Bladder Tumors and other Topics in Urological Oncology
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In , a team led by Bert Vogelstein, M. As part of the study, they studied the presence of TERT promoter mutations in urine samples from 14 patients who had been treated for early-stage bladder cancer.
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Among patients whose tumors harbored TERT promoter mutations, the same mutations were present in follow-up urine samples from seven of eight patients whose cancer recurred. The mutations were not present in follow-up urine samples from six patients whose cancer did not recur.
The work was published in the journal Cancer Research. In and , a team led by Netto received grants from the Greenberg Bladder Cancer Institute to continue their work.
The study is a collaborative effort to sequence the genomic profiles of metastatic bladder cancer patients and house the information in a repository that is accessible to all partner institutions. The data collected can be used by any partner institution or group for research into targeted genetic treatment approaches and to develop clinical trials. The consortium plans to track the results of this collaborative effort to ensure it is making a substantial, real-world impact. Smooth muscle cells are then isolated from the sample in a lab and grown on a collagen-based scaffold. Within four weeks, a tube, called a neo-urinary conduit, is available for surgical implantation in the patient.
Understanding bladder cancer
One end of the tube is attached to the ureters, and the other is attached to a small opening in the abdomen. Urine can then flow from the body through the tube and exit the skin into a disposable bag. Intravesical chemotherapy is a mainstay of treatment for non-muscle-invasive bladder cancer; however, the biology of the bladder means that intravesical therapy is limited by washout of the agent during voiding and systemic effects caused by absorption through the bladder wall.
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In this Review, the authors consider novel approaches to improving the pharmacokinetics of intravesical chemotherapy, such as chemohyperthermia, sustained release devices, and nanoparticle conjugation. Research 24 July Open Access. Research 17 July Open Access. Research Highlights 12 August Research Highlights 08 August Research Highlights 06 August News and Views 11 June Immune checkpoint therapy is beneficial for patients with advanced bladder cancer; however, trials generally exclude patients with comorbidities or uncommon histologies.
The SAUL trial demonstrates that atezolizumab is safe and efficacious in a patient population that more accurately reflects the real-world scenario, but its benefit might still be limited in historically poorly performing populations. Research Highlights 26 April Research Highlights 04 March Advanced search. Skip to main content. According to the recommendations, the risk of disease progression is low less than 10 percent in this group, and there is little evidence that adjuvant therapy affects disease progression. In patients with carcinoma in situ or T1 or high-grade Ta tumors, the panel recommends as a guideline the use of intravesical instillation of BCG or mitomycin C.
Bladder cancer: Causes, symptoms, and treatment
On the basis of the medical literature and the panel's opinion, BCG and mitomycin C are superior to doxorubicin or thiotepa for reducing recurrence of these tumors. Categorized as an optional policy, based on the panel's expert opinion, is the use of cystectomy as initial therapy in some patients with carcinoma in situ or T1 tumors. The recommendations explain that cystectomy is deemed to be an option because of the risk of progression to muscle invasive disease even after intravesical therapy.
An increased risk of disease progression is associated with large tumor, high-grade tumor, location of the tumor at a site that is poorly accessible to complete resection, diffuse disease, infiltration of lymphatic or vascular spaces and prostatic urethral involvement. Cystectomy is classified as an optional policy in patients with carcinoma in situ or high-grade T1 bladder cancer that has persisted or recurred after initial intravesical treatment.
This recommendation is based on the panel's expert opinion rather than evidence from outcomes data. The recommendations note that data show a substantial risk of progression to muscle invasive cancer in patients with diffuse carcinoma in situ and high-grade T1 tumors. It is not known whether intravesical therapy alters this risk. As a result, the recommendations state, some patients with symptomatic disease or high-grade tumors may prefer to undergo cystectomy. Intravesical Therapy. The recommendations state that additional intravesical therapy may be considered an option for patients with carcinoma in situ or high-grade T1 cancers that have persisted or recurred after initial intravesical therapy.
While optimal dosing regimens have not been established, the recommendations state that six weekly instillations are used most often. The AUA guidelines panel notes that substratification of stage T1 bladder cancer based on depth of infiltration needs further clarification.http://alexacmobil.com/components/pucowitu/muwu-come-controllare.php
Also, the risk and significance of urothelial carcinoma outside the bladder must be further determined. The report notes that the risk of urothelial cancer in the ureter or intrarenal collecting system in patients with carcinoma in situ may exceed the generally accepted rate of 5 percent. Another area that needs further elucidation is the role of treatment regimens using alternating or combined medications. In addition, the report states that randomized studies are needed to investigate the effects of early instillation of medications, sometimes immediately after transurethral resection of the bladder tumor.
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Bladder Cancer Care at Levine Cancer Institute
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