Lokeshwar / Merseburger / Hautmann Bladder Tumors:

Molecular Aspects and Clinical Management
1. Auflage 2010
ISBN: 978-1-60761-928-4
Verlag: Humana Press
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 468 Seiten

Reihe: Cancer Drug Discovery and Development

Bladder cancer is a common cancer of the urinary tract. It is the fourth leading cause of cancer-related death among men and the seventh among women. Clinical management of bladder cancer is challenging because of the heterogeneity among bladder tumors with respect to invasion and metastasis, frequent occurrence of new tumors in the bladder among patients treated with bladder preservation treatments and poor prognosis of patients with tumors that invade the bladder muscle and beyond. Due to these factors it has been said that the cost per patient of bladder cancer, from diagnosis to death is the highest of all cancers. In addition to it being a significant health problem, bladder cancer is an interesting cancer to study in many ways than one. For example, Environmental factors such as cigarette smoking and other carcinogens play a major role in the development of transitional carcinoma of the bladder, whereas, schitosomasis, a protozoan infection results in squamous cell carcinoma of the bladder. Different molecular pathways with distinct molecular signatures appear to be involved in the development of low-grade versus high-grade bladder tumors. Currently being monitored by an invasive endoscopic procedure, cystectomy, with urine cytology as an adjunct, bladder cancer is at the forefront of developing cancer biomarkers for non-invasive detection. Due to the differences in the invasive and metastatic potential of bladder tumors, treatment options differ depending upon tumor grade and stage. New advances are being made in treatment options to improve the outcome and quality of life for patients with bladder cancer. Similarly, new molecular nomograms are being discovered to predict treatment outcome so that individualized treatment options can be offered to patients.

Autoren/Hrsg.

Merseberger, Axel

Lokeshwar, Vinata B.

Merseburger, Axel S.

Hautmann, Stefan H.

Inhaltsverzeichnis

1;Bladder Tumors;3
1.1;Preface;5
1.2;Contents;9
1.4;Chapter 1: Bladder Cancer Epidemiology;17
1.4.1;1.1 Tobacco Smoking and BC;19
1.4.2;1.2 Occupational Exposure and BC;21
1.4.3;1.3 Genetic Predisposition and BC;23
1.4.4;1.4 Infection and BC;24
1.4.5;1.5 Radiation and BC;25
1.4.6;1.6 Dietary Factors and BC;26
1.4.7;1.7 Gender Related Differences in BC;28
1.4.8;1.8 Hereditary BC;30
1.4.9;1.9 Other Related Risk Factors: Cyclophosphamide, Phenacetin;32
1.4.9.1;1.9.1 Cyclophosphamide;32
1.4.9.2;1.9.2 Phenacetin;32
1.4.10;1.10 Screening of BC;32
1.4.11;1.11 Chemoprevention of BC;35
1.4.12;References;35
1.5;Chapter 2: Bladder Carcinogenesis and Molecular Pathways;39
1.5.1;2.1 Introduction;39
1.5.2;2.2 Bladder Carcinogenesis;40
1.5.2.1;2.2.1 Bladder Carcinogens and DNA Adduct Formation;40
1.5.2.2;2.2.2 Phase I and II Enzymes;40
1.5.2.2.1;2.2.2.1 Cytochrome P450 (CYP) Monooxygenases;40
1.5.2.3;2.2.3 Phase II Enzymes;41
1.5.2.3.1;2.2.3.1 N-Acetyl Transferases (NAT);41
1.5.2.3.2;2.2.3.2 Glutathione-S-Transferase (GST);42
1.5.3;2.3 Field Cancerization and Clonal Origin of Bladder Cancer;44
1.5.4;2.4 Chromosomal Aberrations in Bladder Cancer;45
1.5.5;2.5 Molecular Pathways for Bladder Cancer Development;48
1.5.6;2.6 Summary;50
