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Bladder Cancer

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Biotargets of Cancer in Current Clinical Practice

Part of the book series: Current Clinical Pathology ((CCPATH))

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Abstract

This chapter is a thorough review of the current knowledge on superficial and muscle-invasive bladder cancer. Epidemiological data regarding incidence and prevalence of the disease and risk factors are discussed in the light of the known chemical carcinogenesis of the tumor.

The management of superficial bladder cancer is currently based on endoscopic and ultrasound imaging followed by transurethral resection which provides a confirmatory diagnosis, tumor grading, and local staging. When required, intravesical instillation of chemotherapeutic agents or biological response modifiers such as the Bacillus Calmette-Guerin can be used to lower the risk of local recurrences and progression. Proper management of T1G3 bladder tumors is critical because correct timing of radical surgery is of importance when the risk of tumor progression is high.

Thirty percent of bladder tumors are muscle invasive at diagnosis, and demolitive surgery with radical cystectomy and urinary diversion is the current standard of care. In selected case, organ-sparing management with transurethral resection and intravenous chemotherapy or transurethral resection plus external beam radiotherapy can be used to cure the disease. The use of intravenous chemotherapy in the management of bladder cancer remains an open issue: data from randomized clinical trials showed the clinical benefit of adjuvant chemotherapy in selected case, but no clear evidence as to the role of adjuvant chemotherapy is available in locally advanced and node-positive disease.

Looking beyond the current standards for the management of bladder cancer, a thorough review of the ongoing clinical research on target therapy of bladder cancer is provided. Numerous trials are currently underway to test the efficacy of new agents targeting the epidermal growth factor receptor pathway and angiogenesis.

The management of bladder cancer remains a challenge because of the risk of progression of T1G3 tumors and the lack of efficacious adjuvant treatment for muscle-invasive disease. Individualized patient management with target therapy already proved beneficial in other solid tumors, and several trials are currently underway on bladder cancer.

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Abbreviations

ALA:

5-Aminolaevulinic acid

ATP:

Adenosine triphosphate

BCG:

Bacillus Calmette-Guerin

BTA:

Bladder tumor antigen test

GC:

Gemcitabine/cisplatin

GC:

Gemcitabine, Cisplatin

GCS:

Gemcitabine, cisplatin, and sunitinib

CGA:

Comprehensive geriatric assessment

CIS:

Carcinoma in situ

CISCA:

Cisplatin, cyclophosphamide, adriamycin

CT:

Computerized tomography

EBRT:

External beam radiotherapy

ECOG:

Eastern Cooperative Oncology Group

EGFR:

Epidermal growth factor receptor

EORTC:

European Organization for Research and Treatment of Cancer

ESMO:

European Society of Medical Oncology

FDA:

Food and Drug Administration

FGF:

Fibroblast growth factor

FISH:

Fluorescence in situ hybridization

FLT-3:

FMS-like tyrosine kinase-3 receptor

5-FU:

5-Fluorouracil

GFR:

Glomerular filtration rate

HAL:

Hexaminolevulinic acid

HD:

High dose

HER:

Human epidermal growth factor receptor

HIF:

Hypoxia-inducible factor-1

IHC:

Immunohistochemistry

KIT:

stem cell growth factor receptor or proto-oncogene c-Kit or tyrosine-protein kinase Kit

M-CAVI:

Methotrexate, carboplatin, and vinblastine

MIBC:

Muscle-invasive bladder cancer

MRI:

Magnetic resonance imaging

MSKCC:

Memorial Sloan-Kettering Cancer Center

MVAC:

Methotrexate, vinblastine, doxorubicin, cisplatin

MVD:

Microvessel density

NMIBC:

Non-muscle-invasive bladder cancer

NPP22:

Nuclear matrix protein test

PDGFR:

Platelet-derived growth factor

PFS:

Progression-free survival

PS:

Performance status

PUNLMP:

Papillary urothelial neoplasm of low malignant potential

QLQ-BLM:

Quality of life questionnaire on muscle-invasive bladder cancer

RC:

Radical cystectomy

RCC:

Renal cell carcinoma

RTK:

Receptor tyrosine kinase

TCC:

Transitional cell carcinoma

TKI:

Tyrosine kinase inhibitor

TUR:

Transurethral resection

TURB:

Transurethral resection of the bladder

UUT:

Upper urinary tract

VEGF:

Vascular endothelial growth factor

WHO:

World Health Organization

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Authors and Affiliations

  1. Department of Urology, Sant’Andrea Hospital, “La Sapienza” University of Rome, Via di Grottarossa 1035, Rome, 00198, Italy

    Andrea Tubaro M.D., F.E.B.U. & Cosimo De Nunzio M.D.

  2. Department of Medical Oncology, Campus Bio-Medico University, Rome, Italy

    Daniele Santini M.D., Alice Zoccoli M.D. & Michele Iuliano M.D.

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  1. Andrea Tubaro M.D., F.E.B.U.
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Correspondence to Andrea Tubaro M.D., F.E.B.U. .

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Tubaro, A., Santini, D., De Nunzio, C., Zoccoli, A., Iuliano, M. (2012). Bladder Cancer. In: Bologna, M. (eds) Biotargets of Cancer in Current Clinical Practice. Current Clinical Pathology. Humana Press. https://doi.org/10.1007/978-1-61779-615-9_12

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