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Muscularis Propria Bladder Cancer

Carefully selected group of patients with invasive bladder cancer are suitable for TUR as a curative procedure. In general, the philosophy of these inclusion criteria is to select patients with tumour limited to the muscularis propria in whom radical tumour resection can be performed, and not to perform an extended TUR, even in perivesical fat is involved (Figure 3). In these cases, a more radical procedure, such as cystectomy or radio-chemotherapy, is mandatory. From a clinical point of view,...

Identification Of Adverse Prognostic Factors That Might Preclude Bladder Conservation

Clearly, not everyone is a candidate for function-sparing surgery and a thorough review ofthe clinical presentation ofpatients who failed function-sparing strategies has identified risk factors that should be considered carefully when contemplating an organ-sparing approach. Herr et al. noted that the presence of residual tumour following induction therapy portended a poorer prognosis and likely failure of bladder sparing. They also note that this risk directly correlated with the stage of the...

Biomarker of cancer susceptibility

To exert their carcinogenic effect, aromatic amines, like most chemical carcinogens, require metabolic activation to reactive species that bind to DNA. The activation of aromatic amines is performed by some enzymes, whose polymorphic distribution in the population may give rise to a genetically determined different individual susceptibility. In particular, N-acetyltransferase (NAT) is an enzyme whose activity may result in detoxification of aromatic amines. In humans it is coded by two genes,...

Screening for cancer

Screening is the application of a test to an asymptomatic target population in which a positive result correlates with disease. The measure itself is not diagnostic, and the presence of disease must be confirmed by further diagnostic tests. The goal of screening is to identify disease early in its course, and offer therapy when it can be more effective and associated with lower morbidity.6 The World Health Organization has established criteria for widespread application of a screening...

References

1 American Cancer Society Inc. (2000) Cancer Facts & Figures. American Cancer Society Inc location . 2 Herr HW (1992) Transurethral resection in regionally advanced bladder cancer. Urol Clin North Am 19 695-700. 3 Douglas EM, Kaufman DS, Zeitman AL et al. (1996) Conservative surgery, patient selection, and chemo-radiation as organ-preserving treatment for muscle-invading bladder cancer. Semin Oncol 23 614-20. 4 Montie JE (1999) Against bladder-sparing surgery. Urol 162 452-7. 5 Lerner SP,...

Function Sparing Approaches With Chemotherapy and Conservative Surgery

Herr et al. further championed the potential for bladder preservation in highly selected patients in a study that examined the role of neo-adjuvant M-VAC chemotherapy after aggressive TUR, and subsequent surgical consolidation via partial cystectomy in a select group of patients that had lesions amenable to this approach.8 In this series, 26 of 111 patients were considered to be candidates for partial cystectomy after TUR and M-VAC chemotherapy. The pre-treatment stage of these patients...

Medical considerations for treatments for invasive bladder cancer in the elderly

Deterioration in physiologic function, prolonged exposure to deleterious and damaging substances, and the consequent co-morbidities associated with ageing may affect considerations of various treatment approaches for invasive bladder cancer in the elderly. Therapeutic efficacy, side-effects, potential complications, and effects on overall quality of life are all important factors in this context. In addition, various individual host factors (life expectancy, co-morbid conditions, physiologic...

Candidates for screening

Picture Tcc Bladder Cancer

Major risk factors for developing bladder cancer are age, gender, race and environmental exposures very few cases are directly inherited.10 TCC is not prevalent in people below 50 years of age with the median age of diagnosis being 69 years old in males and 71 years old in females.11 Not surprisingly, incidence and mortality rise with increasing age. Bladder cancer occurs almost three times more frequently in males than females, but mortality is 35-50 higher in women than men. In the United...

Surgical procedures

Ileal Conduit

Together with the stomal therapist, the urologist should mark the site of the stoma prior to surgery. It should be placed in an area free of scars and skin folds. Most often the site will be slightly below a line between the umbilicus and the anterior superior iliac spine. The adhesive portion of the bandage is usually a quadrant with the side 7-8cm, which will influence position. The patient should wear the appliance for a day or two pre-operatively. There are many suggestions of how to...

Preoperative and definitive radiation therapy

Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Canada The majority ofbladder cancer patients present with superficial disease and are managed with conservative measures. Approximately 20-25 present with muscle-invasive bladder cancer that is potentially life threatening and requires radical treatment. Definitive radiation therapy RT has been used for muscle-invasive bladder cancer since the early 1900s and there is evidence that patients can achieve durable local control...

How To Proceed When Bladder Cancer Is Found In Lymph Nodes During Cystectomy

Thus, pT-category of the primary tumour in addition to nodal tumour burden pN-category are the most important stratification variables in determining who may or may not benefit from radical surgery, and may influence the surgeon's decision as to whether to proceed with cystectomy when lymph node involvement becomes evident. Herr et al. have reported a detailed analysis of the outcome of patients with grossly node-positive bladder cancer.7 Among patients with grossly positive nodes,...

The current relevance of salvage cystectomy broadening the definition

Retroperitoneal Node Dissection

Although radiation therapy alone is rarely used today in the United States as definitive therapy for bladder cancer, it is still important to discuss salvage cystectomy for many reasons. The first and foremost reason is the patient with advanced urothelial tumour who, after undergoing definitive chemotherapy, has persistent or recurrent disease within the bladder, despite the absence of distant metastatic disease. Since the difficulty of performing surgery after multiple courses of chemotherapy...

Technical considerations for salvage cystectomy

Handling Cystectomy

Experience with 158 patients who had salvage cystectomy performed by urologists at MD Anderson Cancer Center between 1969 and 1987 114 patients and between 1993 and 1998 42 patients , as well as the additional 55 patients shown in Table 5 who had cystectomy between 1993 and 1998, forms the basis of our conclusions on how to avoid some of the surgical complications associated with salvage cystectomy. It is apparent to us that many of the complications are the result of obliterated tissue planes...