eMedicine Specialties > Urology > Cancer, Bladder, Penis, and Urethra
Bladder Cancer: Treatment & Medication
Updated: Jul 27, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Treatment
Medical Care
The treatment of non–muscle-invasive (Ta, T1, CIS) and muscle-invasive bladder cancer should be differentiated. Treatments within each category include both surgical and medical approaches.
- Non–muscle-invasive disease (Ta, T1, CIS)
- Intravesical immunotherapy (Bacillus Calmette-Guérin [BCG] immunotherapy)
- BCG immunotherapy is used in the treatment of Ta, T1, and CIS urothelial carcinoma of the bladder and may help to decrease the rate of recurrence and progression.
- BCG immunotherapy is the most effective intravesical therapy and involves a live attenuated strain of Mycobacterium bovis. Some early studies purported that an immune response against BCG surface antigens cross-reacted with putative bladder tumor antigens, and this was proposed as the mechanism for the therapeutic effect of BCG; however, multiple subsequent studies refute this claim and demonstrate that BCG induces a nonspecific, cytokine-mediated immune response to foreign protein.
- Because BCG is a live attenuated organism, it can cause an acute disseminated tuberculosislike illness if it enters the bloodstream (BCG sepsis), possibly resulting in death. Therefore, the use of BCG is contraindicated in patients with gross hematuria.
- BCG typically causes mild systemic symptoms that resolve within 24-48 hours after intravesical instillation. BCG can also cause granulomatous cystitis or prostatitis with bladder contraction.
- BCG is recommended for CIS, T1 tumors, and high-risk Ta tumors (large, high-grade, recurrent, or multifocal tumors). This therapy is less effective in reducing the 5-year recurrence rate for low-grade and low-stage urothelial carcinoma (see Table 1).
- Typically, BCG is administered weekly for 6 weeks. Another 6-week course may be administered if a repeat cystoscopy reveals tumor persistence or recurrence. Recent evidence indicates that maintenance therapy with a weekly treatment for 3 weeks every 6 months for 1-3 years may provide more lasting results.
- Consider patients with recurrent CIS for an early cystectomy. At 5 and 10 years, approximately 70% and 30% of patients with CIS who are treated with BCG are disease free, respectively. Recurrent CIS, despite intravesical BCG, is associated with a 63% risk of progression to muscle-invasive bladder cancer. Recurrence after BCG treatment may also occur in the upper urinary tract or prostatic urethra.
- Interferon alpha or gamma has been used in the treatment of stages Ta, T1 and CIS urothelial carcinoma, either as a single agent therapy or in combination with BCG. Its role has primarily been in post-BCG failure with early promising results. Although BCG with interferon has shown a 42% response with tolerable side effects after BCG failure, no evidence has indicated that re-treating with BCG with interferon is superior to re-treating with BCG alone.
- [#table1]Table 1. Recurrence and Progression Rates at 5 Years for Ta, T1, and CIS TCC of the Bladder Treated With BCG
Open table in new window
Stage Recurrence, % Progression, % Ta 55 11 T1 61 31 CIS 45 23 G1 61 7 G2 56 19 G3 45 23
- Intravesical chemotherapy
- Valrubicin has recently been approved as intravesical chemotherapy for CIS that is refractory to BCG. In patients whose conditions do not respond to BCG, the overall response rate to valrubicin is approximately 20%, and some patients can delay time to cystectomy. Valrubicin is presently not commercially available.
- Other forms of adjuvant intravesical chemotherapy for bladder cancer include intravesical triethylenethiophosphoramide (thiotepa [Thioplex]), mitomycin-C, doxorubicin, and epirubicin. Although these agents may increase the time to disease recurrence, no evidence indicates that these therapies prevent disease progression.
- No evidence suggests that these adjuvant therapies are as effective as BCG.
