Primary carcinoma of the upper urinary tract: effect of primary and secondary therapy on survival

Article Abstract:

Carcinoma of the upper urinary tract is a rare cancer that is responsible for two to four percent of all tumors of the tract. Because it is so uncommon, there is limited knowledge about the course and management of this tumor. Survival appears to be related to stage of the disease rather than the choice of treatment. Some studies suggest that the progression of cancer of the ureter (the duct between the kidney and the bladder) differs from that of cancer of the renal pelvis, the expanded proximal end of the ureter which receives the urine. The anticancer agent cisplatin appears to be effective against bladder cancer and may improve survival of patients with metastatic or widespread upper tract cancers. The importance of tumor grade and stage of cancer in predicting survival from carcinoma of the upper urinary tract was assessed in 76 patients with primary upper urinary tract carcinomas. Differences in survival from cancer of the uterus and cancer of the renal pelvis were also determined. The role of local therapy for low-grade, low-stage tumors and effectiveness of adjuvant of additional therapies in metastatic, or widespread, advanced disease were also assessed. Both tumor grade and stage of the disease were shown to be effective predictors of survival. Local therapy for low-grade, low-stage tumors was associated with a risk of recurrence of the tumor. However, there were no differences in survival between patients treated with local therapy or extensive surgery to remove the tumor. Cisplatin was shown to improve survival in patients with metastatic or widespread, advanced cancer. (Consumer Summary produced by Reliance Medical Information, Inc.)

Cisplatin

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Analysis of bladder carcinoma by subsite: cystoscopic location may have prognostic value

Article Abstract:

In many organs, the likelihood of tumor growth is not uniformly distributed throughout the organ; some sites seem to be preferred over others by would-be tumor cells. This trend may be seen in the urinary bladder, where different sorts of tumors seem to have a predilection for different sites. The authors have attempted to determine whether the location of a particular tumor, carcinoma of the bladder, has an influence on the outcome of the cancer. The analysis of 914 cases revealed several associations between prognosis and tumor location. Carcinoma of the neck of the bladder had a significantly worse prognosis than carcinoma in other regions of the bladder; this may be due to the differences in the lymphatic drainage of this portion of the bladder (which may provide a superior route for the spread of the cancer cells). The dome of the bladder had a greater proportion of high-grade tumors than any of the other locations within the bladder, but this was not reflected in reduced survival. Cancers of the dome and the anterior wall tended to occur in slightly older patients (average age over 74) than cancers in areas such as the trigone (average patient age, 68.3). Overall, the percentage of surviving bladder cancer patients at one, two, and five years was 87, 74, and 54 percent, respectively. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Recurrence and treatment of urinary bladder cancer after failure in radiotherapy

Article Abstract:

In cases of advanced disease, old age, poor condition, or patient refusal, surgery is sometimes not performed on patients with urinary bladder cancer. These patients then receive a full course of radiotherapy, although the results are not always satisfactory, with as many as 80 percent relapsing within five years. Little is known about the relative success of different methods of treating patients who have relapsed after radiotherapy. To investigate this, a review of 155 patients who received full-course radiotherapy for bladder cancer was undertaken. Recurrent cancer appeared in the bladders of 94 patients (61 percent). Only 49 of these patients were given further specific treatment. Some of these patients with recurrent bladder cancer were treated with surgery and intravesical cytostatics, that is, anticancer drugs were placed within the bladder. Patients treated in this manner had an average survival of 33 months. Patients treated with local surgery, with anticancer drugs given systemically, and palliative radiotherapy had median survivals of 10, 4, and 2.4 months, In addition to type of treatment, factors associated with outcome were the nature of the treatment failure, obstruction of the ureter, and recurrence rate. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Complications and side effects

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