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__NOTOC__
__NOTOC__
{{Transitional cell carcinoma}}
{{Transitional cell carcinoma}}
{{CMG}}
{{CMG}};{{AE}} {{PSK}}
==Overview==
==Overview==
==Treatment options==
The predominant therapy for transitional cell carcinoma is [[surgical resection]]. Adjunctive [[chemotherapy]], [[radiation therapy]], and [[immunotherapy]] may be required. Patients with superficial tumors of bladder are treated with intravescical injection of BCG, whereas patients with local spread and distant metastasis are treated with systemic chemotherapy. [[External beam radiation therapy]] may be the treatment for people who can’t have surgery.
Treatment depends on the stage of the cancer, the severity of your symptoms, and your overall health.


*Stage 0 and I treatments:
==Medical Therapy==
**Surgery to remove the tumor without removing the rest of the bladder
===Transitional Cell Carcinoma of Bladder===
Chemotherapy or immunotherapy directly into the bladder
'''Immunotherapy'''
*Stage II and III treatments:
* [[Immunotherapy]] is a type of biological therapy that uses the immune system to help destroy cancer cells.<ref name="Canada">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>
**Surgery to remove the entire bladder (radical cystectomy)
* [[ Bacillus Calmette-Guérin]] (BCG)
**Surgery to remove only part of the bladder, followed by radiation and chemotherapy
 
**Chemotherapy to shrink the tumor before surgery
:*[[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>
**A combination of chemotherapy and radiation (in patients who choose not to have surgery or who cannot have surgery)
:* BCG is a [[vaccine]] against [[tuberculosis]] that is prepared from attenuated live ''[[Mycobacterium bovis]]'', that has lost its virulence in humans.
Most patients with stage IV tumors cannot be cured and surgery is not appropriate. In these patients, chemotherapy is often considered.
:*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>
===CHEMOTHERAPY===
:* 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>
 
'''Chemotherapy'''
*Chemotherapy may be given to patients with stage II and III disease either before or after surgery to help prevent the tumor from returning.
*Chemotherapy may be given to patients with stage II and III disease either before or after surgery to help prevent the tumor from returning.
*For early disease (stages 0 and I), chemotherapy is usually given directly into the bladder.
*For early disease (stages 0 and I), chemotherapy is usually given directly into the bladder.
* Intravesical [[chemotherapy]]<ref name=Canada>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>
* Intravesical [[chemotherapy]]<ref name="Canada">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>
:* During intravesical chemotherapy, the drugs are placed into the bladder through a urinary catheter.
:* 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.
:* Intravesical chemotherapy may be given instead of BCG or if the bladder cancer doesn’t respond to BCG.
:* [[Mitomycin]] is the drug most often used in intravesical chemotherapy.
:* [[Mitomycin]] is the drug most often used in intravesical chemotherapy.
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:* 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]].
:* 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]].


===Immunotherapy===
'''Radiation therapy'''
* [[Immunotherapy]] is a type of biological therapy that uses the immune system to help destroy cancer cells.<ref name=Canada>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>
* [[Radiation therapy]] may be the main treatment for people who can’t have surgery.
* Bacillus Calmette–Guérin (BCG)
* [[External beam radiation therapy]] is the type of radiation treatment that is most often used to treat bladder cancer.
:* [[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>
* Palliative radiation therapy may be given to relieve symptoms caused by advanced bladder cancer.
:* 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>


===Transitional Cell Carcinoma of Renal Pelvis and Ureter===
'''Chemotherapy'''
*[[Chemotherapy]] is used to treat cancer of the renal pelvis or ureter that has spread to the [[lymph nodes]] or to other parts of the body.<ref name="pmid16079132">{{cite journal| author=Loehrer PJ, Einhorn LH, Elson PJ, Crawford ED, Kuebler P, Tannock I et al.| title=A randomized comparison of cisplatin alone or in combination with methotrexate, vinblastine, and doxorubicin in patients with metastatic urothelial carcinoma: a cooperative group study. | journal=J Clin Oncol | year= 1992 | volume= 10 | issue= 7 | pages= 1066-73 | pmid=1607913 | doi=10.1200/JCO.1992.10.7.1066 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1607913  }}</ref>
*In patients with metastatic transitional cell carcinoma, combination chemotherapy has produced high response rates and occasional complete responses.
*It may be offered after surgery (called adjuvant chemotherapy) if cancer is found in the lymph nodes removed during surgery.
*Sometimes it is also given before surgery (called neoadjuvant chemotherapy) if the cancer appears more advanced.
*The most common chemotherapy drug combinations used are:
{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align=center
|valign=top|
|+
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Regimens}}
|-
| style="padding: 5px 5px; background: #F5F5F5;" |GemCIS: [[Gemcitabine]] (Gemzar) and cisplatin (Platinol AQ)
|-
| style="padding: 5px 5px; background: #F5F5F5;" |MVAC: [[Methotrexate]], [[vinblastine]] (Velbe), [[doxorubicin]] ([[Adriamycin]]), and [[cisplatin]]
|}


Immunotherapy for bladder cancer is usually performed using the Bacille Calmette-Guerin vaccine (commonly known as BCG). It is given through a Foley catheter directly into the bladder. If BCG does not work, patients may receive interferon.
*GemCIS is used most often because it causes less severe side effects than the other combination.
*Other chemotherapy agents that have shown activity in metastatic transitional cell cancer include the following:<ref name="pmid1607913">{{cite journal| author=Loehrer PJ, Einhorn LH, Elson PJ, Crawford ED, Kuebler P, Tannock I et al.| title=A randomized comparison of cisplatin alone or in combination with methotrexate, vinblastine, and doxorubicin in patients with metastatic urothelial carcinoma: a cooperative group study. | journal=J Clin Oncol | year= 1992 | volume= 10 | issue= 7 | pages= 1066-73 | pmid=1607913 | doi=10.1200/JCO.1992.10.7.1066 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1607913  }}</ref>


