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Naturally, newly diagnosed patients with multiple myeloma have a lot of questions for their physicians. Dr. Joshua Richter had the time to discuss some of them.
 

Addressing Questions From Newly Diagnosed Patients with Multiple Myeloma

A new patient-reported outcomes tool is helping to shift the way end-of-life and depression-related conversations are occurring between patients with multiple myeloma and their health care teams.

Giving Patients Autonomy During Difficult Conversations

Understanding Bladder Cancer: Types, Diagnosis and Treatment Options

A cancer diagnosis is a life-altering event that can bring up a lot of questions and uncertainty. Knowing what to expect is one of the most important things you can do to take control of your health. This guide is designed to provide a comprehensive overview of bladder cancer, from diagnosis to treatment, to help you feel more prepared for conversations with your medical team.

Bladder cancer occurs when cells in the lining of the bladder, a hollow, muscular organ that stores urine, start to grow uncontrollably. The most common type is 

, which accounts for over 90% of cases in industrialized nations. The disease can be classified into two main types based on how deeply it has invaded the bladder wall:

Non-Muscle-Invasive Bladder Cancer (NMIBC):

 This is the most common form, accounting for about 70% to 75% of diagnoses. The cancer is confined to the inner layers of the bladder and has not yet grown into the muscle layer. NMIBC is considered early-stage and often has a very good prognosis, though it has a high rate of recurrence.

 This type is more advanced, as the cancer has grown into the deeper muscle layers of the bladder wall and has a higher chance of spreading (metastasizing) to other parts of the body. Treatment for MIBC is more aggressive, and it represents a more serious health concern.

The primary risk factors for bladder cancer include 

, which is the most significant risk factor, and exposure to certain industrial chemicals. Common symptoms include blood in the urine (hematuria), a frequent urge to urinate and painful urination. These symptoms can also be caused by less serious conditions like a urinary tract infection (UTI), so a proper diagnosis is crucial.

The diagnostic process for bladder cancer is thorough and aims to not only confirm the presence of cancer but also to determine its type, stage and grade. This information is vital for creating an effective treatment plan.

 This is the most important diagnostic procedure. A urologist inserts a thin, flexible tube with a camera (a cystoscope) through the urethra into the bladder to visually inspect the lining for any abnormal growths or tumors. If a suspicious area is found, a small tissue sample (biopsy) is taken for a pathologist to examine under a microscope. This examination confirms the diagnosis and determines the cancer's grade (how aggressive the cells look) and type.

 A urine sample is examined under a microscope for the presence of cancerous cells. While not as definitive as a biopsy, it can provide an initial indication. Some newer tests can also look for specific tumor markers in the urine to help with diagnosis and monitoring.

 To assess the extent of the cancer and check for any spread, your doctor may order imaging tests like a 

. These scans provide detailed pictures of the kidneys, ureters and bladder, helping to stage the cancer. A chest X-ray or bone scan may also be performed if there's a concern that the cancer has spread to other organs.

Treatment for bladder cancer is highly individualized and depends on the type, stage, and grade of the cancer, as well as your overall health.

Transurethral Resection of Bladder Tumor (TURBT):

 This is the initial and often curative treatment for most NMIBC cases. During this procedure, a surgeon removes the tumor from the bladder wall using an instrument inserted through the urethra. This is the same procedure often used for diagnosis and can be a complete treatment if the cancer is superficial.

 After a TURBT, medication may be delivered directly into the bladder via a catheter to prevent the cancer from coming back.

, a weakened bacterium that stimulates an immune response in the bladder to fight cancer cells.

 Chemotherapy drugs, such as mitomycin, are instilled directly into the bladder to kill any remaining cancer cells.

 For more aggressive NMIBC or most MIBC cases, a cystectomy (surgical removal of the bladder) is often necessary.

 A small part of the bladder is removed. This is an option if the cancer is in a single, isolated area.

