Non-Muscle Invasive Transitional Cell Carcinoma
August 10th, 2008 | by admin |UroToday.com - G1-3pTa/1 TCC accounts for up to 80% of all newly diagnosed bladder cancer. Whilst bladder cancer is the 5th commonest cancer it is the most expensive disease to manage because of its propensity to recur and progress.
Identifying risk of recurrence and/or progression is essential in order to plan management. Grade, stage, the presence of CIS and behaviour remain the most sensitive markers for progression. Biomarkers as yet provide little additional information Urine cytology and other urinary markers such as NMP22 add little to prognostic assessment. Novel diagnostic measures such as PDD may identify risk and allow targeted therapy.
Recurrence may be reduced by early intravesical therapy extended in some cases to a 5/6 week course. Optimisation of such therapy may improve response. In terms of recurrence little difference has been shown between intravesical chemotherapy and immunotherapy.
Meta-analyses point to BCG reducing progression if combined with maintenance therapy. Adding interferon to BCG may further increase response.
There are several studies examining the use of EMDA with chemotherapy and microwave enhanced chemo which point to a better response than standard therapy.
Where high risk features are present and there is poor response to intravesical treatment early radical treatment should be offered. There is no evidence favouring radiation, the standard of care is radical surgery. Delay in this group will decrease the patients’ chance of survival.
Presented by: David Gillatt, MD, at the Masters in Urology Meeting - July 31, 2008 - August 2, 2008, Elbow Beach Resort, Bermuda
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