Bladder Tumors: (eBook)

Molecular Aspects and Clinical Management

Vinata B. Lokeshwar, Axel S. Merseburger, Stefan H. Hautmann (Herausgeber)

eBook Download: PDF

2010 | 2011
XVI, 468 Seiten
Humana Press (Verlag)
978-1-60761-928-4 (ISBN)

Infos

Bladder cancer is a common cancer of the urinary tract. It is the fourth leading cause of cancer-related death among men and the seventh among women. Clinical management of bladder cancer is challenging because of the heterogeneity among bladder tumors with respect to invasion and metastasis, frequent occurrence of new tumors in the bladder among patients treated with bladder preservation treatments and poor prognosis of patients with tumors that invade the bladder muscle and beyond. Due to these factors it has been said that the cost per patient of bladder cancer, from diagnosis to death is the highest of all cancers. In addition to it being a significant health problem, bladder cancer is an interesting cancer to study in many ways than one. For example, Environmental factors such as cigarette smoking and other carcinogens play a major role in the development of transitional carcinoma of the bladder, whereas, schitosomasis, a protozoan infection results in squamous cell carcinoma of the bladder. Different molecular pathways with distinct molecular signatures appear to be involved in the development of low-grade versus high-grade bladder tumors. Currently being monitored by an invasive endoscopic procedure, cystectomy, with urine cytology as an adjunct, bladder cancer is at the forefront of developing cancer biomarkers for non-invasive detection. Due to the differences in the invasive and metastatic potential of bladder tumors, treatment options differ depending upon tumor grade and stage. New advances are being made in treatment options to improve the outcome and quality of life for patients with bladder cancer. Similarly, new molecular nomograms are being discovered to predict treatment outcome so that individualized treatment options can be offered to patients.

Inhalt

Bladder Tumors 3
Preface 5
Contents 9
Chapter 1: Bladder Cancer Epidemiology 17
1.1 Tobacco Smoking and BC 19
1.2 Occupational Exposure and BC 21
1.3 Genetic Predisposition and BC 23
1.4 Infection and BC 24
1.5 Radiation and BC 25
1.6 Dietary Factors and BC 26
1.7 Gender Related Differences in BC 28
1.8 Hereditary BC 30
1.9 Other Related Risk Factors: Cyclophosphamide, Phenacetin 32
1.9.1 Cyclophosphamide 32
1.9.2 Phenacetin 32
1.10 Screening of BC 32
1.11 Chemoprevention of BC 35
References 35
Chapter 2: Bladder Carcinogenesis and Molecular Pathways 39
2.1 Introduction 39
2.2 Bladder Carcinogenesis 40
2.2.1 Bladder Carcinogens and DNA Adduct Formation 40
2.2.2 Phase I and II Enzymes 40
2.2.2.1 Cytochrome P450 (CYP) Monooxygenases 40
2.2.3 Phase II Enzymes 41
2.2.3.1 N-Acetyl Transferases (NAT) 41
2.2.3.2 Glutathione-S-Transferase (GST) 42
2.3 Field Cancerization and Clonal Origin of Bladder Cancer 44
2.4 Chromosomal Aberrations in Bladder Cancer 45
2.5 Molecular Pathways for Bladder Cancer Development 48
2.6 Summary 50
References 51
Chapter 3: Histopathology and Molecular Pathology of Bladder Cancer 58
3.1 Introduction 58
3.2 New Aspects of the WHO Classification of Bladder Carcinoma 59
3.3 Benign Urothelial Changes 60
3.3.1 Reactive Atypia in the Urothelium and Atypia of Unknown Significance 60