 The entire bladder is removed, along with nearby lymph nodes and, for men, the prostate and seminal vesicles; for women, the uterus, ovaries and part of the vagina. If you have a radical cystectomy, a surgeon will create a new way for your body to store and pass urine, a procedure known as 

, the director of urologic oncology at the CU Cancer Center and UCHealth University of Colorado Hospital, about the patient experience of radical cystectomy.

“From a patient's perspective, getting ready for the surgery, having the surgery, and then recovering from the surgery are the main parts,” she said. “I generally recommend that patients recover from surgery at home but stay active, which is also the best way to get ready for surgery. I often have patients, even well into their 80s, do long walks multiple times a day and make sure they're eating high-protein diets and things like that so their bodies can recover.

“I generally like to perform bladder removal surgery with laparoscopic robot assistance. This means we make small incisions in the abdominal wall, put ports through them, and then insert the instruments through the ports and dock the robot. This allows me to get deep into the pelvis and see everything. When you do the surgeries open, it's very hard to get both hands into the pelvis and perform very fine surgery, at least for me. So, we remove the bladder, and often we remove lymph nodes with it as well to make sure that the cancer hasn't spread. Then we create some sort of 

, [which is] some way to reroute the urine to leave the body.”

 These treatments use drugs that travel through the bloodstream to kill cancer cells throughout the body.

 Used to shrink tumors before surgery (neoadjuvant chemotherapy) or to kill any remaining cancer cells after surgery (adjuvant chemotherapy).

 Newer drugs, called checkpoint inhibitors, can help your immune system recognize and attack cancer cells.

 These drugs specifically target cancer cells by interfering with their growth signals, causing less harm to healthy cells.

 High-energy X-rays are used to kill cancer cells. It can be used alone or in combination with chemotherapy, particularly for patients who can't have or don't want surgery.

It's important to be aware of the potential side effects of treatment, as managing them is a key part of your journey.

 Common side effects include bladder irritation, a frequent need to urinate, painful urination and flu-like symptoms, such as fever and fatigue. These are usually temporary.

 A radical cystectomy is a major surgery with significant side effects. You will need to adjust to a new way of urinating through a urinary diversion. Side effects can include urinary leakage, infections and changes in sexual function due to nerve damage.

 Systemic treatments can cause a range of side effects, including fatigue, nausea, vomiting, hair loss, loss of appetite and a higher risk of infection. Immunotherapy can also cause an overactive immune response, leading to inflammation in various organs.

 Side effects can include skin changes in the treated area, fatigue and bladder or bowel symptoms like frequent urination or diarrhea.

Editor's note: This guide is designed to be a starting point. Your personal experience will be unique. By using this information as a foundation for your discussions, you can partner with your oncologist to make the best decisions for your health.

This article is for informational purposes only and is not a substitute for professional medical advice. Please contact your healthcare team with any questions or concerns.

For more news on cancer updates, research and education,

don’t forget to subscribe to CURE®’s newsletters here.

Bladder cancer, primarily urothelial carcinoma, is categorized into non-muscle-invasive and muscle-invasive types, with smoking as a major risk factor. Diagnosis involves cystoscopy, biopsy, urine cytology, and imaging scans. Treatment varies by cancer stage and includes transurethral resection, intravesical therapy, immunotherapy, chemotherapy, and cystectomy. Radical cystectomy, often performed with robotic assistance, requires significant recovery and lifestyle adjustments. Systemic therapies like chemotherapy, immunotherapy, and targeted therapy are used for advanced cases. Treatment side effects range from bladder irritation to systemic symptoms, necessitating comprehensive management.

This guide provides an overview of bladder cancer, from diagnosis to treatment, helping patients understand options, manage side effects, and plan care.

Tumor

Breast Cancer: What You Need to Know About Types, Staging and Genetics 

Breast cancer is a complex disease, but understanding its fundamental aspects can empower you to have more informed and productive conversations with your oncologist. This guide provides an overview of the key topics in breast cancer care, from diagnosis to survivorship.

What Are the Different Types of Breast Cancer?

Breast cancers are classified by the cells they originate from. The two most common types are:

: This is the most prevalent type, starting in the milk ducts and then invading surrounding breast tissue.

