BCG CANCER DE VEJIGA PDF
cuál es el más apropiado. En este artículo se presenta una revisión del uso del BCG en el carcinoma superficial de vejiga, indicaciones, mecanismo de acción. Síndrome de Reiter asociado con la administración de BCG inmunoterapeutico intravesical por carcinoma de vejiga. Data (PDF Available) · June with . CANCER DE VEJIGA URINARIA- BIOLOGÍA MOLECULAR Y BCG: OR 60% en cancer residual, OR 75% Cis, MDR 70% a 5 años. Mecanismo: secrecion de.
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This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of bladder cancer. It is intended as a resource to inform and assist clinicians cacer care dr cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.
Bladder cancer is the sixth most common cancer in the United States after lung cancer, prostate cancer, breast cancer, colon cancer, and lymphoma. It is the third most common cancer in men and the eleventh most common cancer in women. Of the roughly 70, new cases annually, about 53, are in men and about 18, are in women. Of the roughly 15, annual deaths, more than 10, are in men and fewer than 5, are in women. The reasons for this disparity between the sexes are not well understood. The urinary tract consists of the kidneys, the ureters, the bladder, and the urethra.
The urinary tract is lined with transitional cell urothelium from the renal veijga to the proximal urethra. Transitional cell carcinoma also referred to as urothelial carcinoma can develop anywhere along this pathway. Anatomy of the male urinary system left panel and female urinary system right panel showing the kidneys, vejia, bladder, and urethra. Urine is made in the renal tubules and collects in the renal pelvis of each kidney.
[The bacillus Calmette-Guérin as immunomodulator in bladder cancer].
The urine flows from the kidneys through the ureters to the bladder. The urine is stored in the bladder until it leaves the body through the urethra. Under normal conditions, the bladder, the lower part of the kidneys the renal pelvisesthe ureters, and the proximal urethra are lined with a specialized mucous membrane referred to as transitional epithelium also called urothelium.
Most cancers that form in these tissues are transitional cell carcinomas also called urothelial carcinomas that derive from transitional epithelium. Bladder cancer is also divided into muscle-invasive and nonmuscle-invasive disease, based on invasion of the muscularis propria also referred to as the detrusor musclewhich is the thick muscle deep in the bladder wall. Under conditions of chronic inflammation, such as infection of the bladder with the Schistosoma haematobium parasite, squamous metaplasia may occur in the bladder; the incidence of squamous cell carcinomas of the bladder is higher under conditions of chronic inflammation than is otherwise seen.
In addition to transitional cell carcinomas and squamous cell carcinomas, bct, small cell carcinomas, and sarcomas can form in the bladder. However, a significant number of transitional cell carcinomas have areas vejigga squamous or other differentiation. Increasing age is the most important risk factor for most cancers. Other risk factors for bladder cancer include the following:.
There is strong evidence linking exposure to carcinogens to bladder cancer. The most common risk factor for bladder cancer in the United States is cigarette smoking.
Bladder cancer – Wikipedia
ve Smokers with less functional polymorphisms of N-acetyltransferase-2 known as slow acetylators have a higher risk of bladder cancer than other smokers, presumably because of their reduced ability to detoxify carcinogens. Certain occupational exposures have also been bdg to bladder cancer, and higher rates of bladder cancer have been reported in textile dye and rubber tire industries; among painters; leather workers; shoemakers; and aluminum- iron- and steelworkers.
Specific chemicals linked to bladder carcinogenesis include beta-naphthylamine, 4-aminobiphenyl, and benzidine. Although these chemicals are now generally banned in Western countries, many other chemicals still in use are also suspected of causing bladder cancer.
Exposure to the chemotherapy drug cyclophosphamide has also been associated with an increased risk of bladder cancer.
Chronic urinary tract infections and infection with the parasite S. Chronic inflammation is thought to play a key role in carcinogenesis in these settings. Bladder cancer typically presents with gross or microscopic hematuria. Less commonly, patients may complain of urinary frequency, nocturia, and dysuria, symptoms that are more common in vejia with carcinoma in situ.
Patients with upper urinary tract urothelial carcinomas may present with pain resulting from obstruction by the tumor.
Acute oligoarthritis following BCG treatment for urinary bladder cancer: A case report
Urothelial carcinomas are often multifocal—the entire urothelium needs to be evaluated if a tumor is found. In patients with bladder cancer, upper urinary tract imaging is essential for staging and surveillance.
This can be accomplished with ureteroscopy, retrograde pyelograms during cystoscopy, intravenous pyelograms, or computed tomography CT urograms. Similarly, patients with an upper urinary tract transitional cell carcinoma have a high risk of developing bladder cancer; these patients need periodic cystoscopy and surveillance of the contralateral upper urinary tract.
When bladder cancer is suspected, the most useful diagnostic test is cystoscopy. Radiological studies such as CT scans or ultrasound do not have sufficient sensitivity to be useful for detecting bladder cancers. Cystoscopy can be performed in a urology clinic. If a high-grade cancer including carcinoma in situ or invasive cancer is seen, the patient is staged with a CT scan of the abdomen and pelvis or CT urogram and either a chest x-ray or chest CT scan. Patients with a nonhepatic elevation of alkaline phosphatase or symptoms suggestive of bone metastases undergo a bone scan.
Most superficial tumors are well differentiated. Patients in whom superficial tumors are less differentiated, large, multiple, or associated with carcinoma in situ Tis in other areas of the bladder mucosa are at greatest risk of recurrence and the development of invasive cancer.