- Intravesical immunotherapy (Bacillus Calmette-Guérin [BCG] immunotherapy)
- Muscle-invasive disease (T2 and greater)
- Adjuvant and neoadjuvant chemotherapy
- Neoadjuvant chemotherapy prior to either radical cystectomy or external beam radiotherapy is controversial.
- The Southwestern Oncology Group (SWOG) conducted a multicenter randomized prospective study that compared neoadjuvant therapy using a methotrexate, vinblastine, doxorubicin (Adriamycin), and cisplatin (MVAC) combination with surgery alone. The group concluded that neoadjuvant therapy conferred a treatment benefit compared with surgery alone. However, several criticisms of this study exist. The study was purposely underpowered because of slow recruitment (317 patients over 11 y), because 20% of the patients who were to undergo cystectomy alone never underwent surgery, and because there was no comparison to neoadjuvant therapy alone. In addition, a recent study re-evaluated the SWOG data and found that surgical factors significantly affected outcomes.
- In one small series, the T4 tumors of 45% of affected patients responded to chemotherapy, making potentially curative cystectomy possible.
- Although no definite evidence of benefit exists, patients with P3-P4 or N+ urothelial carcinoma in the United States are typically advised to receive adjuvant chemotherapy.
- Chemotherapeutic agents for metastatic disease
- MVAC is the standard treatment of metastatic bladder cancer. MVAC has an objective response rate of 57-70%, a complete response rate of 15-20%, and a 2-year survival rate of 15-20%.
- Gemcitabine and cisplatin (GC) is a newer regimen and has been shown to be as efficacious as MVAC, but with less toxicity. GC is now considered a first-line treatment agent for bladder cancer.
- Several novel compounds have shown activity against transitional cell bladder cancer and are now being tested in combination chemotherapy trials. Some of these promising agents are ifosfamide, paclitaxel, docetaxel, and carboplatin.
- Adjuvant and neoadjuvant chemotherapy
Surgical Care
- Ta, T1, and CIS
- Endoscopic treatment
- Transurethral resection of bladder tumor (TURBT) is the first-line treatment to diagnose, to stage, and to treat visible tumors.
- Patients with bulky, high-grade, or multifocal tumors should undergo a second procedure to ensure complete resection and accurate staging. Approximately 50% of stage T1 tumors are upgraded to muscle-invasive disease.
- Electrocautery or laser fulguration of the bladder tumor is sufficient for low-grade, small-volume, papillary tumors.
- No further metastatic workup is needed for obviously superficial tumors.
- Because bladder cancer is a polyclonal field change defect, continued surveillance is mandatory.
- Radical cystectomy
- Although typically reserved for muscle-invasive disease, radical surgery is more appropriately used to treat some cases of non–muscle-invasive bladder cancer.
- Thirty-five to fifty percent of patients who undergo cystectomy for Ta, T1, or CIS are discovered to have muscle-invasive disease, with 10-15% demonstrating microscopic lymph node metastasis.
- The CIS in upwards of 80% of affected patients progresses to muscle-invasive disease, with 20% of patients found to have muscle-invasive disease at the time of cystectomy.
- High-grade T1 tumors that recur despite BCG have a 50% likelihood of progressing to muscle-invasive disease. Cystectomy performed prior to progression yields a 90% 5-year survival rate. The 5-year survival rate drops to 50-60% in muscle-invasive disease.
- Patients with unresectable large superficial tumors, prostatic urethra involvement, and BCG failure should also undergo radical cystectomy.
- Endoscopic treatment
- Muscle-invasive disease (T2 and greater)
- Radical cystoprostatectomy (men)
- In men, this is the criterion standard for organ-confined, muscle-invasive bladder cancer (eg, T2, T3).
- Remove the bladder, prostate, and pelvic lymph nodes.
- Perform a total urethrectomy for anterior urethral involvement, involvement of the prostatic stroma, or diffuse CIS that involves the prostate.
