Treatment Options for Invasive Bladder Carcinoma

Ahmad Abid Bin Abas 07-5-02

Treatment Modalities

• Surgery :1) Transurethral Resection with fulguration.2) Radical Cystectomy3) Segmental Cystectomy4) Urinary Diversion (Ileal conduit,orthotopic

neobladder)

(TUR)• http://passingtravelers.com/13099-2/cancer-after-the-initial-diagnosis

Radical Cystectomy

Urinary Diversion• http://kidney.niddk.nih.gov/kudiseases/pubs/urostomy/

Treatment Modalities

• Radiation Therapy :1) External Radiation

(Machine outside the body)2) Internal Radiation

(Radioactive substance sealed in needles, seeds, wires, or catheters)

Treatment Modalities

• Chemotherapy1) (MVAC) - 2-3 cycles of

methotrexate,vinblastine, adriamycin plus cisplatin.

2) (CMV) - cisplatin, methotrexate plus vinblastine

Treatment Modalities

• Biologic Therapy (Immunotherapy) 1) An immune-stimulating bacterium.-Bacille

Calmette-Guerin (BCG) 2) A synthetic version of an immune system

protein. (Interferon alpha)

New Treatment Modalities still in Clinical Trials

• Chemoprevention . (drugs,vitamins etc..)

• Photodynamic Therapy (PDT) (drug + laser beam)

Treatment Options by Stage 0

Stage 0 (Papillary Carcinoma and Carcinoma in Situ)

• Transurethral resection with fulguration.• Transurethral resection with fulguration

followed by intravesical biologic therapy or chemotherapy.

• Segmental cystectomy or radical cystectomy.

Treatment Options by Stage I

• * same modalities as stage 0 but more options as follow :

• Radiation implants with or without external radiation therapy.

Treatment Options by Stage II

• Radical cystectomy with or without surgery to remove pelvic lymph nodes.

• Combination chemotherapy followed by radical cystectomy.

• External radiation therapy combined with chemotherapy.

• Radiation implants before or after external radiation therapy.

• Transurethral resection with fulguration.• Segmental cystectomy.

Treatment Options by Stage III

• Radical cystectomy with or without surgery to remove pelvic lymph nodes.

• Combination chemotherapy followed by radical cystectomy.

• External radiation therapy combined with chemotherapy.

• External radiation therapy with radiation implants.

• Segmental cystectomy.

Treatment Options by Stage IV

• Radical cystectomy with surgery to remove pelvic lymph nodes.

• External radiation therapy (may be as palliative therapy to relieve symptoms and improve quality of life).

• Urinary diversion as palliative therapy to relieve symptoms and improve quality of life.

• Cystectomy as palliative therapy to relieve symptoms and improve quality of life.

• Chemotherapy alone or after local treatment (surgery or radiation therapy).

References

• http://www.mayoclinic.com/health/bladder-cancer/DS00177/DSECTION=treatments-and-drugs

• http://www.cancer.gov/cancertopics/pdq/treatment/bladder/Patient/page5