What are the general principles of treatment?
Treatment usually consists of surgical resection along with neoadjuvant chemotherapy and/or radiation therapy.
Metastatic disease is managed with palliative systemic chemotherapy, and, in some cases, palliative surgery (e.g., removal of urethral obstructions).
On what does the treatment of bladder cancer depend?
Bladder cancer is the most common urothelial cancer; treatment differs based on the presence of muscular invasion and/or metastases.
What are the 2 big treatment options?
Nonmuscle invasive
Nonmetastatic muscle invasive
Describe hte nonmuscle invasive treatment.
First line: transurethral resection of bladder tumor (TURBT)
Additional treatments include:
Intravesical adjuvant chemotherapy (e.g., mitomycin C or epirubicin)
Immunotherapy with intravesical bacillus Calmette-Guérin (BCG)
Describe the nonmucle invasive treatment ith intravesival adjuvant chemotherapy.
Depending on risk factors, this may involve a single postoperative dose or induction followed by maintenance.
Describe the nonmucle invasive treatment with intravesival BCG.
Intravesical instillation of BCG causes immunocompetent cells (e.g., natural killer cells), which target and kill malignant cells, to infiltrate the bladder. If induction therapy is successful, it is followed by maintenance therapy.
What is the first-line treatment of nonmetastatic muscle invasive?
Neoadjuvant chemotherapy (cisplatin-based combination regimens)
AND radical cystectomy with bilateral pelvic lymph node dissection and urinary diversion —> Radical cystectomy removes the bladder and regional lymph nodes. In male individuals, the prostate and seminal vesicles are removed, while in female individuals, the uterus, cervix, ovaries, and anterior vaginal wall are removed.
What is the treatment for nonmetastatic muscle invasive (includes invasion of the muscle and possible locoregional lymph node infiltration, but no distant metastases) for patients who are ineligible for radial cystectomy or prefer to retain their bladder?
bladder-preserving treatment involves a combination of:
Maximal debulking TURBT
Chemotherapy
Radiation therapy
How does the treatment in metastatic disease look like?
First line: palliative cisplatin-based systemic chemotherapy
Palliative immunotherapy, radiation therapy, and/or surgery may also be used.
Describe the monitoring of cancer.
Urothelial carcinoma commonly recurs; therefore, close monitoring for recurrence and progression is required.
Surveillance studies may include repeat cystoscopy, imaging, and laboratory studies (e.g., urine cytology).
The frequency of surveillance depends on patient characteristics and disease features (e.g., tumor grade and stage).
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