Bladder Cancer Treatment
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[edit] Bladder Cancer Treatment
As pointed out above there are many variables that play a role when it comes to surviving bladder cancer. Left alone, bladder cancer is deadly and would in many instances lead to death within 2 years. The following table is an attempt to summarize the information from Ref. 1 and 2 with regard to 5 year survival rates. However, some comments are necessary to explain the data. The table shows that bladder surgery is superior to radiation therapy up to stage T3a. However, at stageT3b the best results come from initial chemotherapy followed by subsequent radiation.
| 5-year survival for bladder cancer with different tratments | ||||
| TNM stage | Surgery | Radiation | Radical surgery and chemotherapy | Chemotherapy, then radiation |
| Tis or T1 | 66 % | 66 % | ||
| T2 | 59 % | 46 % | ||
| T3a | 34 % | 35 % | ||
| T3b | 16 % | 23 % | 54 % | |
| T4 | 0 % | 13 % | 36 % | |
In stageT4 the best results are obtained from initial radical bladder surgery followed by combination chemotherapy (which includes cisplatin). The best outcomes are highlighted in the table above by shading.
The reason there seems to be a wide variation between different centres, which reported these data, is that from stage T3 onward there is so much variation entering into the cancer staging (grade differences, chromosomal variations, hidden metastases) that the predictions for outcome are not that reliable. The reason that surgery does poorly at the T3b and T4 stages is that paraaortic and pelvic lymph nodes are left behind, which would subsequently kill the patient. This has to be addressed with chemotherapy, radiotherapy or both.
Similarly, with radiation alone only a certain proportion of cells gets eradicated, but the remaining cells are resistant to radiation and overcome the patient.
Even with the combination of surgery, which takes care of the local tumor, and with chemotherapy, which takes care of the metastases, there is a lot of room for improvements.
It appears that the more local cancers, the lower grade cancers and the cancers with less chromosomal abnormalities have the better 5-year survival rates. The same is true for chemotherapy followed by radiotherapy. For stage 4 Ref. 7 reported a 41% 5-year survival rate with chemotherapy alone and a 33% 5-year survival rate for more difficult cases where initial chemotherapy had to be followed by "salvage" surgery to remove surviving bladder cancer.
Here is a link for more info on bladder cancer treatment.
| Home page | Cancer overview | Bladder cancer |
References:
1. Cancer: Principles&Practice of Oncology. 5th edition, volume 1. Edited by Vincent T DeVita, Jr. et al. Lippincott-Raven Publ., Philadelphia,PA, 1997.
2. Cancer: Principles &Practice of Oncology, 4th edition, by V.T. De Vita,Jr., et al. J.B. Lippincott Co.,Philadelphia,1993. Chapter 34, page 1054 (data from text arranged as a table).
3. M Simoneau et al. Oncogene 2000 Dec 19(54): 6317-6323.
4. G Dalbagni , HW Herr Urol Clin North Am 2000 Feb 27(1): 137-146.
5. HW Herr J Clin Oncol 2001 Jan 1;19(1): 89-93.
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7. PM Dodd et al. J Clin Oncol 1999 Aug;17 (8): 2546- 2552.
8. B. Sears: "The age-free zone".Regan Books, Harper Collins, 2000.
9. Conn's Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier
10. Ferri: Ferri's Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc
