you to date.

WHERE DO I FIND A SPECIALIST FOR A SECOND OPINION?

Start by asking your primary care physician. You may be able to see another urologist in your community. Do not see another urologist in the same group as a conflict of interest may deter a different opinion. If you are considering a different course of action, such as radiation or chemotherapy, a referral to the appropriate specialist should be made.

Many times your urologist will be highly supportive and suggest a second opinion. He will offer his recommendations and facilitate your visit to the appropriate physician. If there is an issue regarding the care given at your local hospital, you may wish a referral to a “tertiary” or teaching hospital. In most areas, a referral for this reason is unnecessary, as excellent care is obtainable in the community hospital.

 

Our use of the term or terms Actos Side Effects 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 Legal News

By admin | Published January 25, 2012

Actos and Bladder Cancer: Due to the ease of obtaining voided urine specimens, bladder cancer is on the forefront of developing tumor markers. Drs. McNeil, Ekwenna, and Getzenberg take an in depth look at various tumor markers and molecular signatures of bladder cancer in Chap. 6. Although several new tumor markers for bladder cancer are discovered each year and are the subject of numerous review articles, only few reviews are written on the subject of healthcare cost associated with bladder cancer diagnosis, screening, and surveillance. Chapter 7 by Yair Lotan is devoted to the subject of cost associated with bladder cancer detection and surveillance in the general versus high-risk population and using noninvasive techniques such as hematuria detection and tumor markers.

 

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Prognostic markers and molecular nomograms involving proteomics and genom­ics are highly researched and some of the new emerging areas in bladder cancer. In Chap. 8, Dr. Habuchi focuses on seven different classes of molecules ranging from cell adhesion molecules to genetic alterations, which have been investigated for pre­dicting disease progression, response to treatment (local versus systemic control of the disease),

and survival. Chapter 9 by Smith and Theodorescu dwells on a novel idea of molecular nomograms for personalized medicine. While Chap. 8 includes information on individual markers, this chapter focuses on multiplexing of molecular biomarkers to predict response to therapy. Of note is COXEN or Co-expression Extrapolation) algorithm that compares microarray gene expression profiles between cell lines and patient tumors to generate signatures predictive of drug sensitivity or resistance.

 

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Bladder cancer being a complex disease, a practical guide that provides the nec­essary facts at the fingertips is very useful and Chap. 10 by Drs. Levy and Jones provides just that for the management of nonmuscle invasive bladder cancer. Specifically the chapter provides a succinct description of epidemiology, etiology, pathophysiology, clinical and diagnostic evaluations, available molecular markers for disease, as well as the current American Urological Association Guidelines Panel Recommendations and therapies for nonmuscle invasive and recurrent blad­der cancer.Chapters 11-22 encompass clinical management of bladder cancer. Starting from the low-grade bladder cancer, Chap. 11 by Dr. William Oosterlink focuses on histology, risk factors, and diagnosis and detection of low-grade tumors in the blad­der and the upper tract, whereas Chap. 12 by Allaparthi and Balaji covers the clini­cal management of low-grade tumors.

Intravesical chemotherapy or immunotherapy (Bacillus Calmette-Guerin [BCG]) are key adjuvant therapies for the control of high-grade nonmuscle invasive bladder cancer. In Chap. 13, Drs. Adiyat, Katkoori, and Soloway is a review of indications and practical aspects of administration of intravesical chemotherapy, properties, efficacy, and side effects of various intravesical agents, and newer methods improv­ing the efficacy of the intravesical drugs. Although, many reviews have been writ­ten on intravesical BCG therapy, the review by Drs. Bishay, Park, and Hemstreet is unique because of the depth of discussion on the mechanism of action of BCG in animal versus cell culture models, and the involvement of the immune system and inflammatory cytokines/chemokines in mediating response to BCG.