1.5.7;References;51
1.6;Chapter 3: Histopathology and Molecular Pathology of Bladder Cancer;58
1.6.1;3.1 Introduction;58
1.6.2;3.2 New Aspects of the WHO Classification of Bladder Carcinoma;59
1.6.3;3.3 Benign Urothelial Changes;60
1.6.3.1;3.3.1 Reactive Atypia in the Urothelium and Atypia of Unknown Significance;60
1.6.3.2;3.3.2 Urothelial Hyperplasia;61
1.6.3.3;3.3.3 Urothelial Papilloma;61
1.6.3.4;3.3.4 Inverted Urothelial Papillomas;62
1.6.3.5;3.3.5 Papillary Urothelial Neoplasia of Low Malignant Potential (PUNLMP);63
1.6.4;3.4 Malignant Urothelial Lesions;64
1.6.4.1;3.4.1 Urothelial Dysplasia (UD—Synonym: Intraurothelial Neoplasia, Low-Grade);64
1.6.4.2;3.4.2 Carcinoma In Situ (CIS—Synonym: Intraurothelial Neoplasia, High-Grade);65
1.6.4.3;3.4.3 Noninvasive Papillary Urothelial Carcinoma, Low-Grade and High-Grade;66
1.6.4.4;3.4.4 Invasive Bladder Cancer;67
1.6.4.5;3.4.5 TNM Classification 2010;69
1.6.5;3.5 Molecular Pathways in Bladder Cancer Pathogenesis;70
1.6.5.1;3.5.1 Are New Findings in Molecular Analysis Clinically Relevant?;71
1.6.5.2;3.5.2 Microarrays: The Future in Bladder Pathology?;73
1.6.6;3.6 Conclusions;73
1.6.7;References;74
1.7;Chapter 4: Bladder Cancer Diagnosis and Detection: Current Status;77
1.7.1;4.1 Urinary Cytology (A Brief Reference);77
1.7.2;4.2 Cystoscopy;78
1.7.2.1;4.2.1 Limitations;78
1.7.2.2;4.2.2 Photodynamic Diagnosis;79
1.7.2.3;4.2.3 Narrow Band Imaging;79
1.7.2.4;4.2.4 Optical Coherence Tomography;80
1.7.3;4.3 Transurethral Resection of Bladder Tumor;80
1.7.3.1;4.3.1 New Techniques;81
1.7.4;4.4 Bimanual Palpation;82
1.7.5;4.5 Staging of Bladder Cancer;82
1.7.5.1;4.5.1 T-Category;83
1.7.5.2;4.5.2 N-Category;84
1.7.5.3;4.5.3 M-Category;85
1.7.6;4.6 Role of Imaging;85
1.7.6.1;4.6.1 Local Staging;85
1.7.6.2;4.6.2 Lymph Node Involvement;86
1.7.6.3;4.6.3 Distant Metastasis;87
1.7.6.4;4.6.4 Upper Tract Imaging (Brief Reference);87
1.7.7;4.7 Summary;88
1.7.8;References;88
1.8;Chapter 5: Urine Cytology, DNA Ploidy and Morphometry;92
1.8.1;5.1 Introduction;92
1.8.2;5.2 Cellular and Noncellular Components of Normal Urine Specimens;93
1.8.3;5.3 Types of Urinary Specimens;94
1.8.4;5.4 Cytology of Urothelial Carcinoma;94
1.8.4.1;5.4.1 Cytology of High-Grade Urothelial Carcinoma;95
1.8.4.2;5.4.2 Cytology of Low-Grade Urothelial Carcinoma;96
1.8.5;5.5 Cause of Atypical Urine Cytology;97
1.8.5.1;5.5.1 Urinary Tract Calculi (Nephrolithiasis);97
1.8.5.2;5.5.2 Therapeutic Effects;97
1.8.5.3;5.5.3 Human Polyoma Virus;98
1.8.6;5.6 DNA Ploidy;98
1.8.6.1;5.6.1 DNA Ploidy by Flow Cytometry;99
1.8.6.2;5.6.2 DNA Ploidy by Static Image Analysis;99
1.8.6.3;5.6.3 DNA Ploidy by Laser Scanning Cytometry;100
1.8.7;5.7 Fluorescence In situ Hybridization;100
1.8.8;5.8 Morphometry;101
1.8.9;5.9 Conclusion;102
1.8.10;References;102
1.9;Chapter 6: Molecular Signatures of Bladder Cancer;104
1.9.1;6.1 Molecular Signatures;104
1.9.2;6.2 Bladder Cancer;105
1.9.3;6.3 Molecular Signatures of Bladder Cancer: A Historical Perspective;110
1.9.3.1;6.3.1 Proteomics;111
1.9.4;6.4 Epigenetic Signatures of Bladder Cancer;112
1.9.4.1;6.4.1 Introduction to Epigenetics;112
1.9.4.2;6.4.2 Epigenetic Mechanisms of Bladder Cancer;113
1.9.5;6.5 Nuclear Matrix Protein 22 (NMP22);114
1.9.6;6.6 Bladder Tumor Antigen;115
1.9.7;6.7 Soluble Fas;116
1.9.8;6.8 Fluorescence In situ Hybridization;117
1.9.9;6.9 ImmunoCyt;118
1.9.10;6.10 BLCA-4;118
1.9.11;6.11 Telomerase;119