- Anterior pelvic exenteration (women)
- Perform this procedure in women diagnosed with muscle-invasive bladder cancer.
- The procedure involves removal of the bladder, urethra, uterus, ovaries, anterior vaginal wall, and pelvic lymph nodes.
- If no tumor involvement of the bladder neck is present, the urethra and anterior vaginal wall may be spared with the construction of an orthotopic neobladder.
- Pelvic lymphadenectomy
- Approximately 25% of patients undergoing radical cystectomy have lymph node metastases at the time of surgery.
- Bilateral pelvic lymphadenectomy (PLND) should be performed in conjunction with radical cystoprostatectomy and anterior pelvic exenteration.
- PLND adds prognostic information by appropriately staging the patient and may confer a therapeutic benefit.
- The boundaries of a standard PLND include the bifurcation of the common iliac artery and vein superiorly, the genitofemoral nerve laterally, the obturator fossa posteriorly, and the circumflex iliac vein (or node of Cloquet) inferiorly.
- Extended PLND includes the lymph nodes in the presacral region and those surrounding the common iliac vessels to the level of the aortic bifurcation. The additional benefit of an extended PLND is controversial. Based on several retrospective studies, some experts believe that an extended dissection provides additional staging information and offers a survival benefit. However, no randomized trials to date have proven that an extended PLND is more beneficial than a standard PLND.
- After performing a cystectomy, a urinary diversion must be created from an intestinal segment. The various types of urinary diversions can be separated into the following continent and incontinent diversions:
- Conduit (incontinent diversion): Conduits can be constructed from either ileum or colon. The ileal conduit is the most common incontinent diversion performed (see Image 1) and has been used for more than 40 years with excellent reliability and minimal morbidity. A small segment of ileum (at least 15 cm proximal to the ileocecal valve) is taken out of gastrointestinal continuity but maintained on its mesentery, with care to preserve its blood supply. The gastrointestinal tract is restored with a small-bowel anastomosis. The ureters are anastomosed to an end or side of this intestinal segment and the other end is brought out as a stoma to the abdominal wall. Urine continuously collects in an external collection device worn over the stoma.
In an ileal conduit, a small segment of ileum is taken out of continuity with the gastrointestinal tract but is maintained on its mesentery. Ureters are anastomosed to one end of this ileal segment, and the other end is brought out as a stoma to the abdominal wall.
- Indiana pouch (continent diversion): This is a continent urinary reservoir created from a detubularized right colon and an efferent limb of terminal ileum (see Image 2). The terminal ileum is plicated and brought to the abdominal wall. The ileocecal valve acts as a continence mechanism. The Indiana pouch is emptied with a clean intermittent catheterization 4-6 times per day.
In an Indiana pouch, a urinary reservoir is created from detubularized right colon and an efferent limb of terminal ileum. Terminal ileum is plicated and brought to the abdominal wall. The continence mechanism is the ileocecal valve.
- Neobladder (continent diversion): Various segments of intestine including ileum, ileum and colon, and sigmoid colon (see Image 3) can be used to construct a reservoir. The ureters are implanted to the reservoir, and the reservoir is anastomosed to the urethra. This operation has been performed successfully in men for more than 20 years and, more recently, in women. The orthotopic neobladder most closely restores the natural storage and voiding function of the native bladder. Patients have volitional control of urination and void by Valsalva. Contraindications to performing continent urinary diversions include multiple comorbid health problems, chronic renal insufficiency, hepatic dysfunction, and advanced disease stage.
In an orthotopic neobladder, a segment of ileum is used to construct a neobladder, which is connected to the urethra. Orthotopic neobladder most closely restores the natural storage and voiding function of the native bladder.
- Laparoscopic and robotic surgery
- Recently, laparoscopic and robotic-assisted radical cystectomies have been performed in small numbers at select tertiary academic centers.
