possible recurrence

1 year 11 months ago #60858 by joea73
Replied by joea73 on topic possible recurrence
I am so sorry to hear that  cancer was found in the lmph nodes inspite of partial cystectomy.
Also thank you updating us the status.  It helps everyone of us understand more about adenocarcinoma and  its treatment which is considered rare type of bladder cancer.  I understand that adenoma carcinoma is the cancer that starts in the glands which produces mucus.  So, colon, breasts, lungs, pancreas and prostate which has many glands in its organ seem to have high occurance for adenocarcinoma.  I did not think there were glands in the bladder because I do not know the role of glands in the bladder. 

Wikipedia says 5FU is often used as a treatment for colon cancer.  5FU is a type of chemo agent which inhibit duplication of DNA in cell divicion, in effect stops prolification of  cancer cells (normal cells too).  Since most of colon cancers are adenocarcinoma, it sounds like it is used for adenomacarcinoma of bladder.  

Optivo and Yervoy are immuotherapy drugs, but they have different mechanism of actions.  In 2018, two scientists were awarded Nobel prize for discovery of immunotherapies.   Dr. Honjo of Japan was awarded for his discovery of immune check point inhibitor.  Immune check point (PD-1, PD-L1) inhibitor is what we usually use for bladder cancer.   Several check point inhibitors which were commercialized are Keytruda by Merck, Tecentriq by Roche, Optivo by Bristol Meyers Squibb.  Keytruda is T-cell PD-1 checkpoint inhibitor and is well known and used for bladder cancer treatment.  Optivo is also PD-1 checkpoint inhibitor.  So, w can consider Optivo and Keytruda as almos the same immunotherapy drugs.   The other Nobel prize recipient in 2019 for Medicne is Dr. Allison of the USA for his discovery of immunotherapy to inhibit T-cell CTLA-4 protein which is acting as brakes to attack cancer cells.   PD-L1 inhibitor has shown to kill advanced bladder cancer cellls and Keyruda has been notably used to treat bladder cancer.   As per your reference CTLA-4 and PD-1/PD-L1 inhibitor combination have shown to inhibits tumor growth in colon cancer.  As colon cancer is mostly adenocarcinoma,  there is a hope that it can work for adenocarcinoma gladder cancer as well, so I understand.    

Incidentally, mismatching which the article you refered mentions was termed because a wrong nucleotide was paired.  Cancer is abornomal cells.  Abnormal cells are produced because of abnormal genes in DNA.  If abnormal genes are proteins which have imortant function, the cell which is made up with many proteins behave abnormally and can have features of cancer cells.   DNA is a long string of many genes - some are used to produce protein and some are just for other traits such as eye color, etc.  DNA string is made of four different nucelotides,  A,G,C,T, coding information.   Actually DNA is made of two long strings of  A,G,C,T.  One string has all the information to make up our entire body, but because the information on DNA is so critical to be correc because every cell in our body has the exactly same information, there is second string which goes in oposit direction with A on one string is paired with T on the other string.  G on one string is paired with C.  But our body sometimes mistake and make a mistake and A  on one string get paired with C instead of T on other string.  This is called mismatching.  Out body has evolved to be smart so when this mismatching happnes it will correct itself.  But some people's body cannot repair this mismatching.  If this mismatching is not repaired before the cell is divided, it can cause abnormal genes , subsequently protein which cannot perform intended function, thus creating abornomal cell, which might become cancer cell.

Anyway, I hope you 5FU and radiation work for your husband.  Also those new treatments for adenocarcinoma for other organs will become available for adenocacinoma of bladder.



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1 year 11 months ago #60850 by ckfun
Replied by ckfun on topic possible recurrence
My husband was diagnosed with adenocarcinoma bladder last year..
He had a partial bladder removal..
A month ago the lymph nodes showed cancer.  He is going through 6 weeks of radiation and oral chemo (5-FU)
Yesterday I read an article that Opdivo and Yervoy combo were having good results on colorectal cancer.
This is encouraging to me for bladder, as well...Squamous and Adenocarcinoma.

