Carcinoma of the Bladder : Innovations in Management

This volume provides up-to-date information on the diagnosis and treatment of carcinoma of the bladder and will appeal to all physicians concerned with this field. Advances in molecular genetics that are of importance to clinical practice are discussed in depth. Progress in both imaging and nonimaging modalities is well documented and critically evaluated in a manner that will prove invaluable for practicing uro-oncologists. Furthermore, the management of patients with superficial, muscle-invasive, and advanced disease is discussed, and new treatment results presented. The numerous illustrations and tables will serve to assist the reader in understanding the presented data. Front Matter....Pages i-xii Epidemiology of Bladder Cancer....Pages 1-13 Natural History of Bladder Carcinoma....Pages 15-21 Prognostic Factors in Bladder Cancer: Emphasis on Immunohistochemical Analysis....Pages 23-35 Molecular Genetics in Carcinoma of the Bladder....Pages 37-51 Pathology of Bladder Cancer....Pages 53-62 Imaging Modalities in the Diagnosis and Staging of Carcinoma of the Bladder....Pages 63-88 Contemporary Nonimaging Methods in the Diagnosis and Prognosis of Carcinoma of the Bladder....Pages 89-92 Staging of Bladder Cancer....Pages 93-102 Photodynamic Therapy of Bladder Cancer....Pages 103-112 Fluorescence Detection of Bladder Cancer....Pages 113-125 Treatment of Ta, T1 Bladder Tumors: Recent Results of the EORTC-GU Group....Pages 127-133 Surgical Treatment of Carcinoma of the Bladder: The USC Experience....Pages 135-141 Prophylactic Urethrectomy: When and How?....Pages 143-153 Orthotopic Reconstruction Following Radical Cystectomy: the USC Experience....Pages 155-167 Complications of Radical Cystectomy....Pages 169-185 Long-term Results of Brachytherapy with Iridium-192 Implants....Pages 187-195 Bladder-Conserving Therapy for Invasive Bladder Cancer Using Transurethral Surgery, Chemotherapy, and Radiation Therapy with Patient Selection by Initial Treatment Response....Pages 197-204 Muscle-Invasive Bladder Cancer: Transurethral Resection and Radiochemotherapy as an Organ-Sparing Treatment Option....Pages 205-214 External Radiotherapy in the Treatment of Muscle-Invasive Transitional Cell Carcinoma of the Bladder....Pages 215-220 Chemotherapy Before Definitive Treatment for Locally Advanced Bladder Cancer....Pages 221-233 Continuous Infusion Chemotherapy and Irradiation in the Treatment of Advanced Bladder Carcinoma....Pages 235-241 Postoperative Chemotherapy for Bladder Carcinoma....Pages 243-250 Management of Patients with Pelvic Recurrence Following Radical Cystectomy....Pages 251-258 Management of Patients with Failure Following Definitive Radiotherapy....Pages 259-265 Treatment-Related Complications for Bladder Carcinoma: Radical Surgery Versus Bladder-Preserving Techniques....Pages 268-278 Special Considerations in the Management of Carcinoma in the Neurogenic Bladder....Pages 279-285 Hyperthermia in Bladder Cancer....Pages 287-295 Management of Patients with Metastatic Carcinoma of the Bladder....Pages 297-308 National Differences in the Management of Bladder Cancer....Pages 309-315 Back Matter....Pages 317-328 Bladder cancer represents a major challenge to the oncologist. In spite of new tech­ niques for early diagnosis and innovative imaging procedures for staging, the outcome in terms of cure has not improved during the past ten years. Fortunately, about 74% of the patients present with localized disease, with 18% presenting with localized and regional disease, and 3% with distant metastases at diagnosis. In accordance with the stage at presentation, 94% of patients with localized disease are controlled at 5 years, as are 50% of patients with local and regional disease but un­ fortunately only 7% of those with distant disease. The survival data for Afro-Americans are more grave, with only 79% of patients with localized disease surviving at 5 years, 38% with local and regional disease, and 4% with disseminated disease. Even after 5 years, however, patients continue to fail not only locally and regionally but also with disseminated disease, thereby creating enigmas as to the continued influence of basic molecular changes, basic etiologic agents, and unsuspected more advanced disease, as well as demonstrating the inadequacies of local surgical treatment programs. These factors have led to braoder programs of combined integrated multimodal treatment earlier in the course of the disease process. Clearly, these newer innovative programs have placed increasing emphasis on the combination of surgery with radiation therapy and chemotherapy.