Optimal treatment for intermediate- and high-risk, nonmuscle-invasive bladder cancer.
According to clinical and pathological factors the prognosis of a patient with non-muscle invasive bladder tumors can be assessed. The prognosis is determined by the likelihood of recurrence (30-70%) and/or progression to muscle invasive bladder cancer (1-15%).Trans urethral resection of bladder tumors remains the initial therapy but adjuvant intravesical instillations are necessary. All patients benefit from a single immediate post operative instillation with a chemotherapeutic agent and for low risk tumors this is the optimal therapy. Patients with intermediate and high risk tumors need more intravesical chemo-or immunotherapy. Chemotherapy reduces recurrences but not progression. Intravesical immunotherapy(BCG) prevents or delays progression. Patients at high risk for progression may need upfront cystectomy.
van der Meijden
A P M
AP
Department of Urology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands. A.v.d.meijden@jbz.nl
D000970:Antineoplastic Agents / Q000627:therapeutic use; D001500:BCG Vaccine / Q000378:metabolism; D001706:Biopsy; D015653:Cystectomy; D018450:Disease Progression; D006801:Humans; D008495:Medical Oncology / Q000379:methods*; D011379:Prognosis; D012008:Recurrence; D012306:Risk; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000628:therapy*
D000970:Antineoplastic Agents; D001500:BCG Vaccine