Bladder cancer is a common type of cancer that begins in the cells of the bladder. The bladder is a hollow muscular organ in your lower abdomen that stores urine.

Bladder cancer most often begins in the cells (urothelial cells) that line the inside of your bladder. Urothelial cells are also found in your kidneys and the tubes (ureters) that connect the kidneys to the bladder. Urothelial cancer can happen in the kidneys and ureters, too, but it’s much more common in the bladder.

Most bladder cancers are diagnosed at an early stage, when the cancer is highly treatable. But even early-stage bladder cancers can come back after successful treatment like many other cancers. For this reason, people with bladder cancer typically need follow-up tests for years after treatment to look for bladder cancer that recurs.

Signs and symptoms of Bladder Cancer may include the following:

• Blood in urine (hematuria), which may cause urine to appear bright red or cola colored, though sometimes the urine appears normal and blood is detected on a lab test
• Frequent urination
• Painful urination
• Back pain

Bladder cancer begins when cells in the bladder develop changes (mutations) in their DNA. A cell’s DNA contains instructions that tell the cell what to do. The changes tell the cell to multiply rapidly and to go on living when healthy cells would die. The abnormal cells form a tumor that can invade and destroy normal body tissue. In time, the abnormal cells can break away and spread (metastasize) through the body.

How common is Bladder cancer:

Urinary Bladder Cancer is the sixth most common type of cancer in the United States. In 2024, approximately 83,190 people will receive a diagnosis of bladder cancer, and some 16,840 people are expected to die from it, according to estimates by the Surveillance, Epidemiology, and End Results Program (SEER) of the National Cancer Institute (NCI).

Bladder cancer is most likely to affect white men. In fact, the incidence rate of bladder cancer is four times higher among men than among women. It is also twice as high in white males as among Black, Hispanic or Asian/Pacific Islander men.

The NCI explains that there are three major types of bladder cancer. The name of each type of cancer indicates the kind of cells that become malignant.

• Transitional cell carcinoma begins in cells in the innermost tissue layer of the bladder.
• Squamous cell carcinoma begins in the squamous cells. This type may form after long-term infection or irritation.
• Adenocarcinoma begins in glandular (secretory) cells in the lining of the bladder.

Cancer in the lining of the bladder is called superficial bladder cancer. Cancer that has spread through the lining of the bladder and has invaded the muscle wall of the organ, or has spread to nearby organs and lymph nodes, is called invasive bladder cancer.

Survival Rate:

Approximately 78 percent of people diagnosed with bladder cancer survived five years or more after diagnosis between 2012 and 2019, according to federal estimates.

Types of bladder cancer:

Different types of cells in your bladder can become cancerous. The type of bladder cell where cancer begins determines the type of bladder cancer. Doctors use this information to determine which treatments may work best for you.

Types of bladder cancer include:

• Urothelial carcinoma. Urothelial carcinoma, previously called transitional cell carcinoma, occurs in the cells that line the inside of the bladder. Urothelial cells expand when your bladder is full and contract when your bladder is empty. These same cells line the inside of the ureters and the urethra, and cancers can form in those places as well. Urothelial carcinoma is the most common type of bladder cancer in the United States.
• Squamous cell carcinoma. Squamous cell carcinoma is associated with chronic irritation of the bladder — for instance, from an infection or from long-term use of a urinary catheter. Squamous cell bladder cancer is rare in the United States. It’s more common in parts of the world where a certain parasitic infection (schistosomiasis) is a common cause of bladder infections.
• Adenocarcinoma. Adenocarcinoma begins in cells that make up mucus-secreting glands in the bladder. Adenocarcinoma of the bladder is very rare.

Some bladder cancers include more than one type of cell.