- The urinary diversion is almost universally performed extracorporeally through a miniature laparotomy incision. Initially, some centers attempted to create the urinary diversion laparoscopically, but this was abandoned because of inferior outcomes.2
- Immediate postoperative complication rates and functional outcomes appear to be similar to those of open radical cystectomy and urinary diversion. In addition, a few studies suggest faster recovery of bowel function and less use of postoperative narcotics. However, these findings have not been corroborated by other contemporary studies.
- Intermediate and long-term oncologic outcomes for these minimally invasive approaches remain undefined.
- At this time, open radical cystectomy and urinary diversion should be considered the standard of care for invasive bladder cancer, and patients should be counseled to this end.
- Both laparoscopic and robotic-assisted radical cystectomy remain investigative procedures that should be performed only at major academic medical centers after appropriate informed consent.
- Radiation therapy
- External beam radiation therapy has been shown to be inferior to radical cystectomy for the treatment of bladder cancer. The overall 5-year survival rate after treatment with external beam radiation is 20-40% compared to a 90% 5-year survival after cystectomy for organ-confined disease.
- Although inferior to radical cystectomy, external beam radiation therapy is used in various countries other than the United States for T2-T3 urothelial carcinoma of the bladder.
- Neoadjuvant external beam radiation therapy has been attempted for muscle-invasive bladder cancer, with no improvement in survival rate.
- In certain facilities, a bladder-preserving strategy for T2-T3 urothelial carcinoma is applied using a combination of external beam radiation, chemotherapy, and endoscopic resection.
- Survival rates associated with this approach are comparable with those of cystectomy in selected patients.
- This combination has a widespread application that is limited by the complexity of the protocol, its toxicity, and a high mortality rate.
- The mortality rate in the 2 largest US series with the longest follow-up study is 4-5%. In comparison, the mortality rate for most modern cystectomy series is 1-2%.
- In addition, a significant number of patients ultimately require salvage cystectomy, which is associated with significantly increased morbidity and decreased options for urinary diversions. In some series, local recurrence of bladder cancer is as high as 50-60% despite the completion of bladder-preserving therapy.
- Radical cystoprostatectomy (men)
Medication
MVAC is the standard treatment for metastatic bladder cancer. No proven role exists for adjuvant chemotherapy. When selecting therapy, the MVAC combination has substantial toxicity and must be weighed against the expected benefit. The major dose-limiting toxicity is myelosuppression. The new combination regimens (eg, gemcitabine, cisplatin) show response rates and median survival comparable to MVAC but with less toxicity.
Antineoplastic agents
These agents inhibit cell growth and proliferation.
Methotrexate (Folex PFS)
Inhibits dihydrofolate reductase (DHFR), causing a block in the reduction of dihydrofolate to tetrahydrofolate. This inhibits the formation of thymidylate and purines and arrests DNA, RNA, and protein synthesis.
Adult
30 mg/m2 IV on day 1; repeat on days 15 and 22 if WBC count >2000/µL and platelet count >50,000/µL
Pediatric
Not established
Oral aminoglycosides may decrease absorption and blood levels of concurrent oral MTX; charcoal lowers MTX levels; coadministration with etretinate may increase hepatotoxicity of MTX; folic acid or its derivatives contained in some vitamins may decrease response to MTX; coadministration with NSAIDs may be fatal; indomethacin and phenylbutazone can increase MTX plasma levels; may decrease phenytoin serum levels; probenecid, salicylates, procarbazine, and sulfonamides, including TMP-SMZ, may increase MTX effects and toxicity; may increase plasma levels of thiopurines
Documented hypersensitivity; severe renal or hepatic impairment; pre-existing profound bone marrow suppression; alcoholic liver disease; AIDS; pre-existing blood dyscrasias
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Toxicities include anorexia, nausea, vomiting, stomatitis, diarrhea, bone marrow suppression, acute hepatotoxicity, renal failure, acute pneumonitis, mild alopecia, and dermatologic toxicities; monitor CBCs monthly; monitor liver and renal function q1-3mo during therapy (monitor more frequently during initial dosing, dose adjustments, or when at risk of elevated MTX levels from dehydration); MTX has toxic effects on hematologic, renal, GI, pulmonary, and neurologic systems; discontinue use if blood counts significantly drop; aspirin, NSAIDs, or low-dose steroids may be administered concomitantly with MTX (possibility of increased toxicity with NSAIDs, including salicylates, has not been tested)
Vinblastine (Velban, Alkaban-AQ)
Vinca alkaloid with cytotoxic effect via mitotic arrest. Binds to specific site on tubulin, prevents polymerization of tubulin dimers, and inhibits microtubule formation. Intrathecal (IT) administration use may result in death.