1.9.12;6.12 Fibronectin;120
1.9.13;6.13 Survivin;121
1.9.14;6.14 Fibroblast Growth Factor Receptor 3 (FGFR3);121
1.9.15;6.15 Reg 1;122
1.9.16;6.16 Cytokeratin/Urinary Bladder Cancer Test;122
1.9.17;6.17 Prothymosin Alpha;123
1.9.18;6.18 Matrix Metalloproteinases;123
1.9.19;6.19 Hyaluronic Acid and HYAL-1 Hyaluronidase;124
1.9.20;6.20 Urothelial Cell Carcinoma Versus Squamous Cell Carcinoma;125
1.9.21;6.21 Conclusion;125
1.9.22;References;126
1.10;Chapter 7: Economics of Bladder Cancer Diagnosis and Surveillance;133
1.10.1;7.1 Introduction;134
1.10.1.1;7.1.1 Cost Analysis in Health Care;134
1.10.1.1.1;7.1.1.1 The Importance of Perspective;135
1.10.1.1.2;7.1.1.2 Cost Versus Charge;135
1.10.1.1.3;7.1.1.3 Discounting;136
1.10.1.2;7.1.2 Overall Bladder Cancer Costs;136
1.10.1.3;7.1.3 The Economics of Bladder Cancer Diagnosis and Screening;138
1.10.1.3.1;7.1.3.1 The Costs Associated with Diagnosing Bladder Cancer;138
1.10.1.3.2;7.1.3.2 Screening for Bladder Cancer;140
1.10.1.3.2.1;7.1.3.2.1 Screening Based on the Presence of Hematuria;141
1.10.1.3.2.2;7.1.3.2.2 Screening by Using Bladder Tumor Markers in High-Risk Populations;142
1.10.1.3.3;7.1.3.3 The Economics of Bladder Cancer Surveillance;143
1.10.1.3.4;7.1.3.4 Conclusions;145
1.10.2;References;145
1.11;Chapter 8: Prognostic Markers for Bladder Cancer;150
1.11.1;8.1 Overview;150
1.11.2;8.2 Prognostic Markers According to Clinical Situation;151
1.11.2.1;8.2.1 Intravesical Recurrence After TUR-BT;151
1.11.2.2;8.2.2 Progression to Muscle-Invasive Disease After Endoscopic Management for Nonmuscle-Invasive Bladder Cancer;155
1.11.2.3;8.2.3 Response to Intravesical BCG Instillation Therapy;156
1.11.2.4;8.2.4 Outcome After Radical Cystectomy for Muscle-Invasive or Locally Advanced Disease;157
1.11.2.5;8.2.5 Response to Systemic Chemotherapy for Advanced Disease;158
1.11.3;8.3 Candidate Molecular Predictive Markers Classified by Target Molecules and Methodology;158
1.11.3.1;8.3.1 Chromosomal Alterations and DNA/Nucleotide-Based Markers;159
1.11.3.2;8.3.2 cDNA Microarray mRNA Expression Analysis and Gene Expression Signature;160
1.11.3.3;8.3.3 Proto-oncogenes/Oncogenes;160
1.11.3.4;8.3.4 Tumor Suppressor Genes;162
1.11.3.5;8.3.5 Cell Cycle Regulators;164
1.11.3.6;8.3.6 Angiogenesis-Related Factors;166
1.11.3.7;8.3.7 Extracellular Matrix, Adhesion Molecules, Cell Surface Markers, and Related Proteins;167
1.11.4;8.4 Conclusion;168
1.11.5;References;169
1.12;Chapter 9: Molecular Nomograms for Predicting Prognosis and Treatment Response;175
1.12.1;9.1 Introduction;176
1.12.1.1;9.1.1 From Classical Prognostic Factors to Nomograms;176
1.12.1.2;9.1.2 Molecular Nomograms?;177
1.12.1.3;9.1.3 Molecular Pathogenesis of Bladder Cancer: Opportunities for Biomarker Discovery;178
1.12.2;9.2 Key Technologies in Biomarker Development;181
1.12.3;9.3 Towards Molecular Nomograms for Nonmuscle-Invasive Urothelial Carcinoma;185
1.12.3.1;9.3.1 Microarray Studies;185
1.12.3.2;9.3.2 Recent Reports: Towards Molecular Signatures of Recurrence and Progression;186
1.12.4;9.4 Towards Molecular Nomograms for Muscle-Invasive Urothelial Carcinoma (MIUC);190
1.12.4.1;9.4.1 Immunohistochemical Technologies Applied to MIUC;190
1.12.4.2;9.4.2 Microarray Studies of Survival Outcomes in MIUC;191
1.12.4.3;9.4.3 Recent Reports: Molecular Signatures Predicting Response to Therapy;192
1.12.5;9.5 New Strategies;194
1.12.6;9.6 Concluding Remarks;196