Risk factors:

Factors that may increase bladder cancer risk include:

• Smoking. Smoking cigarettes, cigars or pipes may increase the risk of bladder cancer by causing harmful chemicals to accumulate in the urine. When you smoke, your body processes the chemicals in the smoke and excretes some of them in your urine. These harmful chemicals may damage the lining of your bladder, which can increase your risk of cancer.
• Increasing age. Bladder cancer risk increases as you age. Though it can occur at any age, most people diagnosed with bladder cancer are older than 55.
• Being male. Men are more likely to develop bladder cancer than women are.
• Exposure to certain chemicals. Your kidneys play a key role in filtering harmful chemicals from your bloodstream and moving them into your bladder. Because of this, it’s thought that being around certain chemicals may increase the risk of bladder cancer. Chemicals linked to bladder cancer risk include arsenic and chemicals used in the manufacture of dyes, rubber, leather, textiles and paint products.
• Previous cancer treatment. Treatment with the anti-cancer drug cyclophosphamide increases the risk of bladder cancer. People who received radiation treatments aimed at the pelvis for a previous cancer have a higher risk of developing bladder cancer.
• Chronic bladder inflammation. Chronic or repeated urinary infections or inflammations (cystitis), such as might happen with long-term use of a urinary catheter, may increase the risk of a squamous cell bladder cancer. In some areas of the world, squamous cell carcinoma is linked to chronic bladder inflammation caused by the parasitic infection known as schistosomiasis.
• Personal or family history of cancer. If you’ve had bladder cancer, you’re more likely to get it again. If one of your blood relatives — a parent, sibling or child — has a history of bladder cancer, you may have an increased risk of the disease, although it’s rare for bladder cancer to run in families. A family history of Lynch syndrome, also known as hereditary nonpolyposis colorectal cancer (HNPCC), can increase the risk of cancer in the urinary system, as well as in the colon, uterus, ovaries and other organs.

“Arthritis includes approximately 100 conditions that affect the joints and surrounding tissues. It is a leading cause of activity limitations, disability, and chronic pain, and is associated with dispensed opioid prescriptions, substantially contributing to health care costs.

Combined 2019–2021 National Health Interview Survey data were analyzed to update national prevalence estimates of self-reported diagnosed arthritis. An estimated 21.2% (18.7% age-standardized) of U.S. adults aged ≥18 years (53.2 million) had diagnosed arthritis during this time frame. Age-standardized arthritis prevalences were higher among women (20.9%) than men (16.3%), among veterans (24.2%) than nonveterans (18.5%), and among non-Hispanic White (20.1%) than among Hispanic or Latino (14.7%) or non-Hispanic Asian adults (10.3%). Adults aged ≥45 years represent 88.3% of all U.S. adults with arthritis. Unadjusted arthritis prevalence was high among adults with chronic obstructive pulmonary disease (COPD) (57.6%), dementia (55.9%), a disability (54.8%), stroke (52.6%), heart disease (51.5%), diabetes (43.1%), or cancer (43.1%).

Approximately one half of adults aged ≥65 years with COPD, dementia, stroke, heart disease, diabetes, or cancer also had a diagnosis of arthritis. These prevalence estimates can be used to guide public health policies and activities to increase equitable access to physical activity opportunities within the built environment and other arthritis-appropriate, evidence-based interventions.”

National Library of Medicine (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10578950/)

”More than 100 million people in the United States have asthma and/or allergies. Some people may have more than one of these conditions.

• More than 27 million people in the U.S. have asthma (more than 22 million adults and 4.5 million children).^1,2
• About 20 million people in the U.S. have food allergies (16 million adults and 4 million children).^3,4
• About 81 million people in the U.S. have rhinitis due to nasal allergies, also called “hay fever” (67 million adults and 114 million children).^3,4
• There is no cure for asthma or allergies.”

Asthma and Allergy Foundation of America (https://aafa.org/get-involved/asthma-and-allergy-awareness-month/)

More than 65 million Americans overall have asthma and allergies. Some people may have one or both of these conditions.  About 25 million Americans have asthma (20 million adults and 5 million children)  About 32 million Americans have food allergies (26 million adults and 6 million children).  About 24 million Americans have rhinitis (hay fever), or nasal allergies (19.2 million adults and 5.2 million children)  There is no cure for asthma or allergies.