Adult
3 mg/m2 IV on day 2; repeat on days 15 and 22 if WBC count >2000/µL and platelet count >50,000/µL
Pediatric
Not established
Phenytoin plasma levels may be reduced when administered concomitantly; with use of mitomycin, toxicity of vinblastine may increase significantly
Documented hypersensitivity; severe bone marrow suppression; presence of bacterial infection not under control
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Dose-limiting toxicity is myelosuppression; other toxicities include nausea, vomiting, alopecia, neurologic toxicities, and local skin damage (if extravasated)
Doxorubicin (Adriamycin)
Anthracycline antibiotic that causes DNA strand breakage through effects on topoisomerase II and direct intercalation into DNA, which causes DNA polymerase inhibition. This drug is both mutagenic and carcinogenic.
Adult
30 mg/m2 IV on day 2
Pediatric
Not established
May decrease phenytoin and digoxin plasma levels; phenobarbital may decrease plasma levels of doxorubicin; cyclosporine may induce coma or seizures; mercaptopurine increases toxicity; cyclophosphamide increases cardiac toxicity
Documented hypersensitivity; severe congestive heart failure; cardiomyopathy; pre-existing bone marrow suppression; previous treatment with complete cumulative doses of anthracycline
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Toxicity includes myelosuppression, local skin reaction, alopecia, nausea, vomiting, reddish-orange color of urine, radiation sensitization, and cardiomyopathy; extravasation may result in severe skin and tissue necrosis
Cisplatin (Platinol)
A platinum-containing compound that exerts an antineoplastic effect by covalently binding to DNA, with preferential binding to N-7 position of guanine and adenosine. Can react with 2 different sites on DNA to produce cross-links. Platinum complex also can bind to nucleus and cytoplasmic protein.
Adult
50-70 mg/m2 IV on day 2
Pediatric
Not established
Toxicity decreases with sodium thiosulfate; toxicity increases with ethacrynic acid and bleomycin
Documented hypersensitivity; pre-existing renal insufficiency; myelosuppression; hearing impairment
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Toxicities include bone marrow suppression, nausea, vomiting, mucositis, and high-frequency hearing loss; major dose-limiting toxicity is peripheral neuropathy; can cause acute or chronic renal failure in as many as one third of patients treated but can usually be prevented by vigorous hydration and sodium chloride diuresis; renal tubular wasting of potassium and magnesium are common (monitor closely); cellulitis and fibrosis rarely occur after extravasation
Gemcitabine (Gemzar)
Cytidine analog. After intracellular metabolism to active nucleotide, inhibits ribonucleotide reductase and competes with deoxycytidine triphosphate for incorporation into DNA.
Adult
1 g/m2 IV
Pediatric
Not established
None reported
Documented hypersensitivity
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
May cause myelosuppression (particularly thrombocytopenia); toxicities include flulike syndrome, LFT abnormality, maculopapular rash, pruritus, nausea, vomiting, dyspnea, hematuria, proteinuria, and hemolytic uremic syndrome
More on Bladder Cancer |
| Overview: Bladder Cancer |
| Differential Diagnoses & Workup: Bladder Cancer |
 Treatment & Medication: Bladder Cancer |
| Follow-up: Bladder Cancer |
| Multimedia: Bladder Cancer |
| References |
| Further Reading |
| « Previous Page | Next Page » |
References
Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics, 2009. CA Cancer J Clin. Jul-Aug 2009;59(4):225-49. [Medline].
