Transitional cell carcinoma medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
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.[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
- 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.
- 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.
References
- ↑ 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
- ↑ 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.
- ↑ Bacillus Calmette-Guerin (BCG) for Bladder Cancer