Skip to main content

Advertisement

SpringerLink
Log in

Localized bladder cancer

  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

Transitional cell carcinoma (TCC) of the bladder makes up 90% of bladder cancers. The approach to the management of localized TCC includes accurate clinical and histologic diagnosis and staging with pathologic material obtained through endoscopy. Once the diagnosis of superficial TCC has been established, histologically based prognostic factors guide which therapy or combination of therapies is indicated in the management of individual patients. Surgery alone (transurethral resection) is appropriate initial therapy for noninvasive papillary TCC. For lamina propria invasive tumors and carcinoma in situ, intravesical immunotherapy with bacille Calmette-Guérin (BCG) is often the first line of treatment to decrease tumor recurrence and to possibly decrease progression and improve survival. Intravesical chemotherapy and interferon are alternative therapies that can also decrease recurrence rates. For BCG-refractory TCC, durable response rates with alternative intravesical therapies are low. For superficial TCC that is refractory to endoscopic procedures and intravesical agents or for disease progression, radical cystectomy with neobladder formation or other forms of urinary diversion is the treatment of choice.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Greenlee RT, Murray T, Bolden S, et al.: Cancer statistics, 2000. CA Cancer J Clin 2000, 50:7–33.

    PubMed  CAS  Google Scholar 

  2. AJCC Cancer Staging Manual, edn 5. Philadelphia: Lippincott-Raven; 1997:241–243.

  3. Lee R, Droller MJ: The natural history of bladder cancer. Urol Clin North Am 2000, 27:1–13.

    Article  PubMed  CAS  Google Scholar 

  4. Heney NM, Ahmed S, Flanagan J, et al.: Superficial bladder cancer: progression and recurrence. J Urol 1983, 130:1083–1086.

    PubMed  CAS  Google Scholar 

  5. Fitzpatrick JM, West AB, Butler MR, et al.: Superficial bladder tumors (stage pTa, grades 1 and 2): the importance of recurrence pattern following initial resection. J Urol 1986, 186:920–922.

    Google Scholar 

  6. Allard P, Bernard P, Fradet Y, et al.: The early clinical course of primary Ta and T1 bladder cancer: a proposed' prognostic index. Br J Urol 1998, 81:692–698.

    PubMed  CAS  Google Scholar 

  7. Johansson SL, Cohen SM: Epidemiology and etiology of bladder cancer. Semin Surg Oncol 1997, 13:291–298.

    Article  PubMed  CAS  Google Scholar 

  8. Taylor JA, Umbach DM, Stephens E, et al.: The role of N-acetylation polymorphisms in smoking-associated bladder cancer: evidence of a gene-gene-exposure three-way interaction. Cancer Res 1998, 58:3603–3610.

    PubMed  CAS  Google Scholar 

  9. Bell DA, Taylor JA, Paulson DF, et al.: Genetic risk and carcinogen exposure: a common inherited defect of the carcinogen-metabolism gene glutathione S-transferase M1 (GSTM1) that increases susceptibility to bladder cancer. J Natl Cancer Inst 1993, 85:1159–1164.

    Article  PubMed  CAS  Google Scholar 

  10. Sidransky D, Frost P, von Eschenbach A, et al.: Clonal origin of bladder cancer. N Engl J Med 1992, 326:737–740. This important study provided strong evidence that multiple bladder tumors can arise from a single transformed cell by analyzing X-chromosome inactivation and allelic loss in cystectomy specimens.

    Article  PubMed  CAS  Google Scholar 

  11. Droller MJ: Bladder cancer: state-of-the-art care. CA Cancer J Clin 1998, 48:269–283.

    Article  PubMed  CAS  Google Scholar 

  12. Cummings RB, Barone JG, Ward WS: Diagnosis and staging of bladder cancer. Urol Clin North Am 1992, 19:455–465.

    PubMed  CAS  Google Scholar 

  13. Bastacky S, Ibrahim S, Wilczynski SP, et al.: The accuracy of cytology in daily practice. Cancer 1999, 87:118–128.

    Article  PubMed  CAS  Google Scholar 

  14. Hozbeierlein JM, Smith Jr JA: Surgical management of noninvasive bladder cancer (stages Ta/T1/CIS). Urol Clin North Am 2000, 27:15–24.

    Article  Google Scholar 

  15. Michaud DS, Spiegelman D, Clinton SK, et al.: Fluid intake and the risk of bladder cancer in men. N Engl J Med 1999, 340:1390–1397. This well-designed prospective study provided data that supports increased fluid intake as a preventive strategy against the development of bladder cancer.

    Article  PubMed  CAS  Google Scholar 

  16. Studer UE, Jenzer S, Biedermann C, et al.: Adjuvant treatment with a vitamin A analogue (etretinate) after transurethral resection of superficial bladder tumors. Eur Urol 1995, 28:284–290.

    PubMed  CAS  Google Scholar 

  17. Lamm DL, Riggs DR, Shriver JS, et al.: Megadose vitamins in bladder cancer: a double blind clinical trial. J Urol 1994, 151:21–26.

