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Clinical Scenario: Rapidly Growing, High Volume, Low-Grade Ta Tumor

A 68-Year-old man with rapidly recurring multiple, low-grade, papillary Ta tumors despite perioperative mitomycin and one induction course of BCG

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Management of Bladder Cancer

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Abstract

Approximately half of all newly diagnosed cases of bladder cancer are non-muscle-invasive tumors confined to the urothelial lining of the bladder (Ta). The vast majority of these (>90 %) will be low grade. Although these tumors carry a low risk of progression to invasion (5–10 %) and an even lower risk of death (1–5 %), they have a very high likelihood of recurrence (50–70 %). Patients with large volume and rapidly recurring low-grade Ta bladder cancer present a significant treatment challenge for the urologist. Intravesical chemotherapy has been shown to decrease the recurrence rate of these tumors, though the optimal agent, dose and treatment schedule has not been determined. Intravesical BCG can be used if intravesical chemotherapy is not successful, or in cases where the risk of recurrence is high. However, BCG has a significantly higher rate of local and systemic toxicity. Other chemotherapeutic agents are currently being investigated as intravesical therapies. Active surveillance with frequent office cystoscopy and fulguration of any small recurrences is also an option. In rare instances, patients who undergo grade or stage progression or those who fail to respond to the above treatments may ultimately require radical cystectomy.

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Author information

Authors and Affiliations

  1. Department of Urology, Yale School of Medicine, 789 Howard Avenue, FMP 312, New Haven, CT, 06519, USA

    James S. Rosoff M.D.

  2. Department of Urology, Medical University of South Carolina, 96 Jonathan Lucas Street, MSC 620 – HE644CSB, Charleston, SC, 29424, USA

    Thomas E. Keane M.B., Ch.B., F.R.C.S.I., F.A.C.S.

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  1. James S. Rosoff M.D.
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  2. Thomas E. Keane M.B., Ch.B., F.R.C.S.I., F.A.C.S.
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Correspondence to James S. Rosoff M.D. .

Editor information

Editors and Affiliations

  1. Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA

    Badrinath R. Konety

  2. Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA

    Sam S. Chang

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Rosoff, J.S., Keane, T.E. (2015). Clinical Scenario: Rapidly Growing, High Volume, Low-Grade Ta Tumor. In: Konety, B., Chang, S. (eds) Management of Bladder Cancer. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1881-2_16

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  • DOI: https://doi.org/10.1007/978-1-4939-1881-2_16

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-1880-5

  • Online ISBN: 978-1-4939-1881-2

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