Haber GP, Campbell SC, Colombo JR Jr, Fergany AF, Aron M, Kaouk J, et al. Perioperative outcomes with laparoscopic radical cystectomy: "pure laparoscopic" and "open-assisted laparoscopic" approaches. Urology. Nov 2007;70(5):910-5. [Medline].
Lotan Y, Roehrborn CG. Cost-effectiveness of a modified care protocol substituting bladder tumor markers for cystoscopy for the followup of patients with transitional cell carcinoma of the bladder: a decision analytical approach. J Urol. Jan 2002;167(1):75-9. [Medline].
Lokeshwar VB, Soloway MS. Current bladder tumor tests: does their projected utility fulfill clinical necessity?. J Urol. Apr 2001;165(4):1067-77. [Medline].
[Best Evidence] Grossman HB, Soloway M, Messing E, Katz G, Stein B, Kassabian V, et al. Surveillance for recurrent bladder cancer using a point-of-care proteomic assay. JAMA. Jan 18 2006;295(3):299-305. [Medline].
Al-Sukhun S, Hussain M. Molecular biology of transitional cell carcinoma. Crit Rev Oncol Hematol. Aug 2003;47(2):181-93. [Medline].
Murphy WM, Crabtree WN, Jukkola AF, Soloway MS. The diagnostic value of urine versus bladder washing in patients with bladder cancer. J Urol. Sep 1981;126(3):320-2. [Medline].
Soloway MS, Briggman V, Carpinito GA, Chodak GW, Church PA, Lamm DL, et al. Use of a new tumor marker, urinary NMP22, in the detection of occult or rapidly recurring transitional cell carcinoma of the urinary tract following surgical treatment. J Urol. Aug 1996;156(2 Pt 1):363-7. [Medline].
Halling KC, King W, Sokolova IA, Meyer RG, Burkhardt HM, Halling AC, et al. A comparison of cytology and fluorescence in situ hybridization for the detection of urothelial carcinoma. J Urol. Nov 2000;164(5):1768-75. [Medline].
Sokolova IA, Halling KC, Jenkins RB, Burkhardt HM, Meyer RG, Seelig SA, et al. The development of a multitarget, multicolor fluorescence in situ hybridization assay for the detection of urothelial carcinoma in urine. J Mol Diagn. Aug 2000;2(3):116-23. [Medline].
Veeramachaneni R, Nordberg ML, Shi R, Herrera GA, Turbat-Herrera EA. Evaluation of fluorescence in situ hybridization as an ancillary tool to urine cytology in diagnosing urothelial carcinoma. Diagn Cytopathol. Jun 2003;28(6):301-7. [Medline].
Skacel M, Fahmy M, Brainard JA, Pettay JD, Biscotti CV, Liou LS, et al. Multitarget fluorescence in situ hybridization assay detects transitional cell carcinoma in the majority of patients with bladder cancer and atypical or negative urine cytology. J Urol. Jun 2003;169(6):2101-5. [Medline].
Saad A, Hanbury DC, McNicholas TA, Boustead GB, Morgan S, Woodman AC. A study comparing various noninvasive methods of detecting bladder cancer in urine. BJU Int. Mar 2002;89(4):369-73. [Medline].
Laudadio J, Keane TE, Reeves HM, Savage SJ, Hoda RS, Lage JM, et al. Fluorescence in situ hybridization for detecting transitional cell carcinoma: implications for clinical practice. BJU Int. Dec 2005;96(9):1280-5. [Medline].
Berezney R, Coffey DS. Identification of a nuclear protein matrix. Biochem Biophys Res Commun. Oct 23 1974;60(4):1410-7. [Medline].
