bladder cancer l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Bladder Cancer PowerPoint Presentation
Download Presentation
Bladder Cancer

Loading in 2 Seconds...

play fullscreen
1 / 25

Bladder Cancer - PowerPoint PPT Presentation


  • 688 Views
  • Uploaded on

Bladder Cancer. R. Zenhäusern. Bladder cancer: Epidemiology. Incidence: 20/100000/year (Europe) Mortality: 8-9/100000/year Fourth most common cancer in men Incidence: 31.1 mortality: 12.1 Seventh most common cancer in women Incidence: 9.5 mortality: 4.5

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Bladder Cancer' - nikki


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
bladder cancer

Bladder Cancer

R. Zenhäusern

bladder cancer epidemiology
Bladder cancer: Epidemiology
  • Incidence: 20/100000/year(Europe)
  • Mortality: 8-9/100000/year
  • Fourth most common cancer in men
    • Incidence: 31.1 mortality: 12.1
  • Seventh most common cancer in women
    • Incidence: 9.5 mortality: 4.5
  • At diagnosis >70%: > 65 y of age
bladder cancer histology
Bladder cancer: Histology
  • 90-95% transitional-cell carcinoma
  • 3% squamos-cell carcinoma
  • 2% adenocarcinoma
  • <1% small-cell carcinoma
bladder cancer entities
Bladder cancer: Entities
  • 75-85% superficial bladder cancer

pTa, pTis, pT1

  • 10-15% muscle-invasive bladder cancer

pT2, pT3, pT4

  • 5% metastatic bladder cancer

N+, M+

bladder cancer stage and prognosis
Bladder cancer: Stage and Prognosis

Stage TNM 5-y. Survival

0 Ta/Tis NoMo >85%

I T1 NoMo 65-75%

II T2a-b NoMo 57%

III T3a-4a NoMo 31%

IV T4b NoMo 24%

each T N+Mo 14%

each T M+ med. 6-9 Mo

superficial bladder cancer pta pt1 tis
Superficial Bladder CancerpTa, pT1, Tis
  • Standard of care=intravesical Therapy

 transurethral resection

  • Relapse rate: 70%

 adjuvant therapy

superficial bladder cancer
Superficial Bladder Cancer
  • Histological grading is important

G1 G2 G3

Relapse rate 42% 50% 80%

Progression rate 2% 11% 45%

superficial bladder cancer adjuvant therapy
Superficial Bladder CancerAdjuvant Therapy
  • Reduces relpase rate by 30-80%
    • Doxorubicin weekly 6-8 w. / monthly 6-12
    • Mitomycin C weekly 6-8 w. / monthly 6-12
    • BCG weekly 6-8 w. /Mo 3 and 6
invasive bladder cancer
Invasive bladder cancer
  • Standard of care =

Radical cystectomy with pelvic lymphadenectomy

Only about 50% of patients with high-grade invasive disease are cured

results of radical cystectomy
Results of radical cystectomy

Stage Recurrence-Free Overall Survival

5 y. 10y. 5 y. 10y.

T2 N- 89 87 77 57

N+ 50 50 52 52

T3a N- 78 76 64 44

N+ 41 37 40 26

T3b N- 62 61 49 29

N+ 29 29 24 12

T4a N- 50 45 44 23

N+ 33 33 26 20

Stein et al JCO 2001;19:666

results of radical cystectomy11
Results of radical cystectomy

Stage Recurrence-Free /Overall Survival 5 years

Organ-confined (<pT2pNo) 73% 62%

non-organ-confined (>pT2pNo) 56% 49%

Positiv lymph nodes (pT1-4, pN+) 33% 24%

Madersbacher et al JCO 2003;21:690

chemotherapy for bladder cancer
Chemotherapy for bladder cancer
  • Bladder cancer is a chemosensitive disease
  • Active single agents.

RR

    • Cisplatin 30%
    • Carboplatin 20%
    • Gemcitabine 20-30%
    • Ifosfamide 20%
chemotherapy for bladder cancer13
Chemotherapy for bladder cancer

Combination chemotherapy.

RR CR

  • MVAC 40-75% <20%
  • Gemzar / Cisplatin 40-70% 5-15%
  • Gemzar / Carboplatin 65% 5%
  • Taxol / Carboplatin 20-40%
adjuvant chemotherapy
Adjuvant chemotherapy
  • Six randomised trials have compared CT with observation after cystectomy or RT
  • 4x no survival benefit
  • 2x benefit from adjuvant CT

 no standard of care

    • node positive disease, lymphovascular invasion, positive margins
neoadjuvant chemotherapy
Neoadjuvant chemotherapy
  • Meta-analysis of ten randomised trials

(2688 patients)

13% reduction in risk of death

5% absolute benefit at 5 years

OS increased from 45% to 50%

ABC Meta-analysis Collaboration. Lancet 2003;361:1927

combined radio and chemotherapy
Combined Radio- and Chemotherapy

CR 5y.OS

  • Radiotherapy 57% 47%
  • RT and cisplatin 85% 69%
  • RT and carboplatin 70% 57%

Birkenhake et al. Strahlenther Onkol 1998;174:121

bladder sparing therapy for invasive bladder cancer
Bladder-sparing therapy for invasive bladder cancer
  • High probability of subsequent distant metastasis after cystectomy or radiotherapy alone (50% within 2 years)
  • Radiotherapy im comparison with cystectomy has inferior results (local control 40%)
  • muscle-invasivebladder cancer is often a systemic disease

 combined modality therapy

bladder sparing protocol
Bladder-sparing protocol

Transurthral resection

Induction Therapy: Radiation + chemotherapy

(cisplatin, paclitacel)

Cystoscopy after 1 month

no tumor

tumor

Consolidation: RT + CT

cystectomy

bladder sparing protocol19
Bladder-sparing protocol

T2: 5y / 10y OS: 74% / 66%

T3-T4a: 5y / 10y OS: 53% / 52%

Shiply et al. Urology 2002;60:62

results of bladder sparing therapy and cystectomy
Results of bladder-sparing therapy and cystectomy

Bladder-sparing n Pat. 5y. OS 5y. Survival

therapy % with Bladder %

Houssett 1997 120 63 NA

Sauer 1998 162 55 44

Shipley 1998 123 49 38

Shipley 2002 190 54 45

Rodel 2002 415 50 42

Cystectomy

Dalbagni 2001 181 36 NA

Stein 2001 633 48 NA

combined modality treatment and organ preservation in invasive bladder cancer
Combined-modality treatment and organ preservation in invasive bladder cancer

Rödel et al. JCO 2002;20:3061

415 patients with T1 high-risk, T1-4, No-1

Treatment: 1. Transurethral resection

2. RT (n=126), RCT (n=289)

RT median 54 Gy, CT cisplatin week 1, 5

3. Restaging-TUR

combined modality treatment and organ preservation in invasive bladder cancer22
Combined-modality treatment and organ preservation in invasive bladder cancer
  • Rödel et al. JCO 2002;20:3061
  • Complete remission 72%
  • Local control after CR 64% (10 y.)
  • distant metastasis 35% (10 y.)
  • Disease-specific survival 42% (10 y.)
  • Preservation of bladder >80%
slide23

Local control

Distant metastasis

Rödel et al. JCO 2002;20:3061

slide24

Disease-specific survival for patients after salvage cystectomy

50%

45%

21%

18%

Rödel et al. JCO 2002;20:3061

tur and adjuvant radio chemotherapy
TUR and adjuvant Radio-Chemotherapy
  • 5 year Survival 50-65%
  • Preservation of Bladder 38-43%