[Guideline on urothelial carcinoma of the bladder].
Urothelial carcinoma of the bladder is diagnosed predominantly in people over 60 years of age. The most common symptom is haematuria. Smoking is an important risk factor (relative risk 2.5 to 3). Cystoscopy is performed whenever bladder carcinoma is suspected. The recurrence rate of a non-muscle invasive urothelial carcinoma is high (31-78% within 5 years). A single intravesical instillation with a chemotherapeutic agent within 24 hours of transurethral resection (TUR) reduces the risk of recurrence. Carcinoma in situ (CIS) should be treated as high-grade urothelial carcinoma. Standard treatment for patients with non-metastasized muscle-invasive urothelial carcinoma is cystectomy in combination with extensive lymph node dissection. There are several possibilities for urinary diversion following cystectomy, none of which are any better than the others. Bladder-sparing brachytherapy may be used in patients with solitary T1 - T2 urothelial carcinoma < 5 cm. Neoadjuvant cisplatin-containing chemotherapy prior to cystectomy in muscle-invasive carcinoma only slightly improves survival. Cisplatin-containing combination chemotherapy is the standard treatment for metastasized urothelial carcinoma.
Bevers
Rob F M
RF
Leids Universitair Medisch Centrum, afd. Urologie, Leiden, The Netherlands. r.f.m.bevers@lumc.nl
Battermann
Jan J
JJ
Gietema
Jourik A
JA
Hulsbergen-Van de Kaa
Christina A
CA
de Reijke
Theo M
TM
Feller
Nicole
N
Witjes
J A Fred
JA
D000283:Administration, Intravesical; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001918:Brachytherapy; D002278:Carcinoma in Situ / Q000150:complications / Q000628:therapy*; D002295:Carcinoma, Transitional Cell / Q000150:complications / Q000628:therapy*; D002945:Cisplatin / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003558:Cystoscopy; D006417:Hematuria / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D008197:Lymph Node Excision; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local; D009426:Netherlands; D010818:Practice Patterns, Physicians'; D001749:Urinary Bladder Neoplasms / Q000150:complications / Q000628:therapy*; D014547:Urinary Diversion; D014572:Urology / Q000592:standards*
D000970:Antineoplastic Agents; D002945:Cisplatin