3.3.2 Urothelial Hyperplasia 61
3.3.3 Urothelial Papilloma 61
3.3.4 Inverted Urothelial Papillomas 62
3.3.5 Papillary Urothelial Neoplasia of Low Malignant Potential (PUNLMP) 63
3.4 Malignant Urothelial Lesions 64
3.4.1 Urothelial Dysplasia (UD—Synonym: Intraurothelial Neoplasia, Low-Grade) 64
3.4.2 Carcinoma In Situ (CIS—Synonym: Intraurothelial Neoplasia, High-Grade) 65
3.4.3 Noninvasive Papillary Urothelial Carcinoma, Low-Grade and High-Grade 66
3.4.4 Invasive Bladder Cancer 67
3.4.5 TNM Classification 2010 69
3.5 Molecular Pathways in Bladder Cancer Pathogenesis 70
3.5.1 Are New Findings in Molecular Analysis Clinically Relevant? 71
3.5.2 Microarrays: The Future in Bladder Pathology? 73
3.6 Conclusions 73
References 74
Chapter 4: Bladder Cancer Diagnosis and Detection: Current Status 77
4.1 Urinary Cytology (A Brief Reference) 77
4.2 Cystoscopy 78
4.2.1 Limitations 78
4.2.2 Photodynamic Diagnosis 79
4.2.3 Narrow Band Imaging 79
4.2.4 Optical Coherence Tomography 80
4.3 Transurethral Resection of Bladder Tumor 80
4.3.1 New Techniques 81
4.4 Bimanual Palpation 82
4.5 Staging of Bladder Cancer 82
4.5.1 T-Category 83
4.5.2 N-Category 84
4.5.3 M-Category 85
4.6 Role of Imaging 85
4.6.1 Local Staging 85
4.6.2 Lymph Node Involvement 86
4.6.3 Distant Metastasis 87
4.6.4 Upper Tract Imaging (Brief Reference) 87
4.7 Summary 88
References 88
Chapter 5: Urine Cytology, DNA Ploidy and Morphometry 92
5.1 Introduction 92
5.2 Cellular and Noncellular Components of Normal Urine Specimens 93
5.3 Types of Urinary Specimens 94
5.4 Cytology of Urothelial Carcinoma 94
5.4.1 Cytology of High-Grade Urothelial Carcinoma 95
5.4.2 Cytology of Low-Grade Urothelial Carcinoma 96
5.5 Cause of Atypical Urine Cytology 97
5.5.1 Urinary Tract Calculi (Nephrolithiasis) 97
5.5.2 Therapeutic Effects 97
5.5.3 Human Polyoma Virus 98
5.6 DNA Ploidy 98
5.6.1 DNA Ploidy by Flow Cytometry 99
5.6.2 DNA Ploidy by Static Image Analysis 99
5.6.3 DNA Ploidy by Laser Scanning Cytometry 100
5.7 Fluorescence In situ Hybridization 100
5.8 Morphometry 101
5.9 Conclusion 102
References 102
Chapter 6: Molecular Signatures of Bladder Cancer 104
6.1 Molecular Signatures 104
6.2 Bladder Cancer 105
6.3 Molecular Signatures of Bladder Cancer: A Historical Perspective 110
6.3.1 Proteomics 111
6.4 Epigenetic Signatures of Bladder Cancer 112
6.4.1 Introduction to Epigenetics 112
6.4.2 Epigenetic Mechanisms of Bladder Cancer 113
6.5 Nuclear Matrix Protein 22 (NMP22) 114
6.6 Bladder Tumor Antigen 115
6.7 Soluble Fas 116
6.8 Fluorescence In situ Hybridization 117
6.9 ImmunoCyt 118
6.10 BLCA-4 118
6.11 Telomerase 119
6.12 Fibronectin 120
6.13 Survivin 121
6.14 Fibroblast Growth Factor Receptor 3 (FGFR3) 121
6.15 Reg 1 122
6.16 Cytokeratin/Urinary Bladder Cancer Test 122
6.17 Prothymosin Alpha 123
6.18 Matrix Metalloproteinases 123
6.19 Hyaluronic Acid and HYAL-1 Hyaluronidase 124
6.20 Urothelial Cell Carcinoma Versus Squamous Cell Carcinoma 125
6.21 Conclusion 125
References 126
Chapter 7: Economics of Bladder Cancer Diagnosis and Surveillance 133
7.1 Introduction 134
7.1.1 Cost Analysis in Health Care 134
7.1.1.1 The Importance of Perspective 135
7.1.1.2 Cost Versus Charge 135
7.1.1.3 Discounting 136
7.1.2 Overall Bladder Cancer Costs 136
7.1.3 The Economics of Bladder Cancer Diagnosis and Screening 138
7.1.3.1 The Costs Associated with Diagnosing Bladder Cancer 138