Rates of asthma are highest among African Americans and Puerto Ricans, young boys, and people living below the poverty line. Each year, asthma leads to more than 1.6 million emergency department visits and 170,000 hospital stays. For many, the change in seasons—with more allergens in the environment—can increase wheezing, chest tightness, shortness of breath, coughing, or severe asthma attacks.

Asthma is a chronic (long-term) condition that affects the airways in the lungs. The airways are tubes that carry air in and out of your lungs. If you have asthma, the airways can become inflamed and narrowed at times. This makes it harder for air to flow out of your airways when you breathe out.  Many of those affected with Covid 19 with asthma have a harder time with dealing with it compared to those with no asthma due to the condition affecting breathing to begin with.

Normally, the body’s immune system helps fight infections. But it may also respond to other things you breathe in, such as pollen or mold.  These are things that trigger symptoms of asthma to come on.   In some people, the immune system reacts strongly by creating inflation.  Ending result is the airways narrow causing it more difficult to breath. Over time, the airway walls can become thicker again making oxygen and carbon dioxide exchange not be as effective as someone without asthma.

“There is no treatment to reverse damage to motor neurons or cure ALS at this time. However, some treatments may slow progression of the disease, improve quality of life, and extend survival. New treatments have become available in the past several years, and researchers continue to explore diverse avenues to slow or stop progression of ALS.

Supportive health care is best provided by integrated, multi-disciplinary teams of professionals.  Doctors may use the medications approved by the U.S. Food and Drug Administration (FDA) to support a treatment plan for ALS.”

National Institute of Neurological Disorders and Stroke – NIH (https://www.ninds.nih.gov/health-information/disorders/amyotrophic-lateral-sclerosis-als)

Over the past decade, understanding of the multiple destructive pathways that lead to neuronal death in amyotrophic lateral sclerosis (ALS) has greatly improved.  There is still no cure for ALS unfortunately with all the technology medicine has but there are therapies.

Home Care at some point in middle to beginning of late stage.

This would include a Home Health Assistant followed under a Visiting Nurse/RN with an Attending Doctor for follow up on the pt care=A whole team of medical care including as soon as needed:

PT and OT:

Physical therapy (PT) is the use of exercises and treatments to improve physical movement and overall mobility. Occupational therapy (OT) is similar but is focused on developing or maintaining the physical skills needed to perform everyday tasks. For example, a physical therapist might prescribe stretching exercises to limit discomfort and preserve range of motion or use pool therapy to help you walk and improve joint function. An occupational therapist may help you find new ways to brush your teeth or recommend equipment that can make your activities of daily living easier to perform.

Speech Therapy:

For people living with ALS with bulbar symptoms, ALS leads to speech problems when it attacks bulbar neurons. These are the nerve cells responsible for bringing messages from the lower parts of the brain (bulbar region) to the muscles that move the lips, tongue, soft palate (back of roof of mouth), jaw, and vocal folds (voice box). As nerves are lost to the disease, the muscles they control become weak and tight. This causes dysarthria-difficulty speaking).  A speech-language pathologist can help with both speaking and swallowing difficulties. This may include finding devices to help you communicate as your speech becomes harder for others to understand.

Respiratory Therapy:

A respiratory therapist can teach you new techniques for breathing and coughing, helping you keep your airway and lungs clear and healthy. When mechanical ventilators are needed, they can help you evaluate the options and choose the best ventilator for your needs.  An ALS diagnosis is shocking and frightening, but as with any disease, knowledge is power. Being aware of symptoms and how you can prepare for – and manage – them is key to quality of life and often, for peace of mind. The impact of ALS on breathing is one of the most daunting aspects of the disease and one for which you and your family can and should prepare for early in the ALS journey.

Psychotherapy:

Feeling sad or scared after being diagnosed with ALS is completely natural.