: This type begins in the milk-producing lobules and spreads to surrounding tissues.

Other types of breast cancer are defined by the presence or absence of hormone and protein receptors:

Hormone receptor–positive (HR+) breast cancer

: the most common type, meaning the cancer grows in response to hormones. This includes estrogen receptor–positive (ER+) and progesterone receptor–positive (PR+) cancers, which often respond well to hormone-blocking therapies

: has higher-than-normal levels of the HER2 protein, which drives cancer growth and can be treated with targeted therapies

: does not have estrogen, progesterone, or HER2 receptors. It is often more aggressive and may require chemotherapy or newer targeted treatments

: a rare, fast-growing cancer that causes swelling, redness, and thickened skin of the breast

: affects the nipple and sometimes the areola, often presenting with redness, scaling, or irritation

: include medullary, mucinous, and tubular breast cancers, each with unique cellular features

Staging describes the extent of the cancer’s spread. It’s a crucial tool that helps doctors determine the best treatment plan and predict the prognosis. The staging system typically uses a scale of 0 to IV.

: Non-invasive cancer, such as ductal carcinoma insitu (DCIS).

: Small invasive tumor, contained within the breast.

I: Larger tumors or cancer that has spread to nearby lymph nodes.

: Metastatic breast cancer, meaning it has spread to distant parts of the body like the bones, liver, or lungs.

What Is the Role of Genetics, Such as BRCA1/2, in Breast Cancer?

Genetic factors play a significant role in some breast cancers. Mutations in the BRCA1 and BRCA2 genes are the most well-known. These genes normally help repair cell damage and prevent cancer development. A mutation in one of these genes significantly increases a person's risk of developing breast cancer and other cancers, such as ovarian cancer. Genetic testing can determine if you carry one of these mutations, which may influence your treatment and screening plan.

Breast Cancer Diagnosis: What Tests Are Used?

A definitive diagnosis of breast cancer is made through a biopsy, where a small tissue sample is taken and examined by a pathologist. Additional tests help classify the cancer, including:

: This test determines if the cancer cells have receptors for the hormones estrogen (ER) and progesterone (PR). Cancers that are ER-positive or PR-positive may be treated with hormone therapy.

: This test checks for the presence of the HER2 protein. Cancers that are HER2-positive tend to grow faster but can be treated with targeted therapies.

 This is a marker that indicates how fast the cancer cells are dividing.

For some patients with early-stage, ER-positive breast cancer, the Breast Cancer Index (BCI) is a genomic test that can help predict the likelihood of cancer recurrence after five years of hormonal therapy. This information can help you and your oncologist decide whether to continue hormone therapy beyond five years.

What Are the Available Breast Cancer Treatment Options?

Treatment plans are highly individualized and often involve a combination of therapies.

 This is often the first step to remove the tumor. Options include a lumpectomy, which removes only the tumor and a small amount of surrounding tissue, or a mastectomy, which removes the entire breast.

:This therapy uses high-energy rays to kill any remaining cancer cells in the breast or chest wall. It is often used after a lumpectomy.

: These powerful drugs are used to kill fast-growing cancer cells throughout the body. Chemotherapy may be given before surgery to shrink a tumor or after surgery to destroy any remaining cancer cells.

: This treatment is for ER-positive and PR-positive cancers. It works by blocking hormones from reaching cancer cells or by reducing hormone levels in the body to prevent cancer from growing.

: This treatment targets specific characteristics of cancer cells, such as the HER2 protein, with less harm to normal cells. It may include monoclonal antibodies, small molecule inhibitors, or antibody-drug conjugates, which deliver chemotherapy directly to cancer cells while sparing healthy tissue.

Dr. Erika Hamilton, a board-certified medical oncologist and director of Breast Cancer and Gynecologic Cancer Research at Sarah Cannon Research Institute said in an interview with CURE

. “We not only have new agents, but we're quickly trying to move these agents up into earlier lines when they prove to be beneficial for our metastatic patients. It's a quickly emerging field. We treat breast cancer almost completely differently than we treated breast cancer a decade ago. This is really exciting, because it means our patients are doing better due to these advances.”