7.1.3.2 Screening for Bladder Cancer 140
7.1.3.2.1 Screening Based on the Presence of Hematuria 141
7.1.3.2.2 Screening by Using Bladder Tumor Markers in High-Risk Populations 142
7.1.3.3 The Economics of Bladder Cancer Surveillance 143
7.1.3.4 Conclusions 145
References 145
Chapter 8: Prognostic Markers for Bladder Cancer 150
8.1 Overview 150
8.2 Prognostic Markers According to Clinical Situation 151
8.2.1 Intravesical Recurrence After TUR-BT 151
8.2.2 Progression to Muscle-Invasive Disease After Endoscopic Management for Nonmuscle-Invasive Bladder Cancer 155
8.2.3 Response to Intravesical BCG Instillation Therapy 156
8.2.4 Outcome After Radical Cystectomy for Muscle-Invasive or Locally Advanced Disease 157
8.2.5 Response to Systemic Chemotherapy for Advanced Disease 158
8.3 Candidate Molecular Predictive Markers Classified by Target Molecules and Methodology 158
8.3.1 Chromosomal Alterations and DNA/Nucleotide-Based Markers 159
8.3.2 cDNA Microarray mRNA Expression Analysis and Gene Expression Signature 160
8.3.3 Proto-oncogenes/Oncogenes 160
8.3.4 Tumor Suppressor Genes 162
8.3.5 Cell Cycle Regulators 164
8.3.6 Angiogenesis-Related Factors 166
8.3.7 Extracellular Matrix, Adhesion Molecules, Cell Surface Markers, and Related Proteins 167
8.4 Conclusion 168
References 169
Chapter 9: Molecular Nomograms for Predicting Prognosis and Treatment Response 175
9.1 Introduction 176
9.1.1 From Classical Prognostic Factors to Nomograms 176
9.1.2 Molecular Nomograms? 177
9.1.3 Molecular Pathogenesis of Bladder Cancer: Opportunities for Biomarker Discovery 178
9.2 Key Technologies in Biomarker Development 181
9.3 Towards Molecular Nomograms for Nonmuscle-Invasive Urothelial Carcinoma 185
9.3.1 Microarray Studies 185
9.3.2 Recent Reports: Towards Molecular Signatures of Recurrence and Progression 186
9.4 Towards Molecular Nomograms for Muscle-Invasive Urothelial Carcinoma (MIUC) 190
9.4.1 Immunohistochemical Technologies Applied to MIUC 190
9.4.2 Microarray Studies of Survival Outcomes in MIUC 191
9.4.3 Recent Reports: Molecular Signatures Predicting Response to Therapy 192
9.5 New Strategies 194
9.6 Concluding Remarks 196
References 196
Chapter 10: Practical Approaches to the Management of Superficial Bladder Cancer 202
10.1 Introduction 202
10.2 Incidence 202
10.3 History of Cystoscopy 203
10.4 Problem 204
10.5 Etiology 205
10.6 Pathophysiology 205
10.7 Genetic Pathophysiology 206
10.8 Clinical 207
10.9 Indications 207
10.10 Relevant Anatomy 208
10.11 Contraindications 208
10.12 Workup 208
10.12.1 Lab Studies 208
10.12.2 Imaging Studies 209
10.12.3 Other Tests 211
10.13 Diagnostic Procedures 211
10.14 AUA Guidelines Panel Recommendations 212
10.15 Treatment Guidelines Statements 212
10.15.1 For All Index Patients 212
10.15.2 Index Patient No. 1 212
10.15.3 Index Patient No. 2 213
10.15.4 Index Patient No. 3 213
10.15.5 Index Patient No. 4 213
10.15.6 Index Patient No. 5 214
10.16 Medical Therapy 214
10.17 Surgical Therapy 215
10.17.1 Transurethral Resection of Bladder Tumor 215
10.17.2 Cystectomy 215
10.17.3 Random Biopsies 216
10.18 Preoperative Details 216
10.19 Intraoperative Details 217
10.19.1 Transurethral Resection of Bladder Tumor 217
10.20 Surveillance Cystoscopy 218
10.20.1 Cystoscopy Techniques for Men 218
10.20.2 Cystoscopy Techniques for Women 220
10.21 Postoperative Details 221