    PubMed  CAS  Google Scholar 

  18. Herr HW, Schwalb DM, Zhang Z, et al.: Intravesical bacillus Calmette-Guérin therapy prevents tumor progression and death from superficial bladder cancer: ten-year follow-up of a prospective randomized trial. J Clin Oncol 1995, 13:1404–1408. This randomized prospective study with 10-year follow-up showed that the use of BCG in patients with recurrent superficial bladder TCC can delay tumor progression.

    PubMed  CAS  Google Scholar 

  19. Lamm DL, Blumenstein BA, Crissman JD, et al.: Maintenance BCG immunotherapy in recurrent Ta, T1, and carcinoma in situ transitional cell carcinoma: a randomized Southwest Oncology Group Study. J Urol 2000, 163:1124–1129. This large randomized study demonstrates the superiority of intensive maintenance BCG in improving time to recurrence and time to progression (worsening free survival).

    Article  PubMed  CAS  Google Scholar 

  20. Krege S, Giani G, Meyer R, et al.: A randomized multicenter trial of adjuvant therapy in superficial bladder cancer: transurethral resection only versus transurethral resection plus mitomycin C versus transurethral resection plus bacillus Calmette-Guérin. J Urol 1996, 156:962–966.

    Article  PubMed  CAS  Google Scholar 

  21. Bouffioux CH, Kurth KH, Bono A, et al.: Intravesical adjuvant chemotherapy for superficial transitional cell bladder carcinoma: results of 2 European Organization for Research and Treatment of Cancer randomized trials with mitomycin C and doxorubicin comparing early versus delayed instillations and short-term versus long-term treatment. J Urol 1995, 153:934–941.

    Article  PubMed  CAS  Google Scholar 

  22. Solsona E, Iborra I, Ricos JV, et al.: Effectiveness of a single immediate mitomycin C instillation in patients with low risk superficial bladder cancer: short and long-term followup. J Urol 1999, 161:1120–1123.

    Article  PubMed  CAS  Google Scholar 

  23. Duque JLF, Loughlin KR: An overview of the treatment of superficial bladder cancer. Urol Clin North Am 2000, 27:125–135. This is a timely review that provides a brief yet comprehensive review of intravesical chemotherapy for the treatment of superficial bladder cancer.

    Article  PubMed  CAS  Google Scholar 

  24. Brown DH, Wagner TT, Bahnson RR: Interferons and bladder cancer. Urol Clin North Am 2000, 27:171–178.

    Article  PubMed  CAS  Google Scholar 

  25. Dalbagni G, Herr HW: Current use and questions concerning intravesical bladder cancer group for superficial bladder cancer. Urol Clin North Am 2000, 27:137–146.

    Article  PubMed  CAS  Google Scholar 

  26. Belldegrun AS, Franklin JR, O'Donnell MA, et al.: Superficial bladder cancer: the role of interferon-a. J Urol 1998, 159:1793–1801.

    Article  PubMed  CAS  Google Scholar 

  27. Rajala P, Liukkonen T, Raitanen M, et al.: Transurethral resection with perioperative instillation of interferona or epirubicin for the prophylaxis of recurrent primary superficial bladder cancer: a prospective randomized multicenter study—Finnbladder III. J Urol 1999, 161:1133–1136.

    Article  PubMed  CAS  Google Scholar 

  28. Jimenez-Cruz JF, Vera-Donoso CD, Leiva O, et al.: Intravesical immunoprophylaxis in recurrent superficial bladder cancer (stage T1): multicenter trial comparing bacille Calmette-Guérin and interferonalpha. Urology 1997, 50:529–535.

    Article  PubMed  CAS  Google Scholar 

  29. Boccardo F, Cannata D, Rubagotti A, et al.: Prophylaxis of superficial bladder cancer with mitomycin or interferon alfa-2b: results of a multicentric Italian study. J Clin Oncol 1994, 12:7–13.

    PubMed  CAS  Google Scholar 

  30. Sternberg CN, Calabro F: Chemotherapy and management of bladder tumours. BJU Int 2000, 85:599–610.

    Article  PubMed  CAS  Google Scholar 

  31. Herr HW, Bajorin DF, Scher HI: Neoadjuvant chemotherapy and bladder-sparing surgery for invasive bladder cancer: ten-year outcome. J Clin Oncol 1998, 16:1298–1301.

    PubMed  CAS  Google Scholar 

  32. Shipley WU, Kaufman DS, Heney NM, et al.: An update of combined modality therapy for patients with muscle invading bladder cancer using selective bladder preservation or cystectomy. J Urol 1999, 162:445–450.

    Article  PubMed  CAS  Google Scholar 

  33. Kamat AM, Lamm DL: Intravesical therapy for bladder cancer. Urology 1999, 55:161–168.

    Article  Google Scholar 

  34. Hsieh JT, Dinney CP, Chung LW: The potential role of gene therapy in the treatment of bladder cancer. Urol Clin North Am 2000, 27:103–113.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Box 110, 77030, Houston, TX, USA

    Jonathan I. Izawa MD & H. Barton Grossman MD

Authors
  1. Jonathan I. Izawa MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H. Barton Grossman MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Izawa, J.I., Grossman, H.B. Localized bladder cancer. Curr. Treat. Options in Oncol. 1, 423–432 (2000). https://doi.org/10.1007/s11864-000-0070-5

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11864-000-0070-5

Keywords

Search

Navigation