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__NOTOC__
__NOTOC__
{{Bladder cancer}}
{{Bladder cancer}}
{{SCC}}
 
{{CMG}}; {{SCC}} {{AE}} {{F.K}}  


==Overview==
==Overview==
The predominant therapy for bladder cancer is [[surgical resection]]. Adjunctive [[chemotherapy]], [[radiation therapy]], and [[immunotherapy]] may be required.
==Medical Therapy==
==Medical Therapy==
'''Immunotherapy'''
'''Immunotherapy'''


* [[Immunotherapy]] is a type of biological therapy that uses the immune system to help destroy cancer cells.<ref>Bladder Cancer. Canadian Cancer Society 2015. http://www.cancer.ca/en/cancer-information/cancer-type/bladder/treatment/?region=ab Accessed on October, 7 2015 </ref>
* [[Immunotherapy]] is a type of biological therapy that uses the immune system to help destroy cancer cells.<ref name="pmid19711266">{{cite journal |vauthors=Ghahestani SM, Shakhssalim N |title=Palliative treatment of intractable hematuria in context of advanced bladder cancer: a systematic review |journal=Urol J |volume=6 |issue=3 |pages=149–56 |date=2009 |pmid=19711266 |doi= |url=}}</ref>
* Bacillus Calmette–Guérin (BCG)
* Bacillus Calmette–Guérin (BCG)
:* [[Immunotherapy]] by intravesicular delivery of Bacillus Calmette–Guérin (BCG) is often used to treat and prevent the recurrence of superficial tumors.<ref>{{Cite journal|author=Alexandroff AB, Jackson AM, O'Donnell MA, James K |title=BCG immunotherapy of bladder cancer: 20 years on |journal=Lancet |volume=353 |issue=9165 |pages=1689–94 |date=May 1999 |pmid=10335805 |doi=10.1016/S0140-6736(98)07422-4}}</ref>  
:* [[Immunotherapy]] by intravesicular delivery of Bacillus Calmette–Guérin (BCG) is often used to treat and prevent the recurrence of superficial [[tumors]].<ref>{{Cite journal|author=Alexandroff AB, Jackson AM, O'Donnell MA, James K |title=BCG immunotherapy of bladder cancer: 20 years on |journal=Lancet |volume=353 |issue=9165 |pages=1689–94 |date=May 1999 |pmid=10335805 |doi=10.1016/S0140-6736(98)07422-4}}</ref>  
:* BCG is a [[vaccine]] against tuberculosis that is prepared from attenuated live bovine tuberculosis bacillus, [[Mycobacterium bovis]], that has lost its virulence in humans. BCG immunotherapy is effective in up to 2/3 of the cases at this stage, and in randomized trials has been shown to be superior to standard [[chemotherapy]].<ref>{{Cite journal|doi=10.1056/NEJM199110243251703|title=A Randomized Trial of Intravesical Doxorubicin and Immunotherapy with Bacille Calmette–Guérin for Transitional-Cell Carcinoma of the Bladder|year=1991|last1=Lamm|first1=Donald L.|last2=Blumenstein|first2=Brent A.|last3=Crawford|first3=E. David|last4=Montie|first4=James E.|last5=Scardino|first5=Peter|last6=Grossman|first6=H. Barton|last7=Stanisic|first7=Thomas H.|last8=Smith Jr|first8=Joseph A.|last9=Sullivan|first9=Jerry|last10=Sarosdy|first10=Michael F.|last11=Crissman|first11=John D.|last12=Coltman|first12=Charles A.|journal=New England Journal of Medicine|volume=325|issue=17|pages=1205–9|pmid=1922207|pmc=1164610}}</ref>  
:* BCG is a [[vaccine]] against [[tuberculosis]] that is prepared from attenuated live ''[[Mycobacterium bovis]]'', that has lost its virulence in humans. BCG immunotherapy is effective in up to 2/3 of the cases at this stage, and in randomized trials has been shown to be superior to standard [[chemotherapy]].<ref>{{Cite journal|doi=10.1056/NEJM199110243251703|title=A Randomized Trial of Intravesical Doxorubicin and Immunotherapy with Bacille Calmette–Guérin for Transitional-Cell Carcinoma of the Bladder|year=1991|last1=Lamm|first1=Donald L.|last2=Blumenstein|first2=Brent A.|last3=Crawford|first3=E. David|last4=Montie|first4=James E.|last5=Scardino|first5=Peter|last6=Grossman|first6=H. Barton|last7=Stanisic|first7=Thomas H.|last8=Smith Jr|first8=Joseph A.|last9=Sullivan|first9=Jerry|last10=Sarosdy|first10=Michael F.|last11=Crissman|first11=John D.|last12=Coltman|first12=Charles A.|journal=New England Journal of Medicine|volume=325|issue=17|pages=1205–9|pmid=1922207|pmc=1164610}}</ref>  
:* The mechanism by which BCG prevents recurrence is unknown, but the presence of bacteria in the bladder may trigger a localized immune reaction which clears residual cancer cells.<ref>[http://www.webmd.com/cancer/bladder-cancer/bacillus-calmette-guerin-bcg-for-bladder-cancer Bacillus Calmette-Guerin (BCG) for Bladder Cancer]</ref>
:* The mechanism by which BCG prevents recurrence is unknown, but the presence of bacteria in the bladder may trigger a localized immune reaction which clears residual cancer cells.
 
