Bladder cancer
Anju Sahdev, Sarah J. Vinnicombe in Husband & Reznek's Imaging in Oncology, 2020
Patients with bladder cancer are apt to develop multiple recurrences. In patients with high-grade non-muscle invasive disease, the 10-year recurrence, progression, and bladder cancer-related mortality rates are 74.3%, 33.3%, and 12.3%, respectively, with T1 associated with higher rate of recurrence (76). In patients who present with or subsequently develop invasive disease, radical cystectomy is frequently undertaken. The risk of disease relapse following radical cystectomy is reportedly 5%–70%, the majority occurring within 2 years of surgery (77,78). Slaton et al. found that recurrence occurred in 5%, 20%, and 40% of patients with stage T1, T2, and T3 bladder cancer, respectively. They also reported that the median times to recurrence were 53, 19, and 12 months for stage T1, T2, and T3, respectively (77).
Bladder cancer
Pat Price, Karol Sikora in Treatment of Cancer, 2014
Radical cystectomy remains the treatment associated with highest local cure, with pelvic recurrence rates of less than 10% in node-negative tumours and 10%-20% in patients with resected pelvic nodal metastases.164–166 A review comparing outcomes of surgery in National Cancer Institute cancer centres (n = 2977) with those in other American hospitals (n = 2566) included patients over 65 years of age on the Medicare database treated for cancer by cystectomy in cancer centres between 1994 and 19 9 9.167,168 As illustrated in Figure 13.3, there was no significant difference between the two hospital groups, with a 5-year survival of approximately 38%. In the past, cystectomy was associated with significant morbidity and high mortality, but improvements in operative technique have seen the perioperative complication rate fall from approximately 35% prior to 1970 to less than 10% reported currently, with a corresponding fall in operative mortality from nearly 20% to 3%.167,168
Bladder Cancer
Pat Price, Karol Sikora in Treatment of Cancer, 2020
Radical cystectomy remains the treatment associated with highest local cure, with pelvic recurrence rates of less than 10% in node-negative tumors and 10–20% in patients with resected pelvic nodal metastases.53 A review comparing outcomes of surgery in National Cancer Institute (NCI) cancer centers (n = 2,977) with those in other American hospitals (n = 2,566) included patients over 65 years of age on the Medicare database treated for cancer by cystectomy in cancer centers between 1994 and 1999.54 As illustrated in Figure 13.5a, there was no significant difference between the two hospital groups, with 5-year survival of approximately 38%. In the past, cystectomy was associated with significant morbidity and high mortality, but improvements in operative technique have seen the perioperative complication rate fall from approximately 35% prior to 1970 to less than 10% reported currently. In the UK, combined with centralization surgery this has resulted in a fall in operative mortality from nearly 20% to 3% and improvement in 5-year survivals (Figure 13.5b).54,55
Patient perspectives of vigorous intensity aerobic interval exercise prehabilitation prior to radical cystectomy: a qualitative focus group study
Published in Disability and Rehabilitation, 2021
Srijit Banerjee, Kelly Semper, Katy Skarparis, Jenni Naisby, Liane Lewis, Gabriel Cucato, Robert Mills, Mark Rochester, John Saxton
Bladder cancer is the tenth most common cancer in the UK and the eighth most common cancer in men [1]. It is usually slow to develop and is most common in older people over 60 years [2]. Bladder cancer is a heterogeneous disease, with 70% of patients presenting with nonmuscle invasive tumors confined to the bladder, and 30% presenting with muscle invasive bladder cancer, in which the cancer has spread beyond the inner lining of the bladder to the muscle wall, and this is associated with a high risk of death from distant metastases [3]. The initial treatment for high risk nonmuscle invasive bladder cancer is typically a course of intravesical immunotherapy with Bacillus Calmette-Guerin or primary cystectomy if disease is extensive. Those who do not respond to this, or progress on treatment are offered radical cystectomy. A radical cystectomy is complete removal of the bladder, and in men may involve removal of the prostate and seminal vesicles and in women the fallopian tubes and womb are often removed. The standard treatment for muscle invasive bladder cancer is radical cystectomy. Radical cystectomy is associated with high rates of morbidity (19–64%) and mortality (0.8–8.3%) [4–7].
Standardized care pathway for bladder cancer in Sweden. So far lots of pain but little gain
Published in Scandinavian Journal of Urology, 2022
Sten Holmäng, Hans Hedelin
The inability to obtain the desired reduction in the time to diagnosis and treatment was one of the major disappointments. The maximal number of days from referral to transurethral resection for patients in the standardized care pathway was thus set to 13 days but disappointingly the median time that was achieved in 2016–2019 was 27 days, thus far from the goal. The waiting time was decreasing already before 2015 so the effect of the standardized care pathway is indeed mediocre. True, the reduction from 37 to 27 days to bladder cancer resection is statistically significant but is of marginal clinical significance. Time to resection was dichotomized in the study, 0–20 days or more than 20 days (Table 1 in reference 1). The proportion of patients with a waiting time of 13 days or less would in our opinion be more interesting. The time from referral to cystectomy should have been at most 37 days according to the standardized care pathway but median was far longer, 123 days [2]. Only 1% of all patients underwent cystectomy within 37 days after the date of diagnosis i.e. very far from the goal that was set. There was no improvement in tumor stage at diagnosis or survival. Furthermore, the number of missing data increased from 6% before the introduction of the standardized care pathway to 15% in 2018 indicating increasing difficulties in reporting despite the large resources allocated to the standardized care pathway.
Swedish National Guidelines on Urothelial Carcinoma: 2021 update on non-muscle invasive bladder cancer and upper tract urothelial carcinoma
Published in Scandinavian Journal of Urology, 2022
Fredrik Liedberg, Sofia Kjellström, Anna-Karin Lind, Amir Sherif, Karin Söderkvist, Karin Falkman, Helena Thulin, Firas Aljabery, Dimitrious Papantonio, Viveka Ströck, Elisabeth Öfverholm, Tomas Jerlström, Johan Sandzen, Ingrida Verbiene, Anders Ullén
Patients with high risk of progression are recommended a re-resection of the tumor base in stage T1 disease (but not in TaG3 if the primary TURB was macroscopically radical and with detrusor muscle in the resected specimen) and subsequently adjuvant BCG-instillations with six induction courses and maintenance with an additional three courses at 3, 6 and 12 months. This strategy is applied provided no other risk factors for progression that not are included in the EAU 2021 risk group stratification are present, such as residual T1-disease at re-resection, lymphovascular invasion, deep lamina propria invasion (T1e), T1-disease in a diverticulum, variant histology or concomitant CIS in the prostatic urethra. Under these circumstances primary cystectomy is another and more valid treatment option. Patients with very high risk of progression according to the EAU 2021 risk group stratification are recommended primary cystectomy upfront, without performing a re-resection.
Related Knowledge Centers
- Bladder
- Bladder Cancer
- Cancer Staging
- Carcinoma In Situ
- Cyst
- Detrusor Muscle
- Surgery
- Diverticulum
- Urinary Diversion
- Tnm Staging System