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Nichtinvasives und invasives Harnblasenkarzinom

Diagnostik und Therapie

Noninvasive and invasive bladder cancer

Diagnostics and treatment

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Zusammenfassung

Die Therapie des oberflächlichen Urothelkarzinoms besteht in der transurethralen Resektion, wobei bei pT1-Tumoren und bei high-grade-Tumoren die Indikation zur Nachresektion gegeben ist. Bei Diagnose eines Carcinoma in situ wird zunächst eine intravesikale Chemo- oder Immuntherapie durchgeführt; bei Therapieversagen nach 3 Monaten wird die radikale Zystektomie empfohlen. Aufgrund der Möglichkeit eines für den Patienten funktionell adäquaten Blasenersatzes stellt die radikale Zystektomie eine effektive Therapie muskelinvasiver, nicht metastasierter Harnblasenkarzinome dar. Regionale Lymphknotenmetastasen finden sich in bis zu 15% bei T1-Tumoren und bis zu 33% bei T3/T4-Läsionen. Aus diesem Grunde hat die Lymphadenektomie diagnostische, möglicherweise aber auch therapeutische Bedeutung. Für ausgewählte Patienten, die mit einer radikalen Zystektomie nicht behandelt werden können, werden multimodale Behandlungskonzepte mit dem Ziel des Blasenerhaltes diskutiert. Nach oder auch vor Zystektomie kann eine systemische Chemotherapie für einen Teil der Patienten nötig werden, um den weiteren Verlauf einer lokal fortgeschrittenen oder metastasierten Erkrankung günstig zu beeinflussen.

Abstract

Therapy of superficial bladder tumors is transurethral resection (TUR), and in cases of pT1 or high-grade tumors a re-TUR is indicated. Patients with carcinoma in situ receive intravesical chemotherapy or BCG for at least 3 months. Persistent carcinoma in situ may be treated by radical cystectomy. With the provision of a functionally adequate urinary diversion, cystectomy represents an effective treatment for patients with muscle-invasive bladder cancer without metastatic spread. Regional lymph node metastases can be found in up to 15% of stage T1 disease and are present in 33% of stage T3/4 lesions. Thus, lymphadenectomy gains diagnostic and possibly also therapeutic importance. For selected patients, who cannot be treated by radical cystectomy, multimodal concepts aiming to preserve the bladder are discussed. After or prior to cystectomy systemic chemotherapy may become necessary for some patients to positively affect the course of the disease in cases of locally advanced or metastatic lesions.

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Authors and Affiliations

  1. Klinik und Poliklinik für Urologie, Universitätsklinikum Essen, Hufelandstraße 55, 45122 , Essen

    P. J. Goebell, F. vom Dorp & H. Rübben

  2. Westdeutsches Tumorzentrum Essen (WTZE)

    P. J. Goebell, F. vom Dorp, K. W. Schmidt & H. Rübben

  3. Klinik für Strahlentherapie der Universität Erlangen

    C. Rödel & R. Sauer

  4. Urologische Klinik, Städtisches Klinikum Karlsruhe GmbH, Karlsruhe

    D. Frohneberg

  5. Urologische Klinik, Johannes-Gutenberg-Universität, Mainz

    J. W. Thüroff & C. Wiesner

  6. Urologische Klinik, Universitätsklinikum Kiel

    D. Jocham & I. Kausch

  7. Urologische Klinik, Universitätsklinikum Großhadern

    C. Stief & D. Zaak

  8. Urologische Klinik, Helios Klinikum Wuppertal

    S. Roth

  9. Institut für Pathologie, Universitätsklinikum Aachen

    R. Knüchel

  10. Institut für Pathologie, Universitätsklinikum Essen

    K. W. Schmidt

  11. Urologische Klinik, Charité, Campus Benjamin Franklin, Berlin

    K. Miller

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  1. P. J. Goebell
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  2. F. vom Dorp
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Goebell, P.J., vom Dorp, F., Rödel, C. et al. Nichtinvasives und invasives Harnblasenkarzinom. Urologe 45, 873–886 (2006). https://doi.org/10.1007/s00120-006-1065-z

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