1.12.7;References;196
1.13;Chapter 10: Practical Approaches to the Management of Superficial Bladder Cancer;202
1.13.1;10.1 Introduction;202
1.13.2;10.2 Incidence;202
1.13.3;10.3 History of Cystoscopy;203
1.13.4;10.4 Problem;204
1.13.5;10.5 Etiology;205
1.13.6;10.6 Pathophysiology;205
1.13.7;10.7 Genetic Pathophysiology;206
1.13.8;10.8 Clinical;207
1.13.9;10.9 Indications;207
1.13.10;10.10 Relevant Anatomy;208
1.13.11;10.11 Contraindications;208
1.13.12;10.12 Workup;208
1.13.12.1;10.12.1 Lab Studies;208
1.13.12.2;10.12.2 Imaging Studies;209
1.13.12.3;10.12.3 Other Tests;211
1.13.13;10.13 Diagnostic Procedures;211
1.13.14;10.14 AUA Guidelines Panel Recommendations;212
1.13.15;10.15 Treatment Guidelines Statements;212
1.13.15.1;10.15.1 For All Index Patients;212
1.13.15.2;10.15.2 Index Patient No. 1;212
1.13.15.3;10.15.3 Index Patient No. 2;213
1.13.15.4;10.15.4 Index Patient No. 3;213
1.13.15.5;10.15.5 Index Patient No. 4;213
1.13.15.6;10.15.6 Index Patient No. 5;214
1.13.16;10.16 Medical Therapy;214
1.13.17;10.17 Surgical Therapy;215
1.13.17.1;10.17.1 Transurethral Resection of Bladder Tumor;215
1.13.17.2;10.17.2 Cystectomy;215
1.13.17.3;10.17.3 Random Biopsies;216
1.13.18;10.18 Preoperative Details;216
1.13.19;10.19 Intraoperative Details;217
1.13.19.1;10.19.1 Transurethral Resection of Bladder Tumor;217
1.13.20;10.20 Surveillance Cystoscopy;218
1.13.20.1;10.20.1 Cystoscopy Techniques for Men;218
1.13.20.2;10.20.2 Cystoscopy Techniques for Women;220
1.13.21;10.21 Postoperative Details;221
1.13.21.1;10.21.1 Follow-up;221
1.13.21.2;10.21.2 Complications;221
1.13.22;10.22 Outcomes and Prognosis;222
1.13.23;10.23 Future and Controversies;222
1.13.24;References;223
1.14;Chapter 11: Clinical Management of Low Grade Bladder Tumors;225
1.14.1;11.1 Introduction;226
1.14.2;11.2 Histology;226
1.14.3;11.3 Risk Factors;227
1.14.4;11.4 Diagnosis;227
1.14.4.1;11.4.1 Symptoms;227
1.14.4.2;11.4.2 Imaging;227
1.14.4.3;11.4.3 Cystoscopy Is the Method by Which Most of the Papillary Tumors Are Detected;228
1.14.4.4;11.4.4 Urinary Cytology;228
1.14.4.5;11.4.5 Accuracy of Cystoscopy in Defining Low Grade Papillary Tumors;228
1.14.4.6;11.4.6 Upper Urinary Tract Exploration in Low Grade Bladder Tumors;230
1.14.5;11.5 Primary Treatment of Low Grade Ta Bladder Tumors;230
1.14.5.1;11.5.1 TUR of Bladder Tumors;230
1.14.5.2;11.5.2 Need for Random Biopsies and Fluorescence Cystoscopy;231
1.14.5.3;11.5.3 Second Resection;231
1.14.5.3.1;11.5.3.1 One Early Post TUR Chemo-Instillation;231
1.14.5.3.2;11.5.3.2 Recent Clinical Trials;232
1.14.5.3.3;11.5.3.3 Working Mechanism;234
1.14.5.3.4;11.5.3.4 Timing of the Instillation;234
1.14.5.3.5;11.5.3.5 Toxicity and Precautions;235
1.14.5.3.6;11.5.3.6 Further Intravesical Chemotherapy;236
1.14.5.3.7;11.5.3.7 The Role of BCG;236
1.14.6;11.6 Prognostic Factors;236
1.14.6.1;11.6.1 Follow-up;237
1.14.6.2;11.6.2 Frequency of Cystoscopy;238
1.14.6.3;11.6.3 Duration of Follow-up;239
1.14.6.4;11.6.4 Active Surveillance;239
1.14.6.4.1;11.6.4.1 Office Fulguration of Recurrent Low Grade Tumors;239
1.14.7;11.7 Summary;240
1.14.8;References;240
1.15;Chapter 12: Treatment of Low-Grade Bladder Tumors;245
1.15.1;12.1 Introduction;245
1.15.2;12.2 Treatment of Low-Grade Bladder Tumors;246
1.15.2.1;12.2.1 Transurethral Resection of Bladder Tumor;246
1.15.2.2;12.2.2 Procedure;246
1.15.2.3;12.2.3 Complications of TURBT;247
1.15.3;12.3 Repeat TURBT;248
