Transitional cell carcinoma medical therapy

Transitional cell carcinoma Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Transitional cell carcinoma from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Staging
History and Symptoms
Physical Examination
Laboratory Findings
Cystoscopy and Bladder Biopsy
CT
MRI
Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Transitional cell carcinoma medical therapy On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Transitional cell carcinoma medical therapy All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Transitional cell carcinoma medical therapy
CDC on Transitional cell carcinoma medical therapy
Transitional cell carcinoma medical therapy in the news
Blogs on Transitional cell carcinoma medical therapy
Directions to Hospitals Treating Transitional cell carcinoma
Risk calculators and risk factors for Transitional cell carcinoma medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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..

Medical Therapy

Transitional Cell Carcinoma of Bladder

Immunotherapy

• Immunotherapy is a type of biological therapy that uses the immune system to help destroy cancer cells.
• 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.
• 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.
• 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 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

• 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.
• 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:

• Paclitaxel
• Ifosfamide
• Gallium nitrate
• Pemetrexed

• Ifosfamide, gallium, and pemetrexed have shown limited activity in patients previously treated with cisplatin.