'''Chemotherapy'''
'''Chemotherapy'''


Intravesical chemotherapy or systemic chemotherapy may be used to treat bladder cancer.
* Intravesical [[chemotherapy]]
 
:* During intravesical chemotherapy, the drugs are placed into the bladder through a urinary catheter.<ref>Bladder Cancer. Canadian Cancer Society 2015. http://www.cancer.ca/en/cancer-information/cancer-type/bladder/treatment/?region=ab Accessed on October, 7 2015 </ref><ref name="pmid26604440">{{cite journal |vauthors=Porten SP, Leapman MS, Greene KL |title=Intravesical chemotherapy in non-muscle-invasive bladder cancer |journal=Indian J Urol |volume=31 |issue=4 |pages=297–303 |date=2015 |pmid=26604440 |pmc=4626913 |doi=10.4103/0970-1591.166446 |url=}}</ref>
During intravesical chemotherapy, the drugs are placed into the bladder through a urinary catheter. Intravesical chemotherapy may be given instead of BCG or if the bladder cancer doesn’t respond to BCG. Mitomycin (Mutamycin) is the drug most often used in intravesical chemotherapy. A dose of mitomycin is usually put into the bladder after surgery to remove the bladder tumour. Intravesical chemotherapy with mitomycin reduces the risk of bladder cancer recurring (coming back) in people with tumours that are only in the lining of the bladder and have not grown into the muscle layer of the bladder wall (called non-muscle-invasive bladder cancer).
:* Intravesical chemotherapy may be given instead of BCG or if the bladder cancer doesn’t respond to BCG.<ref name="pmid18369709">{{cite journal |vauthors=Shen Z, Shen T, Wientjes MG, O'Donnell MA, Au JL |title=Intravesical treatments of bladder cancer: review |journal=Pharm. Res. |volume=25 |issue=7 |pages=1500–10 |date=July 2008 |pmid=18369709 |pmc=2440939 |doi=10.1007/s11095-008-9566-7 |url=}}</ref>
:* [[Mitomycin]] is the drug most often used in intravesical chemotherapy.<ref name="pmid20562793">{{cite journal |vauthors=Volpe A, Racioppi M, D'Agostino D, Cappa E, Filianoti A, Bassi PF |title=Mitomycin C for the treatment of bladder cancer |journal=Minerva Urol Nefrol |volume=62 |issue=2 |pages=133–44 |date=June 2010 |pmid=20562793 |doi= |url=}}</ref><ref name="pmid20205607">{{cite journal |vauthors=Williams SK, Hoenig DM, Ghavamian R, Soloway M |title=Intravesical therapy for bladder cancer |journal=Expert Opin Pharmacother |volume=11 |issue=6 |pages=947–58 |date=April 2010 |pmid=20205607 |doi=10.1517/14656561003657145 |url=}}</ref>