10.21.1 Follow-up 221
10.21.2 Complications 221
10.22 Outcomes and Prognosis 222
10.23 Future and Controversies 222
References 223
Chapter 11: Clinical Management of Low Grade Bladder Tumors 225
11.1 Introduction 226
11.2 Histology 226
11.3 Risk Factors 227
11.4 Diagnosis 227
11.4.1 Symptoms 227
11.4.2 Imaging 227
11.4.3 Cystoscopy Is the Method by Which Most of the Papillary Tumors Are Detected 228
11.4.4 Urinary Cytology 228
11.4.5 Accuracy of Cystoscopy in Defining Low Grade Papillary Tumors 228
11.4.6 Upper Urinary Tract Exploration in Low Grade Bladder Tumors 230
11.5 Primary Treatment of Low Grade Ta Bladder Tumors 230
11.5.1 TUR of Bladder Tumors 230
11.5.2 Need for Random Biopsies and Fluorescence Cystoscopy 231
11.5.3 Second Resection 231
11.5.3.1 One Early Post TUR Chemo-Instillation 231
11.5.3.2 Recent Clinical Trials 232
11.5.3.3 Working Mechanism 234
11.5.3.4 Timing of the Instillation 234
11.5.3.5 Toxicity and Precautions 235
11.5.3.6 Further Intravesical Chemotherapy 236
11.5.3.7 The Role of BCG 236
11.6 Prognostic Factors 236
11.6.1 Follow-up 237
11.6.2 Frequency of Cystoscopy 238
11.6.3 Duration of Follow-up 239
11.6.4 Active Surveillance 239
11.6.4.1 Office Fulguration of Recurrent Low Grade Tumors 239
11.7 Summary 240
References 240
Chapter 12: Treatment of Low-Grade Bladder Tumors 245
12.1 Introduction 245
12.2 Treatment of Low-Grade Bladder Tumors 246
12.2.1 Transurethral Resection of Bladder Tumor 246
12.2.2 Procedure 246
12.2.3 Complications of TURBT 247
12.3 Repeat TURBT 248
12.4 Role of “Random” Bladder and Prostatic Additional Biopsies 249
12.5 Laser Treatment 250
12.5.1 Advantages 250
12.5.2 Complications 251
12.6 Photodynamic Therapy 251
12.6.1 Procedure 252
12.6.2 Complications 252
12.7 Radical or Partial Cystectomy 252
12.7.1 Indications for Radical Cystectomy in Patients with Low-Grade Bladder Tumors 253
12.7.2 Outcome of Radical Cystectomy in Low-Grade Noninvasive Bladder Tumors 253
12.7.3 Partial Cystectomy 253
12.8 Radiation Therapy 254
12.9 Predicting Recurrence and Progression in Low-Grade Tumors 254
12.10 Surveillance 255
12.10.1 Cystoscopic Surveillance 255
12.10.2 Fluorescence Cystoscopy 256
12.11 Discussion and Conclusion 257
References 257
Chapter 13: Intravesical Chemotherapy 261
13.1 Introduction 261
13.2 Goals and Principles of Intravesical Chemotherapy 261
13.3 Indications for Intravesical Chemotherapy 262
13.3.1 Single Perioperative Instillation 262
13.3.2 Induction Cycle 263
13.3.3 Maintenance Therapy 263
13.4 Sylvester Risk Assessment 263
13.5 Practical Aspects of Intravesical Therapy 264
13.6 Complications of Intravesical Chemotherapy 265
13.6.1 Cystitis 265
13.6.2 Hematuria 265
13.6.3 Contracted Bladder 266
13.6.4 Contact Dermatitis 266
13.6.5 Bladder Calcifications 266
13.6.6 Myelosuppression 266
13.7 Chemotherapeutic Agents 267
13.7.1 Mitomycin 267
13.7.2 Adriamycin 268
13.7.3 Epirubicin 268
13.7.4 Valrubicin 269
13.7.5 Gemcitabine 269
13.7.6 Interferon 270
13.7.7 Apaziquone 270
13.8 Combination Chemo-immunotherapy 272
13.9 Device-Assisted Therapy and Newer Approaches 272
13.10 Conclusion 273
References 273
Chapter 14: Intravesical Immunotherapy: BCG 279
14.1 Introduction 279
14.2 Mechanism of Action 281
14.2.1 BCG Attachment 282
14.2.2 Cytokine and Chemokine Production 283
14.2.3 Infiltrating Lymphocytes 283
14.2.4 TH1 Immune Response 284
14.2.5 Natural Killer Cells 284