In time the patient with ALS has there life completed turned upside down when they need assistance with there activitities of daily living from independent in their ADLs.  It’s not unusual to feel depressed or anxious after getting diagnosed with ALS. If you have difficulty coping with the mental and emotional side of ALS, a counselor or psychiatrist can help.

Potential symptoms of depression include:  Prolonged feelings of sadness, hopelessness, worthlessness, anxiety, or guilt.   Irritability or angry outbursts over small matters. Changes in sleeping patterns, including insomnia or sleeping too much.  Changes in appetite.

Medications:

There are a number of medications that can help treat the various symptoms of ALS and new drugs are being developed all the time. Talk with your doctor or therapist to find out what is currently available and whether any such medications might be right for you.

There are currently four drugs approved by the U.S. Food and Drug Administration to treat ALS (Radicava, Rilutek, Tiglutik, and Nuedexta). Studies all over the world, many funded by The ALS Association, are ongoing to develop more treatments and a cure for ALS.

Radicava™ (edaravone)

The FDA approved Radicava™ in 2017, less than a year after Mitsubishi Tanabe Pharma America submitted a new drug application, making it the first new treatment specifically for ALS in 22 years.

Rilutek (riluzole, now generic)

This was the first FDA-approved drug available to treat ALS — in 1995. It inhibits glutamate release and prolongs life approximately three months. Riluzole is the generic name of Rilutek.

Tiglutik (thickened riluzole)

The first and only thickened liquid form of riluzole, Tiglutik was approved by the FDA in September 2018. This formulation contrasts with the oral pill form of riluzole that has been on the market for ALS for more than 20 years. It is designed to avoid potential problems of crushing tablets.

Nuedexta®

Indicated for the treatment of pseudobulbar affect (PBA), which is characterized by frequent, involuntary, and often sudden episodes of crying and/or laughing that are exaggerated and/or don’t match how you feel. PBA occurs secondary to a variety of otherwise unrelated neurologic conditions. Nuedexta® (dextromethorphan HBr and quinidine sulfate) was FDA-approved in 2011.

“ALS is a disease that typically involves a gradual onset. The initial symptoms of ALS can be quite varied. One person may have trouble grasping a pen or lifting a coffee cup, while another may experience a change in vocal pitch when speaking.

The progression rate of ALS can be quite variable, as well. Although the mean survival time with ALS is two to five years after diagnosed with ALS, some people go longer for live five years, 10 years or even longer.  It varies from individual to individual after diagnosed with ALS.”

ALS Association (https://www.als.org/understanding-als/symptoms-diagnosis)

Once ALS starts, it almost always progresses, eventually taking away the ability to walk, dress, write, speak, swallow, and breathe, and shortening the life span. The onset of ALS often involves muscle weakness or stiffness as early symptoms. Progression of weakness, wasting, and paralysis of the muscles of the limbs and trunk, as well as those that control vital functions such as speech, swallowing, and breathing, generally follows.

How fast and in what order this occurs is very different from person to person. While the average survival time is three years, about 20 percent of people with ALS live five years, 10 percent will survive 10 years and 5 percent will live 20 years or longer.

End stages of ALS often include trouble swallowing and speaking. Weak and paralyzed vocal cords make speaking difficult and eventually impossible. Trouble swallowing occurs gradually in some patients, but can occur suddenly in others.

Stages of ALS

ALS is a relentlessly progressive disorder. The rate of progression between individuals is variable and the history generally reflects gradual and progressive worsening over time until death occurs.

Early stages:

Muscles

• Muscles may be weak and soft, or they may be stiff, tight, and spastic. Muscle cramping and twitching (fasciculation) occurs, as does loss of muscle bulk (atrophy).
• Symptoms may be limited to a single body region or mild symptoms may affect more than one region.

Physical effects

• The person may experience fatigue, poor balance, slurred words, a weak grip, tripping when walking, or other minor symptoms.
• Sometimes this stage occurs before a diagnosis is made.

Middle stages:

Muscles

• Symptoms become more widespread.
• Some muscles are paralyzed, while others are weakened or unaffected. Fasciculations may continue.