1.15.4;12.4 Role of “Random” Bladder and Prostatic Additional Biopsies;249
1.15.5;12.5 Laser Treatment;250
1.15.5.1;12.5.1 Advantages;250
1.15.5.2;12.5.2 Complications;251
1.15.6;12.6 Photodynamic Therapy;251
1.15.6.1;12.6.1 Procedure;252
1.15.6.2;12.6.2 Complications;252
1.15.7;12.7 Radical or Partial Cystectomy;252
1.15.7.1;12.7.1 Indications for Radical Cystectomy in Patients with Low-Grade Bladder Tumors;253
1.15.7.2;12.7.2 Outcome of Radical Cystectomy in Low-Grade Noninvasive Bladder Tumors;253
1.15.7.3;12.7.3 Partial Cystectomy;253
1.15.8;12.8 Radiation Therapy;254
1.15.9;12.9 Predicting Recurrence and Progression in Low-Grade Tumors;254
1.15.10;12.10 Surveillance;255
1.15.10.1;12.10.1 Cystoscopic Surveillance;255
1.15.10.2;12.10.2 Fluorescence Cystoscopy;256
1.15.11;12.11 Discussion and Conclusion;257
1.15.12;References;257
1.16;Chapter 13: Intravesical Chemotherapy;261
1.16.1;13.1 Introduction;261
1.16.2;13.2 Goals and Principles of Intravesical Chemotherapy;261
1.16.3;13.3 Indications for Intravesical Chemotherapy;262
1.16.3.1;13.3.1 Single Perioperative Instillation;262
1.16.3.2;13.3.2 Induction Cycle;263
1.16.3.3;13.3.3 Maintenance Therapy;263
1.16.4;13.4 Sylvester Risk Assessment;263
1.16.5;13.5 Practical Aspects of Intravesical Therapy;264
1.16.6;13.6 Complications of Intravesical Chemotherapy;265
1.16.6.1;13.6.1 Cystitis;265
1.16.6.2;13.6.2 Hematuria;265
1.16.6.3;13.6.3 Contracted Bladder;266
1.16.6.4;13.6.4 Contact Dermatitis;266
1.16.6.5;13.6.5 Bladder Calcifications;266
1.16.6.6;13.6.6 Myelosuppression;266
1.16.7;13.7 Chemotherapeutic Agents;267
1.16.7.1;13.7.1 Mitomycin;267
1.16.7.2;13.7.2 Adriamycin;268
1.16.7.3;13.7.3 Epirubicin;268
1.16.7.4;13.7.4 Valrubicin;269
1.16.7.5;13.7.5 Gemcitabine;269
1.16.7.6;13.7.6 Interferon;270
1.16.7.7;13.7.7 Apaziquone;270
1.16.8;13.8 Combination Chemo-immunotherapy;272
1.16.9;13.9 Device-Assisted Therapy and Newer Approaches;272
1.16.10;13.10 Conclusion;273
1.16.11;References;273
1.17;Chapter 14: Intravesical Immunotherapy: BCG;279
1.17.1;14.1 Introduction;279
1.17.2;14.2 Mechanism of Action;281
1.17.2.1;14.2.1 BCG Attachment;282
1.17.2.2;14.2.2 Cytokine and Chemokine Production;283
1.17.2.3;14.2.3 Infiltrating Lymphocytes;283
1.17.2.4;14.2.4 TH1 Immune Response;284
1.17.2.5;14.2.5 Natural Killer Cells;284
1.17.2.6;14.2.6 Innate Immune Response;285
1.17.2.7;14.2.7 Tumor-Induced Immunosuppression;285
1.17.2.8;14.2.8 BCG Treatment Prognosis and Biomarkers;286
1.17.3;14.3 Clinical Use of BCG;288
1.17.3.1;14.3.1 Indications;288
1.17.3.2;14.3.2 Treatment Schedule and Dosage;289
1.17.3.3;14.3.3 Salvage Therapy;292
1.17.3.4;14.3.4 Prostatic and Upper Tract Disease;293
1.17.3.5;14.3.5 Side Effects/Complications;294
1.17.4;14.4 Conclusion;295
1.17.5;References;296
1.18;Chapter 15: Cystectomy for Nonmuscle-Invasive Bladder Cancer;304
1.18.1;15.1 Introduction;304
1.18.2;15.2 Nonmuscle-Invasive Bladder Cancer: Recurrence and Progression;306
1.18.2.1;15.2.1 Factors Predicting Recurrence and Progression in Nonmuscle-Invasive Disease: Value and Limitations;306
1.18.2.2;15.2.2 Clinical Understaging;308
1.18.2.3;15.2.3 Stage T1;308
1.18.2.4;15.2.4 Stage Tis (CIS-Carcinoma In situ);309
1.18.3;15.3 Indications for Radical Cystectomy for Nonmuscle-Invasive Bladder Cancer;310
1.18.3.1;15.3.1 High-Grade Nonmuscle-Invasive Disease;310
1.18.3.2;15.3.2 BCG-Refractory Bladder Cancer;311
1.18.3.3;15.3.3 Miscellaneous Indications;312
