Biology and management of bladder cancer

Article Abstract:

Bladder cancer is very common in Western society and is the fifth most common cancer among men, with an incidence of 16 to 20 per 100,000 per year. About five cases are diagnosed each year per 100,000 women. The available evidence suggests that bladder cancer is increasing in incidence. Many factors have been epidemiologically implicated in the cause of bladder cancer. Some, like tobacco use and schistosomiasis, are well established. Others, like the use of saccharin, remain controversial. Eighty percent of urothelial tumors, i.e. tumors of the lining of the urinary tract, will remain in the mucosa and submucosa; the remainder will be invasive and are associated with a greater likelihood of metastasis (spread) and a poorer prognosis. There is no firm agreement on the treatment of choice, and strong proponents exist for radical radiotherapy, radical surgery, or combinations of the two. Comparing different studies is difficult because of differences in patient selection and differences between the evaluation of patients clinically vs. surgically. It is clear, however, that for invasive bladder cancer, the five-year survival rate is 50 percent or less, regardless of the therapy. There is some indication that the use of chemotherapy prior to radiation or surgery provides some additional benefit. Although many published reports rely upon follow-ups of less than three years, it appears that five-year survival of bladder cancer ranges from 30 to 70 percent, depending upon the patient population. New chemotherapeutic regimens involving a combination of agents show great promise for the treatment of patients with metastatic disease; the highest response rates have been reported for combinations that include cisplatin, methotrexate, and vinblastine, with or without doxorubicin. Complete remissions have been documented even in patients with metastatic spread to the liver or bone. Further study may permit the development of more effective protocols that continue to avoid bone-marrow suppression, which limits the use of higher dosages of chemotherapeutic agents. (Consumer Summary produced by Reliance Medical Information, Inc.)

Urinary tract cancer, Urologic cancer

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Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer

Article Abstract:

Giving patients with bladder cancer chemotherapy followed by surgery may improve their outcome, according to a study of 307 patients. Patients who received this combined treatment survived an average of six years whereas those treated with surgery only survived an average of four years. The chemotherapy included methotrexate, vinblastine, doxorubicin, and cisplatin.

Patient outcomes, Prognosis

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Case 3-2004: A 57-year-old man with invasive transitional-cell carcinoma of the bladder

Article Abstract:

The case of a 57-year-old man with bladder cancer is reviewed. He did not want to have his bladder removed, so he was treated with chemotherapy and radiation. However, patients who want bladder-sparing treatment must have regular checkups because the cancer can recur.

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