3/2007Urinary bladder cancer – modern diagnostic-therapeutic recommendations

MARIA MAGDALENA BUJNOWSKA-FEDAK (Katedra i Zakład Medycyny Rodzinnej Akademii Medycznej we Wrocławiu;Kierownik: prof. dr hab. med. Andrzej Steciwko)

Summary
Urinary bladder cancer is the second frequent neoplasm of urinary system and significant cause of morbidity and mortality in the world. Mortality of urinary bladder cancer is especially high in some countries in Eastern Europe, unfortunately including Poland as well. Early diagnosis and proper treatment is crucial for better prognosis. Therefore authors made an attempt at enlightening the current recommendations concerning diagnostic and therapeutic process in this type of cancer. The classification to the group of superficial or invasive cancers is the most important factor deciding about therapeutic process. In case of superficial cancer (Ta–T1) TUR (Trans Urethral Resection) is a standard procedure, which may be complemented by intravesical therapy (cytostatics, BCG). Owing to the fact that urinary bladder cancer tends to reoccur (70%), a patient after the treatment is observed for many years, during which control examinations are performed. In case of invasive urinary bladder cancer a cystectomy is a first choice method. Radical radiotherapy is performed in patients with transitional cell carcinoma T1–T4N0M0, if cystectomy is not possible or the patient does not approve it. In case of disseminated process combined therapy is processed (cystectomy, chemotherapy, radiotherapy). 5-year survival is noted in 50–70% I and II stage and 20–30% in stage III. In stage IV longer survival is rarely observed. The significant cause of inefficient treatment in Poland may refer to insufficient usage of complementary therapeutic methods (BCG, cytostatics, photodynamic therapy) in superficial cancer, as well as limited cooperation between urologists and oncologists. This is the reason why number of patients treated with radiotherapy or cytostatics is relatively low, and results of therapy are unsatisfactory.

Key words: urinary bladder cancer, treatment, intravesical therapy