These patients may be considered to have the entire urothelial surface at risk of cancer development. Patients who die from bladder cancer almost always have disease that has metastasized from the bladder to other organs. Low-grade bladder cancers rarely grow into the muscular wall of the bladder and rarely metastasize, so patients with low-grade grade I bladder cancers very rarely die from their cancer.
Nonetheless, they may experience multiple relapses that need to be resected. The prognosis of these patients depends largely on the grade of the tumor. Patients with high-grade tumors have a significant risk of dying of their cancer even if it is not muscle-invasive.
Among patients with high-grade tumors, those who present with superficial, nonmuscle-invasive bladder cancer can usually be cured, and those with muscle-invasive disease can sometimes be cured. Studies have demonstrated that some patients with distant metastases have achieved long-term complete response after being treated with combination chemotherapy regimens, although most such patients have metastases limited to their lymph nodes and have a near-normal performance status.
There are clinical trials suitable for patients with all stages of bladder cancer; whenever possible, clinical trials designed to improve upon standard therapy should be considered. General information about clinical trials is also available from the NCI website.
Bladder cancer tends to recur, even when it is noninvasive at the time of diagnosis; therefore standard practice is to perform surveillance of the urinary tract after a diagnosis of bladder cancer. However, no trials have been conducted to assess whether surveillance affects rates of progression, survival, or quality of life; nor have clinical trials defined an optimal surveillance schedule. Urothelial carcinomas are thought to reflect a so-called field defect whereby the cancer emerges because of genetic mutations that are widely present in the patient’s bladder or entire urothelium.
Thus, people who have had a bladder tumor resected often subsequently have recurrent tumors in the bladder, often in different locations from the site of the initial tumor. Similarly, but less commonly, they may have tumors appear canncer the upper urinary tract i. An alternative explanation for these patterns of recurrence is that cancer cells that are disrupted when a tumor is resected may reimplant elsewhere in the urothelium.
Support for this second theory is that tumors are more likely to recur downstream than upstream from the initial cancer. Upper urinary tract cancers are more likely to recur in the bladder than bladder cancers are to recur in the upper urinary tract.
Adenocarcinomas may be of urachal origin or nonurachal origin; the latter type is generally thought to arise from metaplasia of chronically irritated transitional epithelium.
Small cell carcinomas also may develop in the cancsr. Sarcomas of the bladder are very rare. Pathologic grade of transitional cell carcinomas, which is based on cellular atypia, nuclear abnormalities, and the number of mitotic figures, is of great prognostic cbg.
The clinical staging of carcinoma of the bladder is determined by the depth of invasion of the bladder wall by the tumor. This determination requires a cystoscopic examination that includes a biopsy and examination under anesthesia to assess the following:.
CT imaging is the standard staging modality.
A clinical benefit from obtaining MRI or positron emission tomography scans instead of CT imaging has not been demonstrated. Treatment of nonmuscle-invasive bladder cancers Ta, Tis, T1 is based on risk stratification. Essentially all patients are initially treated with a transurethral resection TUR of the bladder tumor followed by a single immediate instillation of intravesical chemotherapy mitomycin C is typically used in the United States.
Subsequent therapy after the treatment above is based on risk and typically consists of one of the following:. Standard treatment for patients with muscle-invasive bladder cancers whose goal is cure is either neoadjuvant multiagent cisplatin—based chemotherapy followed by radical cystectomy and urinary diversion or radiation therapy with concomitant chemotherapy.
Other treatment approaches include the following:. Many patients newly diagnosed with bladder cancer are candidates for participation in clinical trials. Reconstructive techniques that fashion low-pressure storage reservoirs from the reconfigured small and large bowel eliminate the need for external drainage devices and, in many patients, allow voiding per urethra. These techniques are designed to improve the quality of life for patients who require cystectomy.
Patients with stage 0 bladder tumors can be cured by a variety of treatments, even though the tendency for new tumor formation is high. Of greater concern than recurrence is the risk of progression to muscle-invasive, locally-advanced, or metastatic bladder cancer. While progression is rare for patients with low-grade tumors, it is common among patients with high-grade cancers.
Risk factors for recurrence and progression are the following:. TUR and fulguration are the most common and conservative forms of management. Careful surveillance of subsequent bladder tumor progression is important. Because most bladder cancers recur after TUR, one immediate intravesical instillation of chemotherapy after TUR is often administered.
Such information may change the definitive management options in these individuals. Evidence TUR with fulguration followed by immediate postoperative instillation of intravesical chemotherapy:. Intravesical BCG is the treatment of choice for reducing the risk of cancer progression and is mainly used for cancers with an intermediate or high risk of progressing.
Intravesical chemotherapy is tolerated better than intravesical BCG. Studies show that intravesical BCG delays tumor recurrence and tumor progression. Intravesical therapy with thiotepa, MMC, doxorubicin, or BCG is most often used in patients with multiple tumors or recurrent tumors or as a prophylactic measure in high-risk patients after TUR.
Evidence TUR with fulguration followed by an immediate postoperative instillation of intravesical chemotherapy followed by periodic intravesical instillations of BCG:. Because of concerns about side effects and toxicity, BCG is not generally used for patients with a low risk of progression to advanced-stage disease.
Segmental cystectomy is rarely indicated. It is applicable to only a small minority of patients because of the tendency of bladder cancer to involve multiple regions of the bladder mucosa and to occur in areas that cannot be segmentally resected.
Moreover, cystectomy whether segmental or radical is generally not indicated for T0 bladder cancer see radical cystectomy below. However, cystectomy whether segmental or radical is generally not indicated for patients with Ta or Tis bladder cancer.