Be well.
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2 years 2 months ago #60693 by Cariboy72
Replied by Cariboy72 on topic possible recurrence
Thank you so much for the response!  I've been having difficulty finding information on this topic.  Your post has been encouraging to us.    Wishing everyone the best!

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2 years 2 months ago #60692 by joea73
Replied by joea73 on topic possible recurrence
A study on the effectiveness of immunotherapy to squamous bladder cancer was published in 2020.   The study was conducted by various hospitals in Germany, involving urologists and pathologists.   The study showed a high expression of PD-L1 protein on squamous bladder cancers.  This is good news for patients with squamous bladder cancer.   At this point, Immunotherapy drugs such as Pembrolizumab( Keytruda by Merck) had been approved for advanced urothelial bladder cancer.  But immunotherapy has shown only effective if PD-L1 expression on the patients' cancer cells is high.  So, those urothelial bladder cancer patients with low expression of PD-L1 are usually not eligible for immunotherapy.   What this study found was that squamous bladder cancer cells showed high expression ( high numbers) of PD-L1, so they think immunotherapy will be effective for squamous bladder cancer.  The clinical case the study group conducted was 65 years old patient, who developed squamous type bladder cancer after having been initially treated with BCG for T1HG.
The patient was treated with OPDIVO® (nivolumab) immunotherapy drug by BRISTOL MYERS SQUIBB and cancer had disappeared. 

Below is the link to the study.

Therapeutic implications of PD-L1 expression in bladder cancer with squamous differentiation

FYI, Immunotherapy is also called immune checkpoint inhibitor therapy.   PD-L1 is an immune checkpoint, often found on the urothelial bladder cancer cells, is used to hide from T-killer cells.   According to MERCK's, many tumor cells produce antigens, which may be released in the bloodstream or remain on the cell surface.   Our innate immune cells such as dendritic cells are called antigen-presenting cells.  Their role is to pick up antigens and deliver them to lymph nodes and help activate anti-bodies and T-killer cells which are antigen-specific.   The activated T-killer cells come and identify the cancer cells and supposed to attack the cancer cells.  But,  when the cancer cells have many PD-L1s on the cell surface,  The PD-1 immune checkpoint of  T-killer cells shakes hand with the PD-L1 immune checkpoint of the cancer cells, and T-killer cells just go away.  What immune checkpoint inhibitor therapy (immunotherapy) is to put a glove on either PD-L1 or PD-1 immune checkpoint, so T-killer cells and the cancer cells cannot shake their hands and let T-killer cells attack the cancer cells.  Keytruda by MERCK and OPDIVO by BRISTOL MYERS SQUIBB are the drugs that put gloves on the PD-1 immune checkpoint of T-killer cells.  

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2 years 2 months ago #60691 by Cariboy72
possible recurrence was created by Cariboy72
Hello everyone.  My partner who is 79 was diagnosed with squamous cell bladder cancer stage 4 last year which resulted in the removal of the bladder and 7 lymph nodes.  A week ago we received some distressing news.  The PET scan revealed a possible recurrence of the cancer only after 6 or 7 months.  There were  a couple of masses found in the left and right abdomen near the surgical site.  The oncologist and the urologist noticed, however, that they had a strange shape and ordered an additional CT to figure out what it is, although I cannot imagine what else it could be.  If it is, in fact, a recurrence, the next steps will be radiation therapy and a round of immunotherapy afterwards.  Prior to the surgery he received adjuvant chemotherapy which did very little, so I don't think chemotherapy will ever be an option again.  I've read that the Squamous cell variant  is often resistant to chemotherapy.  Does anyone happen to know of any studies where this variant is responsive to Radiation and/or immunotherapy?  My deepest thanks to you all.  
 peace and blessings.

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