Physical effects

• Unused muscles may cause contractures, in which the joints become rigid, painful, and sometimes deformed.
• If a fall occurs, the person may not be able to stand back up alone.
• Driving is relinquished.
• Weakness in swallowing muscles may cause choking and greater difficulty eating and managing saliva.
• Weakness in breathing muscles can cause respiratory insufficiency, especially when lying down.
• Some people experience bouts of uncontrolled and inappropriate laughing or crying (pseudobulbar affect). Despite how it seems, the person usually doesn’t feel particularly sad or happy.

Late stages:

Muscles

• Most voluntary muscles are paralyzed.
• The muscles that help move air in and out of the lungs are severely compromised.

Physical effects

• Mobility is extremely limited, and help is needed in caring for most personal needs.
• Poor respiration may cause fatigue, fuzzy thinking, headaches, and susceptibility to pneumonia. (Respiratory insufficiency is a leading cause of death in ALS.)
• Speech, or eating and drinking by mouth, may not be possible
• Assistance needed if not needed in the previous stage yet; in the home care you would need:
  
  • Power wheelchair, hospital bed, mechanical lift, and switches that enable any moving body part to operate computers, environmental control units, and communication devices.
  • Assisted ventilation, either noninvasive or invasive (tracheostomy).
  • Feeding tube.
  • Possibly urinary catheters aren’t required but can make toileting easier.
  • The type of home assistance you need:

  1.) Caregivers should:

  • Find and train caregiving help.
  • Oversee 24-hour care operations.
  • Find ways to help the person with ALS stay socially and mentally active.
  • Get into a routine that supports themselves as well as the person with ALS.
  • Know that although this stage is all-consuming, surprisingly many caregivers report great stability and satisfaction in their daily lives at this later stage of the disease.

       2.) Visiting RN (Nurse) who basically follows up on the care and decline or no change in pt    with letting the attending M.D. in charge be kept informed on pt’s status who makes any change with orders on the pt’s care.  It’s a whole team effect to make sure the pt gets the best care!

• Progression is not always a straight line in an individual, either. It is not uncommon to have periods lasting weeks to months where there is very little or no loss of function. There are even very rare examples in which there is significant improvement and recovery of lost function. These ALS “arrests” and “reversals” are, unfortunately, usually transient. Less than 1 percent of people with ALS will have significant improvement in function lasting 12 months or longer

End stage

• The vast majority of deaths in ALS are the result of respiratory failure, a process that progresses slowly over months. Medications can relieve discomfort, anxiety, and fear caused by respiratory insufficiency.
• Far less-common causes of death in ALS include malnutrition as a result of swallowing problems, pulmonary embolism (a blockage in one of the arteries of the lungs), abnormalities in the heart’s electrical pacing system called cardiac arrhythmias, and pneumonia as the result of aspiration (when food or fluid gets into the lungs).
• Hospice care (in a facility or in the home) focuses on providing comfort and maintaining quality of life by supporting the physical, emotional, and spiritual needs of the individual with ALS and their family members. Families should contact hospice early on to see what in-home services are available even before the most advanced stage.
• At MDA clinics, physicians work closely with palliative care teams to coordinate treatment with in-home hospice care providers, assisted living facilities, or inpatient hospice settings. Such cooperation helps ensure the person with ALS has the most peaceful and painless experience possible.

“The more you learn about ALS, the better prepared you’ll be. Remember, in addition to doing your own research, speaking regularly with your healthcare provider(s) will help you make the most informed decisions moving forward. Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s Disease, is a disease that affects parts of the nervous system that control voluntary muscle movements (the muscles that people move at will, like those of the arms and legs). ALS is referred to as a progressive disease, meaning the symptoms continue to get worse over time. People with ALS gradually lose strength in their muscles and become weaker, which can limit movement and the ability to live an independent life.

As ALS progresses, it will eventually affect muscles that control breathing, as well as chewing and swallowing food.”

ALS Pathways (https://www.alspathways.com/als-overview)