Bladder cancer medical therapy: Difference between revisions
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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> | * [[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 ''[[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. | :* 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 | * 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 | :* 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 | * 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''' | ||
* [[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> | |||
* [[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> | |||
* 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
- Intravesical chemotherapy
- 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
- Radiation therapy may be the main treatment for people who can’t have surgery.[11]
- External beam radiation therapy is the type of radiation treatment that is most often used to treat bladder cancer.[12]
- Palliative radiation therapy may be given to relieve symptoms caused by advanced bladder cancer.[13]
References
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ Bladder Cancer. Canadian Cancer Society 2015. http://www.cancer.ca/en/cancer-information/cancer-type/bladder/treatment/?region=ab Accessed on October, 7 2015
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ Konski A, Feigenberg S, Chow E (April 2005). "Palliative radiation therapy". Semin. Oncol. 32 (2): 156–64. PMID 15815960.
- ↑ 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.
- ↑ 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.