1.18.4;15.4 Outcome After Radical Cystectomy for Nonmuscle-Invasive Bladder Cancer;313
1.18.5;15.5 Summary and Recommendations;314
1.18.6;References;314
1.19;Chapter 16: Radical Surgery for Muscle-Invasive Bladder Cancer;318
1.19.1;16.1 Background;318
1.19.2;16.2 Radical Surgery for Muscle-Invasive Bladder Cancer;319
1.19.2.1;16.2.1 Diagnosis of Invasive Bladder Cancer;319
1.19.2.2;16.2.2 Clinical Relevance of a Secondary TUR for Invasive Bladder Tumors;320
1.19.2.3;16.2.3 Timing and Delay of Radical Cystectomy for Bladder Cancer;320
1.19.2.4;16.2.4 General Indication for Radical Cystectomy in Patients with Bladder Cancer;321
1.19.2.5;16.2.5 Extension of Pelvic Lymph Node Dissection (PLND) Along with Radical Cystetcomy;322
1.19.2.6;16.2.6 Localization of Lymph Node Metastases;322
1.19.2.7;16.2.7 Rationale for an Extended Pelvic Lymph Node Dissection;323
1.19.2.8;16.2.8 Principles of Radical Cystectomy;324
1.19.2.9;16.2.9 Oncological Outcome of Radical Cystectomy for Muscle-Invasive Bladder Cancer with Negative Nodes;325
1.19.2.10;16.2.10 Oncological Outcome of Radical Cystectomy for Invasive Bladder Cancer and Prostatic Involvement;327
1.19.2.11;16.2.11 Oncological Outcome of Radical Cystectomy for Patients with Bladder Cancer and Lymph Node Involvement;328
1.19.2.12;16.2.12 Overall or Disease-Specific Survival as Endpoint of Outcome for Cystectomy patients?;331
1.19.2.13;16.2.13 Palliative Versus Therapeutic Indication of Radical Cystectomy for Bladder Cancer;332
1.19.3;16.3 Conclusion;333
1.19.4;References;334
1.20.1;17.1 Introduction;1
1.20.2;17.2 Historical Aspects of Urinary Diversion;339
1.20.3;17.3 Current Situation of Urinary Diversion;340
1.20.3.1;17.3.1 Quality of Life;340
1.20.3.2;17.3.2 Quality of Surgery;340
1.20.3.3;17.3.3 Trends in Reconstruction After RCX;341
1.20.3.4;17.3.4 Circumstances Under Which Urinary Diversion Is Performed;342
1.20.3.5;17.3.5 Correlation Between Volume of RCX and Outcomes;343
1.20.3.6;17.3.6 Indications, Contraindications, and Patient Selection;343
1.20.3.6.1;17.3.6.1 Substantial Change in Paradigm;343
1.20.3.6.2;17.3.6.2 Patient Selection Criteria: Absolute and Relative Contraindications;343
1.20.3.7;17.3.7 Patient Selection;344
1.20.3.7.1;17.3.7.1 Patient Factors: For (Pros);344
1.20.3.7.2;17.3.7.2 Patient Factors: Against (Cons);344
1.20.3.7.3;17.3.7.3 Patient Selection Criteria: Oncologic Factors;345
1.20.3.7.4;17.3.7.4 Current Practice;345
1.20.4;17.4 General Aspects of Urinary Diversion;346
1.20.4.1;17.4.1 Which Gut Segment Should Be Used;346
1.20.4.2;17.4.2 Difficulty of Operative Technique;347
1.20.4.3;17.4.3 No Standards for Surgical Complication Reporting;347
1.20.4.4;17.4.4 Early Complications of Radical Cystectomy and Urinary Diversion;347
1.20.4.5;17.4.5 Neobladder Specific Complications;349
1.20.4.5.1;17.4.5.1 Mucus Production;349
1.20.4.5.2;17.4.5.2 Chronic Bacteriuria;350
1.20.4.5.3;17.4.5.3 Rupture;350
1.20.4.5.4;17.4.5.4 Renal Function;351
1.20.5;17.5 How to Obtain Good Results with Orthotopic Bladder Substitution: The Ten Commandments;351
1.20.5.1;17.5.1 Commandment IV: Use Ileum Whenever Possible;352
1.20.5.2;17.5.2, 17.5.3 Commandment V: Maximum detubularization is a must;352
1.20.5.3;17.5.4 Commandment VI: Use a Stented Freely Refluxive Ileo Ureterostomy;352
1.20.5.4;17.5.5 Commandment VII: The Low Pressure, Compliant Freely Refluxive Reservoir Is Standard;353
1.20.5.5;17.5.6 Commandment X: Meticulous Follow-up;354
