Bladder Cancer

Published on 04/03/2015 by admin

Filed under Hematology, Oncology and Palliative Medicine

Last modified 04/03/2015

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Chapter 83

Bladder Cancer

Summary of Key Points

Primary Therapy

• Transurethral resection of bladder tumor (TURBT) is the initial procedure and used to determine the clinical stage that drives subsequent treatment approaches.

• For patients with noninvasive bladder cancer (Ta, Tis, or T1), a complete TURBT may be sufficient. The addition of intravesical therapy reduces the risks of recurrence and progression to muscle-invasive cancer.

• Bacillus Calmette-Guerin (BCG) is the most effective agent for intravesical therapy in patients with high-grade noninvasive disease. An induction course of 6-weekly treatments, followed by maintenance therapy every 6 months for 2 to 3 years, may be used.

• For patients with MIBC, radical cystectomy with urinary diversion is the most commonly used treatment approach in the United States. However, there is significant undertreatment of elderly patients with MIBC likely because of concerns about tolerability of cystectomy.

• Trimodality bladder preservation therapy (TURBT followed by concurrent chemoradiation) is a well-tolerated and effective alternative for patients with MIBC, including elderly patients. Overall, 75% to 80% of patients maintain their native bladders long-term.

• Effective radiosensitizing chemotherapy agents include cisplatin-based regimens or 5-fluorouracil (5-FU) with mitomycin C.