How to Manage Side Effects in Breast Cancer Treatment

Treatments can have various side effects, such as fatigue, nausea, or nerve pain. Discussing potential side effects with your care team and having a plan to manage them is crucial for maintaining your quality of life. Strategies may include medication adjustments, dietary changes, gentle exercise, or complementary therapies such as acupuncture, massage, or relaxation techniques. Staying hydrated, pacing daily activities, and getting adequate rest can also help manage fatigue. Communicating openly with your care team about new or worsening side effects ensures timely support and interventions.

Emotional Well-Being During and After Breast Cancer Treatment

A cancer diagnosis is emotionally challenging. Many patients benefit from support groups, therapy, or connecting with others who have gone through a similar experience. Mindfulness practices, journaling, meditation, or creative outlets like art or music can help manage stress and anxiety. It’s normal to experience a range of emotions, from fear and sadness to relief and gratitude. Patients may also find comfort in spiritual practices or connecting with community resources. Early recognition of emotional distress allows for timely support and can improve overall quality of life.

What Does Breast Cancer Survivorship Mean?

After active treatment ends, the focus shifts to survivorship. This includes regular follow-up appointments, monitoring for recurrence, and maintaining a healthy lifestyle. Survivorship also involves managing long-term side effects, addressing other health conditions, and restoring energy and strength. Patients may develop a survivorship care plan with their oncology team to guide ongoing health decisions. Survivorship can also include setting personal health goals, returning to social or professional activities, and maintaining emotional and mental well-being.

Even after successful treatment, there is a risk of recurrence. This can be a local recurrence, in the same area as the original tumor, or a distant recurrence, known as metastatic disease.

“We look at recurrence in several ways,” said Marla Sustin, a nurse practitioner at University Hospitals Seidman Cancer Center in Cleveland, 

“One approach uses prognostic tools, which examine clinical and pathological factors. Theother approach is predictive, often involving genomic testing. Predictive testing is more definitive—you run the test, it gives you an answer, and that guides the treatment path. Prognostic tools consider factors such as tumor size, grade, estrogen receptor status, and other characteristics. Using this information, we can classify patients as high risk, medium risk, or low risk.”

Staying in close contact with your oncologist is essential for long-term monitoring. Being aware of symptoms, following routine imaging and lab tests, and discussing risk-reduction strategies, including lifestyle changes, preventive medications, or clinical trials, can help detect recurrence early. Emotional support for coping with the possibility of recurrence is equally important.

For more news on cancer updates, research and education, 

Breast cancer encompasses various types, primarily classified by cell origin and receptor presence, such as IDC, ILC, HR+, HER2-positive, and triple-negative. Staging, from 0 to IV, guides treatment and prognosis. Genetic factors, notably BRCA1/2 mutations, significantly influence risk and management. Diagnosis involves biopsies and receptor status tests. Treatment options include surgery, radiation, chemotherapy, hormone, and targeted therapies. Managing side effects and emotional well-being is crucial. Survivorship focuses on monitoring, lifestyle, and recurrence risk. Prognostic and predictive tools aid in assessing recurrence risk and guiding treatment.

Breast cancer types, staging, diagnosis, treatment, and survivorship are complex, but understanding them helps patients make informed care decisions. 

Early-stage kidney cancer is limited to the kidney, usually under seven centimeters and often has a very good prognosis when treated promptly.

Navigating Your Early-Stage Kidney Cancer Diagnosis

Early-stage kidney cancer, or stage 1 renal cell carcinoma, is characterized by a tumor confined to the kidney, typically less than seven centimeters. It is often discovered incidentally through imaging tests for unrelated conditions. Treatment is personalized, with surgery being the primary approach, including partial or radical nephrectomy. Minimally invasive therapies and active surveillance are options for specific cases. Advances in adjuvant therapies, such as immunotherapy and targeted therapy, are being explored to reduce recurrence risk. Clinical trials are investigating combination therapies and personalized vaccines to enhance treatment efficacy.

Joshua Richter, M.D.

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