During systemic chemotherapy, the drugs are given through a needle into a vein (intravenously) and circulate throughout the body. Systemic chemotherapy may be a treatment option for bladder cancer that has spread to other tissues near the bladder (called locally advanced cancer) and bladder cancer that has spread to other parts of the body (called metastatic cancer). Chemotherapy is recommended before a radical cystectomy (called neoadjuvant chemotherapy) for many people with bladder cancer that has grown into the muscle layer of the bladder wall. It is also often given after a radical cystectomy (called adjuvant chemotherapy) to people with high-risk features such as cancer that has spread to lymph nodes.
* Systemic chemotherapy
:* During systemic chemotherapy, the drugs are given intravenously.
:* Systemic chemotherapy may be a treatment option for bladder cancer that has spread to other tissues near the bladder and bladder cancer that has spread to other parts of the body.<ref name="pmid26984414">{{cite journal |vauthors=Rose TL, Milowsky MI |title=Improving Systemic Chemotherapy for Bladder Cancer |journal=Curr Oncol Rep |volume=18 |issue=5 |pages=27 |date=May 2016 |pmid=26984414 |doi=10.1007/s11912-016-0512-2 |url=}}</ref>
:* Chemotherapy is recommended before a radical [[cystectomy]] (called neoadjuvant chemotherapy) for many people with bladder cancer that has grown into the muscle layer of the bladder wall. It is also often given after a radical cystectomy (called adjuvant chemotherapy) to people with high-risk features such as cancer that has spread to [[lymph nodes]].<ref name="pmid25404954">{{cite journal |vauthors=Teply BA, Kim JJ |title=Systemic therapy for bladder cancer - a medical oncologist's perspective |journal=J Solid Tumors |volume=4 |issue=2 |pages=25–35 |date=2014 |pmid=25404954 |pmc=4232954 |doi=10.5430/jst.v4n2p25 |url=}}</ref>


'''Radiation therapy'''
'''Radiation therapy'''


External beam radiation therapy is the type of radiation treatment that is most often used to treat bladder cancer.
* [[Radiation therapy]] may be the main treatment for people who can’t have surgery.<ref name="pmid15815960">{{cite journal |vauthors=Konski A, Feigenberg S, Chow E |title=Palliative radiation therapy |journal=Semin. Oncol. |volume=32 |issue=2 |pages=156–64 |date=April 2005 |pmid=15815960 |doi= |url=}}</ref>


Some people with cancer that has grown into the muscle layer of the bladder wall (called muscle-invasive bladder cancer) will have a transurethral resection (TUR) to completely remove all the cancer that the surgeon can see. This surgery is followed by both radiation therapy and chemotherapy.
* [[External beam radiation therapy]] is the type of radiation treatment that is most often used to treat bladder cancer.<ref name="pmid1556049">{{cite journal |vauthors=Kaufman DS, Shipley WU, Althausen AF |title=Radiotherapy and chemotherapy in invasive bladder cancer with potential bladder sparing |journal=Hematol. Oncol. Clin. North Am. |volume=6 |issue=1 |pages=179–94 |date=February 1992 |pmid=1556049 |doi= |url=}}</ref>


Radiation therapy may be the main treatment for people who can’t have surgery. It may also be given to relieve symptoms caused by advanced bladder cancer (called palliative radiation therapy).
* Palliative radiation therapy may be given to relieve symptoms caused by advanced bladder cancer.<ref name="pmid26756029">{{cite journal |vauthors=Byun SJ, Kim JH, Oh YK, Kim BH |title=Concurrent chemoradiotherapy improves survival outcome in muscle-invasive bladder cancer |journal=Radiat Oncol J |volume=33 |issue=4 |pages=294–300 |date=December 2015 |pmid=26756029 |pmc=4707212 |doi=10.3857/roj.2015.33.4.294 |url=}}</ref>


==References==
==References==
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[[Category:Types of cancer]]
[[Category:Types of cancer]]
[[Category:Urology]]
[[Category:Urology]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Nephrology]]
[[Category:Surgery]]

Latest revision as of 14:27, 7 May 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Steven C. Campbell, M.D., Ph.D. Associate Editor(s)-in-Chief: Farima Kahe M.D. [2]

Overview

The predominant therapy for bladder cancer is surgical resection. Adjunctive chemotherapy, radiation therapy, and immunotherapy may be required.

Medical Therapy

Immunotherapy

  • Immunotherapy is a type of biological therapy that uses the immune system to help destroy cancer cells.[1]
  • Bacillus Calmette–Guérin (BCG)
  • Immunotherapy by intravesicular delivery of Bacillus Calmette–Guérin (BCG) is often used to treat and prevent the recurrence of superficial tumors.[2]
  • BCG is a vaccine against tuberculosis that is prepared from attenuated live Mycobacterium bovis, that has lost its virulence in humans. BCG immunotherapy is effective in up to 2/3 of the cases at this stage, and in randomized trials has been shown to be superior to standard chemotherapy.[3]
  • The mechanism by which BCG prevents recurrence is unknown, but the presence of bacteria in the bladder may trigger a localized immune reaction which clears residual cancer cells.

