[MOL] Bladder Cancer..... [00879] Medicine On Line

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[MOL] Bladder Cancer.....


The Challenge Of Bladder Cancer

A DGReview of :"Current concepts in assessment and treatment of bladder cancer"
Current Opinion in Urology

By Mark Greener

Bladder cancer is the fourth most common type of cancer. It is also the tenth most common cause of cancer mortality overall and the fourth leading cause of cancer deaths among men over 80 years of age.

Demographic changes suggest that the public health importance of bladder cancer is likely to increase over the next few years. However, a recent review notes that treatment remains suboptimal.

The review suggests that 90 per cent of bladder cancer cases are transitional cell carcinomas. Squamous cell carcinoma, adenocarcinoma and rhabdomyosarcoma make up the difference. Moreover, around 70 per cent of patients present with "superficial" tumours, usually of the mucosa. However, 70 per cent will recur and between 25 and 30 per cent will develop into invasive disease affecting muscle.

Bladder cancer is linked to numerous environmental and occupational carcinogens. Cigarette smoking, however, is the most common environmental carcinogen and increases bladder cancer risk four-fold. However, genetically determined metabolic factors -- such as rapid acetylation -- are also influential.

In recent years, surgical advances improved the quality of life of patients suffering invasive cancer. Nevertheless, the five-year survival rates remain around 50 per cent.

For instance, transurethral resection is the standard treatment for stage Ta disease. This cancer, however, recurs in between 50 and 70 per cent of such cases. On the other hand, superficial muscle invasive tumours appear to have the best prognosis, whereas the outcome associated with local or advanced metastatic cancers is poor.

To date, the review notes, there is no way to detect patients who will benefit from a specific treatment. But on-going research aims to characterise molecular markers of the diseases' clinical course.

Indeed, the authors remark that the clinical challenge is now to detect invasive disease while still confined to the kidney. Regional therapies are more likely to be effective in such cases. However, they also called for research to discover novel regimens for systemic disease that maintain quality of life.

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