Pardoll DM, Vogelstein B, Coffey DS. A fixed site of DNA replication in eucaryotic cells. Cell. Feb 1980;19(2):527-36. [Medline].
Gordon JN, Shu WP, Schlussel RN, Droller MJ, Liu BC. Altered extracellular matrices influence cellular processes and nuclear matrix organizations of overlying human bladder urothelial cells. Cancer Res. Oct 15 1993;53(20):4971-7. [Medline].
Keesee SK, Briggman JV, Thill G, Wu YJ. Utilization of nuclear matrix proteins for cancer diagnosis. Crit Rev Eukaryot Gene Expr. 1996;6(2-3):189-214. [Medline].
Shariat SF, Marberger MJ, Lotan Y, Sanchez-Carbayo M, Zippe C, Lüdecke G, et al. Variability in the performance of nuclear matrix protein 22 for the detection of bladder cancer. J Urol. Sep 2006;176(3):919-26; discussion 926. [Medline].
Black PC, Brown GA, Dinney CP. Molecular markers of urothelial cancer and their use in the monitoring of superficial urothelial cancer. J Clin Oncol. Dec 10 2006;24(35):5528-35. [Medline].
van Rhijn BW, van der Poel HG, van der Kwast TH. Urine markers for bladder cancer surveillance: a systematic review. Eur Urol. Jun 2005;47(6):736-48. [Medline].
Lin DW, Herr HW, Dalbagni G. Value of urethral wash cytology in the retained male urethra after radical cystoprostatectomy. J Urol. Mar 2003;169(3):961-3. [Medline].
Bracken RB, McDonald M, Johnson DE. Complications of single-stage radical cystectomy and ileal conduit. Urology. Feb 1981;17(2):141-6. [Medline].
Chang SS, Cookson MS. Radical cystectomy for bladder cancer: the case for early intervention. Urol Clin North Am. May 2005;32(2):147-55. [Medline].
Dawson C, Whitfield H. ABC of Urology. Urological malignancy--II: Urothelial tumours. BMJ. Apr 27 1996;312(7038):1090-4. [Medline].
Frazier HA, Robertson JE, Paulson DF. Complications of radical cystectomy and urinary diversion: a retrospective review of 675 cases in 2 decades. J Urol. Nov 1992;148(5):1401-5. [Medline].
Grossfeld GD, Litwin MS, Wolf JS Jr, Hricak H, Shuler CL, Agerter DC, et al. Evaluation of asymptomatic microscopic hematuria in adults: the American Urological Association best practice policy--part II: patient evaluation, cytology, voided markers, imaging, cystoscopy, nephrology evaluation, and follow-up. Urology. Apr 2001;57(4):604-10. [Medline]. [Full Text].
Grossman HB, Natale RB, Tangen CM, Speights VO, Vogelzang NJ, Trump DL, et al. Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer. N Engl J Med. Aug 28 2003;349(9):859-66. [Medline]. [Full Text].
Gschwend J, Vieweg J, Fair W. Contemporary Results of Radical Cystectomy for Primary Bladder Cancer. AUA Update Series. 1999;18:98-103.
Herr HW, Faulkner JR, Grossman HB, Natale RB, deVere White R, Sarosdy MF, et al. Surgical factors influence bladder cancer outcomes: a cooperative group report. J Clin Oncol. Jul 15 2004;22(14):2781-9. [Medline]. [Full Text].
Johansson SL, Cohen SM. Epidemiology and etiology of bladder cancer. Semin Surg Oncol. Sep-Oct 1997;13(5):291-8. [Medline].
Kamat AM, Lamm DL. Chemoprevention of urological cancer. J Urol. Jun 1999;161(6):1748-60. [Medline].
Kaufman D, Raghavan D, Carducci M, Levine EG, Murphy B, Aisner J, et al. Phase II trial of gemcitabine plus cisplatin in patients with metastatic urothelial cancer. J Clin Oncol. May 2000;18(9):1921-7. [Medline].