14.2.6 Innate Immune Response 285
14.2.7 Tumor-Induced Immunosuppression 285
14.2.8 BCG Treatment Prognosis and Biomarkers 286
14.3 Clinical Use of BCG 288
14.3.1 Indications 288
14.3.2 Treatment Schedule and Dosage 289
14.3.3 Salvage Therapy 292
14.3.4 Prostatic and Upper Tract Disease 293
14.3.5 Side Effects/Complications 294
14.4 Conclusion 295
References 296
Chapter 15: Cystectomy for Nonmuscle-Invasive Bladder Cancer 304
15.1 Introduction 304
15.2 Nonmuscle-Invasive Bladder Cancer: Recurrence and Progression 306
15.2.1 Factors Predicting Recurrence and Progression in Nonmuscle-Invasive Disease: Value and Limitations 306
15.2.2 Clinical Understaging 308
15.2.3 Stage T1 308
15.2.4 Stage Tis (CIS-Carcinoma In situ) 309
15.3 Indications for Radical Cystectomy for Nonmuscle-Invasive Bladder Cancer 310
15.3.1 High-Grade Nonmuscle-Invasive Disease 310
15.3.2 BCG-Refractory Bladder Cancer 311
15.3.3 Miscellaneous Indications 312
15.4 Outcome After Radical Cystectomy for Nonmuscle-Invasive Bladder Cancer 313
15.5 Summary and Recommendations 314
References 314
Chapter 16: Radical Surgery for Muscle-Invasive Bladder Cancer 318
16.1 Background 318
16.2 Radical Surgery for Muscle-Invasive Bladder Cancer 319
16.2.1 Diagnosis of Invasive Bladder Cancer 319
16.2.2 Clinical Relevance of a Secondary TUR for Invasive Bladder Tumors 320
16.2.3 Timing and Delay of Radical Cystectomy for Bladder Cancer 320
16.2.4 General Indication for Radical Cystectomy in Patients with Bladder Cancer 321
16.2.5 Extension of Pelvic Lymph Node Dissection (PLND) Along with Radical Cystetcomy 322
16.2.6 Localization of Lymph Node Metastases 322
16.2.7 Rationale for an Extended Pelvic Lymph Node Dissection 323
16.2.8 Principles of Radical Cystectomy 324
16.2.9 Oncological Outcome of Radical Cystectomy for Muscle-Invasive Bladder Cancer with Negative Nodes 325
16.2.10 Oncological Outcome of Radical Cystectomy for Invasive Bladder Cancer and Prostatic Involvement 327
16.2.11 Oncological Outcome of Radical Cystectomy for Patients with Bladder Cancer and Lymph Node Involvement 328
16.2.12 Overall or Disease-Specific Survival as Endpoint of Outcome for Cystectomy patients? 331
16.2.13 Palliative Versus Therapeutic Indication of Radical Cystectomy for Bladder Cancer 332
16.3 Conclusion 333
References 334
17.1 Introduction 1
17.2 Historical Aspects of Urinary Diversion 339
17.3 Current Situation of Urinary Diversion 340
17.3.1 Quality of Life 340
17.3.2 Quality of Surgery 340
17.3.3 Trends in Reconstruction After RCX 341
17.3.4 Circumstances Under Which Urinary Diversion Is Performed 342
17.3.5 Correlation Between Volume of RCX and Outcomes 343
17.3.6 Indications, Contraindications, and Patient Selection 343
17.3.6.1 Substantial Change in Paradigm 343
17.3.6.2 Patient Selection Criteria: Absolute and Relative Contraindications 343
17.3.7 Patient Selection 344
17.3.7.1 Patient Factors: For (Pros) 344
17.3.7.2 Patient Factors: Against (Cons) 344
17.3.7.3 Patient Selection Criteria: Oncologic Factors 345
17.3.7.4 Current Practice 345
17.4 General Aspects of Urinary Diversion 346
17.4.1 Which Gut Segment Should Be Used 346
17.4.2 Difficulty of Operative Technique 347
17.4.3 No Standards for Surgical Complication Reporting 347
17.4.4 Early Complications of Radical Cystectomy and Urinary Diversion 347
17.4.5 Neobladder Specific Complications 349