1.20.5.5.1;17.5.6.1 Management Immediately Postoperatively:;354
1.20.5.5.2;17.5.6.2 Management After Catheter Withdrawal;354
1.20.5.5.3;17.5.6.3 Meticulous Long-Term Follow-Up Is Essential;354
1.20.6;17.6 Long-Term Results of Orthotopic Reconstruction;355
1.20.7;17.7 Operative Technique Ileal Neobladder;355
1.20.7.1;17.7.1 RCX in a Female Patient with Planned Ileal Neobladder;356
1.20.7.2;17.7.2 Construction of the Ileal Neobladder in Both Sexes;359
1.20.7.3;17.7.3 Postoperative Management;365
1.20.8;17.8 Prostate Sparing Cystectomy;368
1.20.9;17.9 Palliative Urinary Diversion by Subcutaneous Nephro-Vesical/Nephro-Cutaneous Bypass;368
1.20.10;References;369
1.21;Chapter 18: Laparoscopic Cystectomy and Robotic-Assisted Cystectomy;371
1.21.1;18.1 Introduction;371
1.21.2;18.2 History;372
1.21.3;18.3 Patient Selection;372
1.21.4;18.4 Patient’s Positioning and Monitoring;373
1.21.5;18.5 Trocar Placement;373
1.21.6;18.6 Extended Lymph Node Dissection;374
1.21.7;18.7 Cystectomy;375
1.21.7.1;18.7.1 Ureteral Dissection;375
1.21.7.2;18.7.2 Male Cystectomy;376
1.21.7.3;18.7.3 Female Cystectomy;376
1.21.8;18.8 Nerve-Sparing Technique;377
1.21.9;18.9 Prostate-Sparing Cystectomy;377
1.21.10;18.10 Female Reproduction Tract-Sparing Cystectomy;377
1.21.11;18.11 Urinary Tract Reconstruction;378
1.21.11.1;18.11.1 Ileal Conduit (Bricker);378
1.21.11.2;18.11.2 Orthotopic Neobladder;378
1.21.12;18.12 Outcome and Comparison to Open Radical Cystectomy;379
1.21.13;18.13 Final Considerations;380
1.21.14;References;380
1.22;Chapter 19: Neoadjuvant Chemotherapy;383
1.22.1;19.1 Rationale of Neoadjuvant Chemotherapy;383
1.22.2;19.2 Pathoanatomical Background of Disseminated Invasive Urinary Bladder Cancer;383
1.22.3;19.3 Definitions of Nodal Dissemination;384
1.22.4;19.4 Dissemination and Neoadjuvant Chemotherapy;385
1.22.5;19.5 Present Status of Neoadjuvant Chemotherapy;385
1.22.6;19.6 Neoadjuvant Chemotherapy and Downstaging;386
1.22.7;19.7 Advantages and Disadvantages of Neoadjuvant Chemotherapy;387
1.22.7.1;19.7.1 Advantages;387
1.22.7.2;19.7.2 Disadvantages;387
1.22.8;19.8 Future Perspectives;387
1.22.9;19.9 Chemosensitivity;388
1.22.10;19.10 Problems with Accuracy in Tested Chemosensitivity;389
1.22.11;19.11 Methods of Preoperative Imaging of Nodal Dissemination;390
1.22.12;19.12 Conclusive Remarks;390
1.22.13;References;391
1.23;Chapter 20: Diagnosis and Treatment of Upper Tract Urothelial Carcinoma;393
1.23.1;20.1 Diagnosis of UTUC;393
1.23.1.1;20.1.1 Urinary Cytology;394
1.23.1.2;20.1.2 Ultrasonography;397
1.23.1.3;20.1.3 Excretory Urography;397
1.23.1.4;20.1.4 Multidetector Computed Tomography Urography (MDCTU);398
1.23.1.4.1;20.1.4.1 A Focal Intraluminal Enhancing Soft-tissue Density Mass;398
1.23.1.4.2;20.1.4.2 Urothelial Wall Thickening with Lumen Narrowing;398
1.23.1.4.3;20.1.4.3 An Infiltrating Mass;398
1.23.1.5;20.1.5 Magnetic Resonance Imaging;400
1.23.1.6;20.1.6 Image-Guided Biopsy;400
1.23.1.7;20.1.7 Retrograde Pyelography;400
1.23.1.8;20.1.8 Diagnostic Ureterorenoscopy Plus Biopsy;401
1.23.2;20.2 Surgical Treatment;402
1.23.2.1;20.2.1 Oncological Results of ORNU and LRNU;402
1.23.2.2;20.2.2 Morbidity of ORNU and LRNU;404
1.23.2.3;20.2.3 Management of the Bladder Cuff During LNU;405
1.23.2.3.1;20.2.3.1 Open Excision;405
1.23.2.3.2;20.2.3.2 Laparoscopic Stapling;405
1.23.2.3.3;20.2.3.3 Transvesical Laparoscopic Detachment Technique;406