Malmstrom PU, Rintala E, Wahlqvist R, Hellstrom P, Hellsten S, Hannisdal E. Five-year followup of a prospective trial of radical cystectomy and neoadjuvant chemotherapy: Nordic Cystectomy Trial I. The Nordic Cooperative Bladder Cancer Study Group. J Urol. Jun 1996;155(6):1903-6. [Medline].
Malmstrom PU, Wijkstrom H, Lundholm C, Wester K, Busch C, Norlen BJ. 5-year followup of a randomized prospective study comparing mitomycin C and bacillus Calmette-Guerin in patients with superficial bladder carcinoma. Swedish-Norwegian Bladder Cancer Study Group. J Urol. Apr 1999;161(4):1124-7. [Medline].
Manoharan M, Soloway MS. Optimal management of the T1G3 bladder cancer. Urol Clin North Am. May 2005;32(2):133-45. [Medline].
Montie J, Smith DC, Sandler H. Clinical Oncology. In: Abeloff, ed. Carcinoma of the Bladder. 3rd Ed. 2004:2059-84.
Navon JD, Soliman H, Khonsari F, Ahlering T. Screening cystoscopy and survival of spinal cord injured patients with squamous cell cancer of the bladder. J Urol. Jun 1997;157(6):2109-11. [Medline].
O'Donnell MA. Practical applications of intravesical chemotherapy and immunotherapy in high-risk patients with superficial bladder cancer. Urol Clin North Am. May 2005;32(2):121-31. [Medline].
O'Donnell MA, Lilli K, Leopold C. Interim results from a national multicenter phase II trial of combination bacillus Calmette-Guerin plus interferon alfa-2b for superficial bladder cancer. J Urol. Sep 2004;172(3):888-93. [Medline].
[Guideline] Stenzl A, Cowan NC, De Santis M, Jakse G, Kuczyk MA, Merseburger AS, et al. The Updated EAU Guidelines on Muscle-Invasive and Metastatic Bladder Cancer. Eur Urol. Jan 13 2009;[Medline].
Tanagho EA, McAninch JW. Urothelial Carcinoma Cancers of the Bladder Ureter and Renal Pelvis. In: Smith's General Urology. Norwalk, Conn: Appleton & Lange; 1995:353-37.
Walsh PC, Retik AB, Vaughan ED. Urothelial Tumors of the Urinary Tract. In: Campbell's Urology. Vol 3. Philadelphia, Pa: WB Saunders; 1998:2327-83.
Warde P, Gospodarowicz MK. New approaches in the use of radiation therapy in the treatment of infiltrative transitional-cell cancer of the bladder. World J Urol. 1997;15(2):125-33. [Medline].
Further Reading
Clinical trials
Selenium in Preventing Cancer Recurrence in Patients With Bladder Cancer
Evaluation of Non-Invasive Assay(s) for the Detection of Bladder Cancer
Quality of Life and Symptom Management in Patients With Bladder Cancer
Peptide Vaccine Focusing on Prevention of the Recurrence for Bladder Cancer
Keywords
urothelial cancer, urothelial carcinoma, bladder cancer, transitional cell cancer, transitional cell carcinoma, TCC, bladder tumor, leiomyosarcoma, rhabdomyosarcoma, hematuria, urothelial tumors, carcinoma in situ, CIS, squamous cell carcinoma, SCC, urothelial carcinoma, indwelling Foley catheter, bladder stones, Schistosoma haematobium, S haematobium, primary bladder lymphoma, smoking, aromatic amines, radiation treatment of the pelvis, nitrosamine, 2-naphthylamine, 4-aminobiphenyl, chemotherapy with cyclophosphamide, acrolein, muscle-invasive bladder cancer, urinary tract infection, superficial transitional cell carcinoma, superficial TCC