 

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 Bladder Cancer News Flash

By admin | Published January 24, 2012

Actos Bladder Cancer : The word “invasive”refers to whether cells from your bladder cancer have “invaded” the muscle wall of the bladder, and if so, how far into the layers of muscle tissue it has penetrated.This can usually be deter­mined from biopsy results, or occasionally when an operation has been performed to remove the bladder and some of the surrounding tissues. In some cases, organs near the bladder (such as the vagina in women, or the prostate in men) may have been invaded as well.

Invasive cancer extends further into the body than superficial TCC does and is therefore a more serious stage of the disease. It requires more complicated treatment, such as surgical removal of the bladder. This may, in turn, change how you manage basic physical functions in your everyday life, such as your bathroom habits and even your sex life. Also of importance is the significant rate of recurrence connected with invasive cancer. Often other organs, such as the lymph nodes, lung or liver, are involved.

Despite such a gloomy introduction to this chapter, there is every reason for you to be hopeful if youVe been diagnosed with invasive cancer. Current treatment, which includes surgery (cystectomy), chemotherapy, radiation therapy, or two of these approaches com­bined, offers you an excellent chance for long-term survival and, in many cases, for a cure. This applies particularly to those invasive tumors that have not penetrated outside the bladder, the so-called ” organ- confined” tumors.

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There is no question that the after effects of surgical removal of the bladder (cystectomy) can be unsettling to think about. You won’t have a bladder or maybe even a urethra any longer. How will you be able to pass urine? Will you have to have some type of urine-collect­ing bag? Will there be an odor? Will it show when you wear certain clothing? We’ll talk about all those things in more detail, but in brief, your team will need to surgically create an artificial urine-collection system for you. This is known as a urinary diversion system. In years past, the only option was a urine-collection bag worn outside the body which many people found to be unpleasant or even embarrassing.

The good news is that now, in many cases, an artificial bladder (sometimes called a neobladder) can be fashioned from a piece taken from the intestine (bowel), enabling you to void urine in a normal or near-normal fashion. You’ll have to learn to use a different set of mus­cles when urinating, and there may be some leakage now and then, particularly at night. Leakage can be controlled by wearing under­wear designed with a disposable pad or, for men, a sort of condom. Overall, it’s a more attractive option that makes it easier to face a complicated and often scary surgery such as cystectomy. And with modern techniques, most patients no longer have to contend with urinary leakage, except on rare occasions.

Even if you are disappointed because the creation of an internal urinary diversion system is not possible in your situation, keep in mind that there is also no question that cystectomy is a powerful weapon against invasive bladder cancer that can increase your odds of living a long, cancer-free life. Cystectomy is the most common treatment option for invasive blad­der cancer. In most cases, your medical team will recommend a com­plete (or radical) cystectomy. This means that your bladder, the lymph nodes tucked around your bladder in the abdomen, the prostate in men, and the uterus, ovaries, and part of the vaginal wall in women will be surgically removed. Depending on where the cancer is locat­ed, the urethra may also be removed.

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It’s easy to confuse some of the terms your doctors use, such as “cystoscopy”(a diagnostic pro- cedure that introduces a tube into the bladder so that the doctor can look at the inner surface and take a biopsy) and “cystectomy” (the surgical removal of the bladder). Don’t hesitate to ask your doctors for clarification. Cystectomy seems like a drastic surgery, doesn’t it? Why remove so many body parts? Why not just take the tumor and some surrounding tissue?

Depending on where your tumor is located, the cancer-causing substances responsible for the tumors in your bladder were also fil­tered through the kidney, ureters, and urethra, and there is a possibil­ity that tumors may be forming in those organs, too. In particular, the tissues lining the bladder, ureters, and urethra (known as the urothe­lial tissues) may be at risk from the after effects of cancer-causing substances, such as agents in cigarette smoke or industrial dyes. Also, because your cancer may have penetrated the muscle wall, it’s possi­ble that organs surrounding the bladder, such as the prostate, uterus, or vagina, may also be at risk from further growth of the cancer cells.

