bladder%20cancer
BLADDER CANCER

Bladder cancer is a heterogenous neoplasm that ranges from non-life-threatening, low-grade, superficial papillary lesions to high-grade invasive tumors that often metastasizes at the presentation.

It is the most common cancer involving the urinary system and it is the 11th most commonly diagnosed in the world.

Microscopic or gross painless hematuria is the most common presenting complaint.

Pharmacotherapy

Chemotherapy

  • In low-risk patients, & those presumed to be at intermediate risk w/ previous low recurrence rate, a single, immediate, post-operative intravesical instillation of chemotherapy has been considered to be the standard & sufficient treatment
    • Shown to act by the destruction of circulating tumor cells resulting from TURB & by an ablative effect (chemoresection) on residual tumor cells at the resection site & on small overlooked tumors
    • Although for other patients, it remains an incomplete treatment because of the considerable likelihood of recurrence &/or progression
    • Should be administered w/in 24 hr after TURBT
    • Mitomycin C, Epirubicin & Doxorubicin have shown beneficial effects
  • In all patients, either 1 year full dose BCG treatment (induction plus 3-weekly instillations at 3, 6, 12 months) or instillations of chemotherapy (the optimal schedule is not known) for a maximum of 1 yr is recommended
    • A course of at least 6 doses of intravesical Mitomycin C is offered in patients who have recurrence w/in 12 mths after cystoscopic treatment of low risk non-muscle-invasive disease
    • Final choice should be based on the individual patient’s risk of recurrence & progression as well as the efficacy & side effects of each treatment modality
  • For patients w/ locally advanced or metastatic urothelial bladder cancer who are otherwise physically fit & have adequate renal function, a Cisplatin-based chemotherapy regimen is suggested
  • Neoadjuvant chemotherapy using a Cisplatin combination regimen before radical cystectomy or radical radiotherapy is suggested in patients w/ diagnosed T2-T4a, cN0M0 bladder cancer
  • Adjuvant Cisplatin combination chemotherapy after radical cystectomy is considered for patients w/ a diagnosis of muscle-invasive or lymph-node-positive urothelial bladder cancer for whom neoadjuvant chemotherapy was not suitable
  • For patients w/ metastatic bladder cancer, chemotherapy regimen include:
    • AC (Methotrexate, Vinblastine, Doxorubicin & Cisplatin) w/ or w/out growth factor support for 3 or 4 cycles
    • Gemcitabine & Cisplatin for 4 cycles
    • CMV (Cisplatin, Methotrexate, & Vinblastine) for 3 cycles
  • In some Asian countries, Gemcitabine is the first-line chemotherapy
  • Cisplatin, the taxanes, & Gemcitabine are the first-line chemotherapy options for metastatic diseases
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