Current Therapy of Bladder Cancer

Abstract

Bladder cancer includes a heterogeneous spectrum of neoplasms for which a variety of surgical and/or radiation treatments has been applied. Local control is generally achieved with the appropriately selected treatment. With superficial neoplasms, new tumor formation is the principal problem and has resulted in the development of intravesical instillations utilizing biologic response modifiers or chemotherapy. With muscle-infiltrating neoplasms, distant metastasis is the principal problem and has stimulated the evolution of systemic chemotherapy. Progress in systemic treatment has resulted in combination chemotherapies capable of inducing protracted complete responses in some patients. Pilot studies of such chemotherapy with or without irradiation and with or without surgery in patients with muscle-infiltrating tumors have the objectives of improving survival and/or of bladder preservation. Tumor heterogeneity requires more detailed specification to facilitate more rational and less empirical selection of the optimal therapy, especially in view of an increasing number of apparent treatment options.