Bladder cancer medical therapy: Difference between revisions
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'''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.<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 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> | ||
'''Chemotherapy''' | '''Chemotherapy''' | ||
Revision as of 14:16, 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.[4]
Chemotherapy
- Intravesical chemotherapy[5]
- 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.
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.
- ↑ Konski A, Feigenberg S, Chow E (April 2005). "Palliative radiation therapy". Semin. Oncol. 32 (2): 156–64. PMID 15815960.
- ↑ Bladder Cancer. Canadian Cancer Society 2015. http://www.cancer.ca/en/cancer-information/cancer-type/bladder/treatment/?region=ab Accessed on October, 7 2015