So in the case of bladder cancer, which often recurs or spreads to other organs, you’ll have a much better chance of a cure once organs and tissue have been removed in areas where the disease is likely to spread or where it may already have infiltrated. And a cure is what you and your doctors most definitely want to strive for. Sometimes, if the cancer is very localized and surrounded by plenty of healthy, noncancerous tissue, a partial cystectomy might be recommended, whereby only a portion of the bladder is removed and some or all of the surrounding organs may be saved.

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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Multaq News

By admin | Published January 24, 2012

Multaq : Liver function tests indicate how well the liver is performing par­ticular functions and the levels of certain measurements associated with inflammation.

Dozens of different LFTs are performed in hospitals, but they all measure the levels of liver proteins, liver enzymes (called trans­aminases and cholestatic liver enzymes), and bilirubin.

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Transamines: AST and ALT

Liver function tests that check the levels of aspartate transaminase (AST) and alanine transaminase (ALT) are looking for inflamma­tion or injury to liver cells-—-in technical terms, hepatocellular liver injur)’’. When the liver is damaged, AST and ALT often leak into the bloodstream, so a blood test result that detected transamines would be a possible indicator of liver damage. However, AST is also found in the heart, kidneys, and muscles, so an elevated amount of AST doesn’t always mean a liver problem. When it is coupled with elevated ALT, which exists only in the liver, a higher AST level indicates that liver damage is more probable.

The extent of liver damage cannot be determined by high transaminase levels alone. If a patient drinks alcohol a few hours before the blood test or works out in the gym the morning his or her blood is drawn, the transaminase levels may be mildly elevated. On the other hand, if alcohol abuse damaged the liver five years ago, the transaminase level may be normal, but still there could be residual liver damage.

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Moreover, men tend to have higher transaminase levels than women, and African American men usually show higher AST and ALT levels than Caucasian men. Almost everyone’s transaminase levels are higher in the morning than they are later in the day.

 

High, levels of AST and ALT serve as the first clues along a path of diagnostic testing to pinpoint what is wrong. Elevated transami­nase levels might indicate strenuous exercise or recent alcohol use, but they could also be caused by a fatty liver, alcoholic liver dis­ease, viral hepatitis, autoimmune hepatitis, a genetic liver disease, a tumor, heart or lung failure, or some toxic injury to the liver.

Our use of the term or terms Multaq 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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Multaq and Liver Damage News Flash

By admin | Published January 24, 2012

Multaq and Liver Damage : Cholestatic Liver Enzymes: GGTP and AP

When a liver function test indicates an elevated level of gamma- glutamyl transpeptidase (GGTP) and alkaline phosphatase (AP), a clinician is likely to suspect blocked, damaged, or inflamed bile ducts. When bile is not flowing adequately, a condition known as cholestatis develops. Any injury or illness involving bile ducts is known as a cholestatic liver injury or cholestatic liver disease.

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Bile ducts are positioned inside and outside the liver. Intra- hepatic cholestasis describes blockage or damage in a bile duct inside the liver, a condition that strikes patients with liver cancer or primary biliary cirrhosis. Extrahepatic cholestasis is an injury or blockage of a duct outside the liver. The bile backs up, the choles­tatic enzymes GGTP and AP seep into the bloodstream, and their levels may be very high. However, both GGTP and AP must be elevated to indicate a liver problem. This distinction is important because while GGTP is mostly found in the liver, AP is routinely found in the bones, kidneys, intestines, and placenta. An elevated level of AP is common during pregnancy and in adolescents who are going through growth spurts. In these circumstances, the level of GGTP would be normal.

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Liver-related conditions that cause GGTP and AP to elevate include liver tumors, autoimmune hepatitis, nonalcoholic fatty liver disease, primary biliary cirrhosis, primary sclerosing cholan­gitis, and alcoholic liver disease, as well as gallstones, particularly those that may have moved out of the gallbladder.

Bilirubin

Bilirubin is the yellowish-green pigment that produces the condi­tion known as jaundice. When the liver fails to excrete bilirubin, symptoms include a yellow cast to die skin and eyes; dark, tea-col­ored urine; and light-colored stools.

Our use of the term or terms Multaq and Liver Damage 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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