The role of the nonsurgical oncologist in the management of advanced transitional cell cancer. Part II: metastatic disease

Abstract

TCC may arise at any site in the urinary tract, and when advanced or metastatic can be regarded by the nonsurgical oncologist as a single tumour type. TCCs commonly develop histologically and may be admixed with areas of squamous carcinoma, adenocarcinoma or peripheral neuro-ectodermal tumour. In most cases this does not alter the therapeutic approach, although it might alter the outcome. TCCs arise most commonly in the bladder, where they are the fourth most common cancer in men and eighth most common in women, responsible for >5000 deaths annually in the UK. They occur increasingly commonly with age, and advanced disease in the elderly is a common clinical management problem, which necessitates adjustment to treatment regimens. Locally advanced disease is routinely managed by cystectomy, with the possibility of bladder reconstruction for selected patients. However, more recently there has been renewed interest in bladder-sparing approaches, including radiotherapy and chemo/radiotherapy. Neoadjuvant chemotherapy has been evaluated in large randomized trials and similar international studies are ongoing, testing the usefulness of adjuvant chemotherapy after chemotherapy. These nonsurgical approaches to this group of cancers will be considered in this review, with an emphasis on data obtained from prospective randomized trials.