17.4.5.1 Mucus Production 349
17.4.5.2 Chronic Bacteriuria 350
17.4.5.3 Rupture 350
17.4.5.4 Renal Function 351
17.5 How to Obtain Good Results with Orthotopic Bladder Substitution: The Ten Commandments 351
17.5.1 Commandment IV: Use Ileum Whenever Possible 352
17.5.2, 17.5.3 Commandment V: Maximum detubularization is a must 352
17.5.4 Commandment VI: Use a Stented Freely Refluxive Ileo Ureterostomy 352
17.5.5 Commandment VII: The Low Pressure, Compliant Freely Refluxive Reservoir Is Standard 353
17.5.6 Commandment X: Meticulous Follow-up 354
17.5.6.1 Management Immediately Postoperatively: 354
17.5.6.2 Management After Catheter Withdrawal 354
17.5.6.3 Meticulous Long-Term Follow-Up Is Essential 354
17.6 Long-Term Results of Orthotopic Reconstruction 355
17.7 Operative Technique Ileal Neobladder 355
17.7.1 RCX in a Female Patient with Planned Ileal Neobladder 356
17.7.2 Construction of the Ileal Neobladder in Both Sexes 359
17.7.3 Postoperative Management 365
17.8 Prostate Sparing Cystectomy 368
17.9 Palliative Urinary Diversion by Subcutaneous Nephro-Vesical/Nephro-Cutaneous Bypass 368
References 369
Chapter 18: Laparoscopic Cystectomy and Robotic-Assisted Cystectomy 371
18.1 Introduction 371
18.2 History 372
18.3 Patient Selection 372
18.4 Patient’s Positioning and Monitoring 373
18.5 Trocar Placement 373
18.6 Extended Lymph Node Dissection 374
18.7 Cystectomy 375
18.7.1 Ureteral Dissection 375
18.7.2 Male Cystectomy 376
18.7.3 Female Cystectomy 376
18.8 Nerve-Sparing Technique 377
18.9 Prostate-Sparing Cystectomy 377
18.10 Female Reproduction Tract-Sparing Cystectomy 377
18.11 Urinary Tract Reconstruction 378
18.11.1 Ileal Conduit (Bricker) 378
18.11.2 Orthotopic Neobladder 378
18.12 Outcome and Comparison to Open Radical Cystectomy 379
18.13 Final Considerations 380
References 380
Chapter 19: Neoadjuvant Chemotherapy 383
19.1 Rationale of Neoadjuvant Chemotherapy 383
19.2 Pathoanatomical Background of Disseminated Invasive Urinary Bladder Cancer 383
19.3 Definitions of Nodal Dissemination 384
19.4 Dissemination and Neoadjuvant Chemotherapy 385
19.5 Present Status of Neoadjuvant Chemotherapy 385
19.6 Neoadjuvant Chemotherapy and Downstaging 386
19.7 Advantages and Disadvantages of Neoadjuvant Chemotherapy 387
19.7.1 Advantages 387
19.7.2 Disadvantages 387
19.8 Future Perspectives 387
19.9 Chemosensitivity 388
19.10 Problems with Accuracy in Tested Chemosensitivity 389
19.11 Methods of Preoperative Imaging of Nodal Dissemination 390
19.12 Conclusive Remarks 390
References 391
Chapter 20: Diagnosis and Treatment of Upper Tract Urothelial Carcinoma 393
20.1 Diagnosis of UTUC 393
20.1.1 Urinary Cytology 394
20.1.2 Ultrasonography 397
20.1.3 Excretory Urography 397
20.1.4 Multidetector Computed Tomography Urography (MDCTU) 398
20.1.4.1 A Focal Intraluminal Enhancing Soft-tissue Density Mass 398
20.1.4.2 Urothelial Wall Thickening with Lumen Narrowing 398
20.1.4.3 An Infiltrating Mass 398
20.1.5 Magnetic Resonance Imaging 400
20.1.6 Image-Guided Biopsy 400
20.1.7 Retrograde Pyelography 400
20.1.8 Diagnostic Ureterorenoscopy Plus Biopsy 401
20.2 Surgical Treatment 402
20.2.1 Oncological Results of ORNU and LRNU 402
20.2.2 Morbidity of ORNU and LRNU 404
20.2.3 Management of the Bladder Cuff During LNU 405
20.2.3.1 Open Excision 405
20.2.3.2 Laparoscopic Stapling 405
20.2.3.3 Transvesical Laparoscopic Detachment Technique 406