Chemotherapy

  • During intravesical chemotherapy, the drugs are placed into the bladder through a urinary catheter.[4][5]
  • Intravesical chemotherapy may be given instead of BCG or if the bladder cancer doesn’t respond to BCG.[6]
  • Mitomycin is the drug most often used in intravesical chemotherapy.[7][8]
  • Systemic chemotherapy
  • During systemic chemotherapy, the drugs are given intravenously.
  • Systemic chemotherapy may be a treatment option for bladder cancer that has spread to other tissues near the bladder and bladder cancer that has spread to other parts of the body.[9]
  • Chemotherapy is recommended before a radical cystectomy (called neoadjuvant chemotherapy) for many people with bladder cancer that has grown into the muscle layer of the bladder wall. It is also often given after a radical cystectomy (called adjuvant chemotherapy) to people with high-risk features such as cancer that has spread to lymph nodes.[10]

Radiation therapy

  • Palliative radiation therapy may be given to relieve symptoms caused by advanced bladder cancer.[13]

References

  1. ↑ Ghahestani SM, Shakhssalim N (2009). "Palliative treatment of intractable hematuria in context of advanced bladder cancer: a systematic review". Urol J. 6 (3): 149–56. PMID 19711266.
  2. ↑ Alexandroff AB, Jackson AM, O'Donnell MA, James K (May 1999). "BCG immunotherapy of bladder cancer: 20 years on". Lancet. 353 (9165): 1689–94. doi:10.1016/S0140-6736(98)07422-4. PMID 10335805.
  3. ↑ Lamm, Donald L.; Blumenstein, Brent A.; Crawford, E. David; Montie, James E.; Scardino, Peter; Grossman, H. Barton; Stanisic, Thomas H.; Smith Jr, Joseph A.; Sullivan, Jerry; Sarosdy, Michael F.; Crissman, John D.; Coltman, Charles A. (1991). "A Randomized Trial of Intravesical Doxorubicin and Immunotherapy with Bacille Calmette–Guérin for Transitional-Cell Carcinoma of the Bladder". New England Journal of Medicine. 325 (17): 1205–9. doi:10.1056/NEJM199110243251703. PMC 1164610. PMID 1922207.
  4. ↑ Bladder Cancer. Canadian Cancer Society 2015. http://www.cancer.ca/en/cancer-information/cancer-type/bladder/treatment/?region=ab Accessed on October, 7 2015
  5. ↑ Porten SP, Leapman MS, Greene KL (2015). "Intravesical chemotherapy in non-muscle-invasive bladder cancer". Indian J Urol. 31 (4): 297–303. doi:10.4103/0970-1591.166446. PMC 4626913. PMID 26604440.
  6. ↑ Shen Z, Shen T, Wientjes MG, O'Donnell MA, Au JL (July 2008). "Intravesical treatments of bladder cancer: review". Pharm. Res. 25 (7): 1500–10. doi:10.1007/s11095-008-9566-7. PMC 2440939. PMID 18369709.
  7. ↑ Volpe A, Racioppi M, D'Agostino D, Cappa E, Filianoti A, Bassi PF (June 2010). "Mitomycin C for the treatment of bladder cancer". Minerva Urol Nefrol. 62 (2): 133–44. PMID 20562793.
  8. ↑ Williams SK, Hoenig DM, Ghavamian R, Soloway M (April 2010). "Intravesical therapy for bladder cancer". Expert Opin Pharmacother. 11 (6): 947–58. doi:10.1517/14656561003657145. PMID 20205607.
  9. ↑ Rose TL, Milowsky MI (May 2016). "Improving Systemic Chemotherapy for Bladder Cancer". Curr Oncol Rep. 18 (5): 27. doi:10.1007/s11912-016-0512-2. PMID 26984414.
  10. ↑ Teply BA, Kim JJ (2014). "Systemic therapy for bladder cancer - a medical oncologist's perspective". J Solid Tumors. 4 (2): 25–35. doi:10.5430/jst.v4n2p25. PMC 4232954. PMID 25404954.
  11. ↑ Konski A, Feigenberg S, Chow E (April 2005). "Palliative radiation therapy". Semin. Oncol. 32 (2): 156–64. PMID 15815960.
  12. ↑ Kaufman DS, Shipley WU, Althausen AF (February 1992). "Radiotherapy and chemotherapy in invasive bladder cancer with potential bladder sparing". Hematol. Oncol. Clin. North Am. 6 (1): 179–94. PMID 1556049.
  13. ↑ Byun SJ, Kim JH, Oh YK, Kim BH (December 2015). "Concurrent chemoradiotherapy improves survival outcome in muscle-invasive bladder cancer". Radiat Oncol J. 33 (4): 294–300. doi:10.3857/roj.2015.33.4.294. PMC 4707212. PMID 26756029.

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