1.23.2.3.4;20.2.3.4 Ligation and the “Pluck” Technique;406
1.23.2.4;20.2.4 Endourologic Treatment;407
1.23.3;References;408
1.24;Chapter 21: Chemotherapy for Metastatic Bladder Cancer;414
1.24.1;21.1 Introduction;414
1.24.2;21.2 Prognostic Factors and Treatment Decisions;415
1.24.3;21.3 Single-Agent Chemotherapy;416
1.24.4;21.4 Standard First-Line Chemotherapy and Its Development;417
1.24.4.1;21.4.1 Newer Platinum-Containing Combination Chemotherapies;417
1.24.4.2;21.4.2 Non-Platinum-Containing First-Line Combination Chemotherapy;418
1.24.5;21.5 Long-Term Overall Survival after Chemotherapy for Metastatic Disease;419
1.24.6;21.6 Refining Standard Chemotherapy;420
1.24.7;21.7 Fit and Unfit for Cisplatin;421
1.24.8;21.8 Carboplatin Versus Cisplatin Combination Chemotherapy in “Fit” Patients;421
1.24.9;21.9 Treatment of Elderly and Frail Patients and Those with Impaired Renal Function;422
1.24.10;21.10 Treatment of the “Unfit” Advanced or Metastatic Bladder Cancer Patient;423
1.24.11;21.11 Second-Line Chemotherapy;424
1.24.11.1;21.11.1 Second-Line Chemotherapy in Patients Who Are Still Eligible for Cisplatin;424
1.24.11.2;21.11.2 Second-Line Monochemotherapy;425
1.24.11.3;21.11.3 Vinflunine for Second-Line Use (see Table 21.10);425
1.24.11.4;21.11.4 Combination Chemotherapy for Second-Line Use;427
1.24.11.5;21.11.5 Novel Approaches for Second-Line Treatment;428
1.24.11.6;21.11.6 Conclusion;428
1.24.12;References;429
1.25;Chapter 22: Nontransitional Carcinoma of the Bladder;437
1.25.1;22.1 Squamous Cell Carcinoma;437
1.25.1.1;22.1.1 SCC Not Associated with Bilharziasis;437
1.25.1.1.1;22.1.1.1 Epidemiology;437
1.25.1.2;22.1.2 Spinal Cord Injury;438
1.25.1.3;22.1.3 Smoking;439
1.25.1.4;22.1.4 Causes;439
1.25.1.5;22.1.5 Clinical and Pathologic Features;440
1.25.1.6;22.1.6 Treatment;441
1.25.1.6.1;22.1.6.1 Radiation;441
1.25.1.6.2;22.1.6.2 Radical Cystectomy;441
1.25.1.6.3;22.1.6.3 Chemotherapy;443
1.25.1.6.4;22.1.6.4 Prevention and Early Detection;443
1.25.1.7;22.1.7 Conclusion;443
1.25.2;22.2 Squamous Cell Carcinoma in the Bilharzial Bladder;444
1.25.2.1;22.2.1 Epidemiology;444
1.25.2.2;22.2.2 Causes;444
1.25.2.3;22.2.3 Clinical and Pathologic Features;445
1.25.2.4;22.2.4 Treatment;445
1.25.2.4.1;22.2.4.1 Endoscopic Resection;445
1.25.2.4.2;22.2.4.2 Segmental Resection (Partial Cystectomy);445
1.25.2.4.3;22.2.4.3 Radical Cystectomy;446
1.25.2.5;22.2.5 Radiation;446
1.25.2.5.1;22.2.5.1 Neoadjuvant Radiation;447
1.25.2.5.2;22.2.5.2 Chemotherapy;447
1.25.2.5.3;22.2.5.3 Prevention and Early Detection;448
1.25.2.5.4;22.2.5.4 Conclusion;448
1.25.3;22.3 Adenocarcinoma;448
1.25.3.1;22.3.1 Overview;448
1.25.3.1.1;22.3.1.1 Epidemiology;449
1.25.3.1.2;22.3.1.2 Clinical Features;449
1.25.3.1.3;22.3.1.3 Pathologic Features;450
1.25.3.1.4;22.3.1.4 Treatment;450
1.25.3.2;22.3.2 Conclusion;451
1.25.4;22.4 Small Cell Carcinoma;452
1.25.4.1;22.4.1 Epidemiology;452
1.25.4.2;22.4.2 Clinical Features;452
1.25.4.3;22.4.3 Pathologic Features;452
1.25.4.4;22.4.4 Treatment;453
1.25.5;22.5 Conclusion;454
1.25.5.1;22.5.1 SCC;454
1.25.5.2;22.5.2 Adenocarcinoma;455
1.25.5.3;22.5.3 Small Cell Carcinoma;455
1.25.5.4;22.5.4 Bladder Sarcoma;455
1.25.5.5;22.5.5 Carcinosarcoma and Sarcomatoid Tumors;455
1.25.5.6;22.5.6 Paraganglioma and Pheochromocytoma;455
1.25.5.7;22.5.7 Bladder Pseudotumor;456
1.25.5.8;22.5.8 Melanoma;456
1.25.5.9;22.5.9 Lymphoma;456
1.25.6;References;456
1.26;Index;461