20.2.3.4 Ligation and the “Pluck” Technique 406
20.2.4 Endourologic Treatment 407
References 408
Chapter 21: Chemotherapy for Metastatic Bladder Cancer 414
21.1 Introduction 414
21.2 Prognostic Factors and Treatment Decisions 415
21.3 Single-Agent Chemotherapy 416
21.4 Standard First-Line Chemotherapy and Its Development 417
21.4.1 Newer Platinum-Containing Combination Chemotherapies 417
21.4.2 Non-Platinum-Containing First-Line Combination Chemotherapy 418
21.5 Long-Term Overall Survival after Chemotherapy for Metastatic Disease 419
21.6 Refining Standard Chemotherapy 420
21.7 Fit and Unfit for Cisplatin 421
21.8 Carboplatin Versus Cisplatin Combination Chemotherapy in “Fit” Patients 421
21.9 Treatment of Elderly and Frail Patients and Those with Impaired Renal Function 422
21.10 Treatment of the “Unfit” Advanced or Metastatic Bladder Cancer Patient 423
21.11 Second-Line Chemotherapy 424
21.11.1 Second-Line Chemotherapy in Patients Who Are Still Eligible for Cisplatin 424
21.11.2 Second-Line Monochemotherapy 425
21.11.3 Vinflunine for Second-Line Use (see Table 21.10) 425
21.11.4 Combination Chemotherapy for Second-Line Use 427
21.11.5 Novel Approaches for Second-Line Treatment 428
21.11.6 Conclusion 428
References 429
Chapter 22: Nontransitional Carcinoma of the Bladder 437
22.1 Squamous Cell Carcinoma 437
22.1.1 SCC Not Associated with Bilharziasis 437
22.1.1.1 Epidemiology 437
22.1.2 Spinal Cord Injury 438
22.1.3 Smoking 439
22.1.4 Causes 439
22.1.5 Clinical and Pathologic Features 440
22.1.6 Treatment 441
22.1.6.1 Radiation 441
22.1.6.2 Radical Cystectomy 441
22.1.6.3 Chemotherapy 443
22.1.6.4 Prevention and Early Detection 443
22.1.7 Conclusion 443
22.2 Squamous Cell Carcinoma in the Bilharzial Bladder 444
22.2.1 Epidemiology 444
22.2.2 Causes 444
22.2.3 Clinical and Pathologic Features 445
22.2.4 Treatment 445
22.2.4.1 Endoscopic Resection 445
22.2.4.2 Segmental Resection (Partial Cystectomy) 445
22.2.4.3 Radical Cystectomy 446
22.2.5 Radiation 446
22.2.5.1 Neoadjuvant Radiation 447
22.2.5.2 Chemotherapy 447
22.2.5.3 Prevention and Early Detection 448
22.2.5.4 Conclusion 448
22.3 Adenocarcinoma 448
22.3.1 Overview 448
22.3.1.1 Epidemiology 449
22.3.1.2 Clinical Features 449
22.3.1.3 Pathologic Features 450
22.3.1.4 Treatment 450
22.3.2 Conclusion 451
22.4 Small Cell Carcinoma 452
22.4.1 Epidemiology 452
22.4.2 Clinical Features 452
22.4.3 Pathologic Features 452
22.4.4 Treatment 453
22.5 Conclusion 454
22.5.1 SCC 454
22.5.2 Adenocarcinoma 455
22.5.3 Small Cell Carcinoma 455
22.5.4 Bladder Sarcoma 455
22.5.5 Carcinosarcoma and Sarcomatoid Tumors 455
22.5.6 Paraganglioma and Pheochromocytoma 455
22.5.7 Bladder Pseudotumor 456
22.5.8 Melanoma 456
22.5.9 Lymphoma 456
References 456
Index 461

Produkt-Details

• Erscheint lt. Verlag: 16.12.2010
• Reihe/Serie: Cancer Drug Discovery and Development
• Reihe/Serie: Cancer Drug Discovery and Development
• Zusatzinfo: XVI, 468 p.
• Verlagsort: Totowa
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Onkologie
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Pharmakologie / Pharmakotherapie
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Urologie
• Themenwelt: Medizin / Pharmazie ► Studium
• Schlagworte: bladder • Cancer Research • Tumors
• ISBN-10: 1-60761-928-8 / 1607619288
• ISBN-13: 978-1-60761-928-4 / 9781607619284