Transitional cell carcinoma medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Medical Therapy

Transitional Cell Carcinoma of Bladder

Immunotherapy

  • Immunotherapy is a type of biological therapy that uses the immune system to help destroy cancer cells.[1]
  • Bacillus Calmette–Guérin (BCG)
  • Immunotherapy by intravesicular delivery of Bacillus Calmette–Guérin (BCG) is often used to treat and prevent the recurrence of superficial tumors.[2]
  • BCG is a vaccine against tuberculosis that is prepared from attenuated live Mycobacterium bovis, that has lost its virulence in humans. BCG immunotherapy is effective in up to 2/3 of the cases at this stage, and in randomized trials has been shown to be superior to standard chemotherapy.[3]
  • The mechanism by which BCG prevents recurrence is unknown, but the presence of bacteria in the bladder may trigger a localized immune reaction which clears residual cancer cells.[4]

Chemotherapy

  • Chemotherapy may be given to patients with stage II and III disease either before or after surgery to help prevent the tumor from returning.
  • For early disease (stages 0 and I), chemotherapy is usually given directly into the bladder.
  • Intravesical chemotherapy[1]
  • During intravesical chemotherapy, the drugs are placed into the bladder through a urinary catheter.
  • Intravesical chemotherapy may be given instead of BCG or if the bladder cancer doesn’t respond to BCG.
  • Mitomycin is the drug most often used in intravesical chemotherapy.
  • Systemic chemotherapy
  • During systemic chemotherapy, the drugs are given intravenously.
  • Systemic chemotherapy may be a treatment option for bladder cancer that has spread to other tissues near the bladder and bladder cancer that has spread to other parts of the body.
  • Chemotherapy is recommended before a radical cystectomy (called neoadjuvant chemotherapy) for many people with bladder cancer that has grown into the muscle layer of the bladder wall. It is also often given after a radical cystectomy (called adjuvant chemotherapy) to people with high-risk features such as cancer that has spread to lymph nodes.

Radiation therapy

  • Radiation therapy may be the main treatment for people who can’t have surgery.
  • External beam radiation therapy is the type of radiation treatment that is most often used to treat bladder cancer.
  • Palliative radiation therapy may be given to relieve symptoms caused by advanced bladder cancer.

Transitional Cell Carcinoma of Renal Pelvis and Ureter

  • In patients with metastatic or recurrent transitional cell carcinoma of the bladder, combination chemotherapy has produced high response rates and occasional complete responses.

References

  1. 1.0 1.1 Bladder Cancer. Canadian Cancer Society 2015. http://www.cancer.ca/en/cancer-information/cancer-type/bladder/treatment/?region=ab Accessed on October, 7 2015
  2. Alexandroff AB, Jackson AM, O'Donnell MA, James K (May 1999). "BCG immunotherapy of bladder cancer: 20 years on". Lancet. 353 (9165): 1689–94. doi:10.1016/S0140-6736(98)07422-4. PMID 10335805.
  3. Lamm, Donald L.; Blumenstein, Brent A.; Crawford, E. David; Montie, James E.; Scardino, Peter; Grossman, H. Barton; Stanisic, Thomas H.; Smith Jr, Joseph A.; Sullivan, Jerry; Sarosdy, Michael F.; Crissman, John D.; Coltman, Charles A. (1991). "A Randomized Trial of Intravesical Doxorubicin and Immunotherapy with Bacille Calmette–Guérin for Transitional-Cell Carcinoma of the Bladder". New England Journal of Medicine. 325 (17): 1205–9. doi:10.1056/NEJM199110243251703. PMC 1164610. PMID 1922207.
  4. Bacillus Calmette-Guerin (BCG) for Bladder Cancer

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