As with all treatments, side effects are possible. Ask your doctor what side effects you might expect, and what to do if they occur.
:*[[Paclitaxel]]
:*[[Ifosfamide]]
:*[[Gallium nitrate]]
:*[[Pemetrexed]]
*Ifosfamide, gallium, and pemetrexed have shown limited activity in patients previously treated with [[cisplatin]].
*Increasing the dose intensity of MVAC by administering treatment every two weeks with granulocyte-colony stimulating factor (G-CSF) support has also been evaluated in an effort to improve long-term survival.<ref name="pmid11352955">{{cite journal| author=Sternberg CN, de Mulder PH, Schornagel JH, Théodore C, Fossa SD, van Oosterom AT et al.| title=Randomized phase III trial of high-dose-intensity methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) chemotherapy and recombinant human granulocyte colony-stimulating factor versus classic MVAC in advanced urothelial tract tumors: European Organization for Research and Treatment of Cancer Protocol no. 30924. | journal=J Clin Oncol | year= 2001 | volume= 19 | issue= 10 | pages= 2638-46 | pmid=11352955 | doi=10.1200/JCO.2001.19.10.2638 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11352955  }}</ref>


==References==
==References==
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[[Category:Disease]]
[[Category:Disease]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]

Latest revision as of 18:24, 4 October 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Suveenkrishna Pothuru, M.B,B.S. [2]

Overview

The predominant therapy for transitional cell carcinoma is surgical resection. Adjunctive chemotherapy, radiation therapy, and immunotherapy may be required. Patients with superficial tumors of bladder are treated with intravescical injection of BCG, whereas patients with local spread and distant metastasis are treated with systemic chemotherapy. External beam radiation therapy may be the treatment for people who can’t have surgery.

Medical Therapy

Transitional Cell Carcinoma of Bladder

Immunotherapy

  • 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.[4]

Chemotherapy

  • Chemotherapy may be given to patients with stage II and III disease either before or after surgery to help prevent the tumor from returning.
  • For early disease (stages 0 and I), chemotherapy is usually given directly into the bladder.
  • Intravesical chemotherapy[1]
  • 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 is the drug most often used in 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.
  • 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.

Radiation therapy

  • Radiation therapy may be the main treatment for people who can’t have surgery.
  • External beam radiation therapy is the type of radiation treatment that is most often used to treat bladder cancer.
  • Palliative radiation therapy may be given to relieve symptoms caused by advanced bladder cancer.

Transitional Cell Carcinoma of Renal Pelvis and Ureter

Chemotherapy

  • Chemotherapy is used to treat cancer of the renal pelvis or ureter that has spread to the lymph nodes or to other parts of the body.[5]
  • In patients with metastatic transitional cell carcinoma, combination chemotherapy has produced high response rates and occasional complete responses.
  • It may be offered after surgery (called adjuvant chemotherapy) if cancer is found in the lymph nodes removed during surgery.
  • Sometimes it is also given before surgery (called neoadjuvant chemotherapy) if the cancer appears more advanced.
  • The most common chemotherapy drug combinations used are:
Regimens
GemCIS: Gemcitabine (Gemzar) and cisplatin (Platinol AQ)
MVAC: Methotrexate, vinblastine (Velbe), doxorubicin (Adriamycin), and cisplatin
  • GemCIS is used most often because it causes less severe side effects than the other combination.
  • Other chemotherapy agents that have shown activity in metastatic transitional cell cancer include the following:[6]
  • Ifosfamide, gallium, and pemetrexed have shown limited activity in patients previously treated with cisplatin.
  • Increasing the dose intensity of MVAC by administering treatment every two weeks with granulocyte-colony stimulating factor (G-CSF) support has also been evaluated in an effort to improve long-term survival.[7]

References

  1. ↑ 1.0 1.1 Bladder Cancer. Canadian Cancer Society 2015. http://www.cancer.ca/en/cancer-information/cancer-type/bladder/treatment/?region=ab Accessed on October, 7 2015
  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. ↑ Bacillus Calmette-Guerin (BCG) for Bladder Cancer
  5. ↑ Loehrer PJ, Einhorn LH, Elson PJ, Crawford ED, Kuebler P, Tannock I; et al. (1992). "A randomized comparison of cisplatin alone or in combination with methotrexate, vinblastine, and doxorubicin in patients with metastatic urothelial carcinoma: a cooperative group study". J Clin Oncol. 10 (7): 1066–73. doi:10.1200/JCO.1992.10.7.1066. PMID 1607913.
  6. ↑ Loehrer PJ, Einhorn LH, Elson PJ, Crawford ED, Kuebler P, Tannock I; et al. (1992). "A randomized comparison of cisplatin alone or in combination with methotrexate, vinblastine, and doxorubicin in patients with metastatic urothelial carcinoma: a cooperative group study". J Clin Oncol. 10 (7): 1066–73. doi:10.1200/JCO.1992.10.7.1066. PMID 1607913.
  7. ↑ Sternberg CN, de Mulder PH, Schornagel JH, Théodore C, Fossa SD, van Oosterom AT; et al. (2001). "Randomized phase III trial of high-dose-intensity methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) chemotherapy and recombinant human granulocyte colony-stimulating factor versus classic MVAC in advanced urothelial tract tumors: European Organization for Research and Treatment of Cancer Protocol no. 30924". J Clin Oncol. 19 (10): 2638–46. doi:10.1200/JCO.2001.19.10.2638. PMID 11352955.

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