Clinical Management of Bladder Cancer [Hardcover]

Reginald Hall (Editor), Reginald R. Hall (Author)

Book Description

Publication Date: March 15, 1999 | ISBN-10: 0340740922 | ISBN-13: 978-0340740927 | Edition: 1st

This book is a comprehensive, and readable, treatise of the current status of bladder cancer management. An area of considerable controversy, the text looks in particular at the opposing views that have arisen in different parts of the world, drawing on the experiences of the international author team. The text includes individual chapters on smoking, statistics, and talking with patients about bladder cancer - a feature unique to this volume. With emphasis given to the multidisciplinary approach to treatment, 'Clinical Management of Bladder Cancer' will appeal to all professionals who specialise in the day-to-day care of patients with bladder cancer.

Editorial Reviews

From The New England Journal of Medicine

A little over 100 years ago, Rehn made the seminal observation that there was a high incidence of bladder cancer among workers exposed to aniline dyes. The subsequent identification of the carcinogens used in the manufacture of these dyes led to the first successful control of cancer by epidemiologic means. In the United States, in 1998 there were 54,000 cases of cancer of the bladder and 12,500 deaths from this disease. The wide discrepancy between incidence and mortality is accounted for by the prevalence of superficial tumors. Such tumors frequently recur, but only 20 percent progress and invade the bladder muscle.

Cancer of the bladder is among the few cancers that have had a clinically significant response to immunotherapy with bacille Calmette-Guerin (BCG), and among epithelial cancers it stands out because of its responsiveness to combination chemotherapy. As a result, there have been many new and exciting advances in the diagnosis and management of this disease in recent years. Clinical Management of Bladder Cancer is a well-researched and comprehensive review of the status of the disease. Each chapter is well referenced so that the reader can easily explore in greater depth controversies in the management of bladder tumors. Many of the chapters are enhanced by brief commentaries that add salient points or express an alternative opinion.

The first three chapters deal with diagnosis and pathology. They include an excellent discussion of hematuria detected by dipstick testing or microscopy, which often presents a dilemma in management for both primary care physicians and urologists. The consensus is that cystoscopy, preferably with a flexible instrument, is warranted in patients over 40 years of age who have no evidence of intrinsic renal disease. There is at present no noninvasive test for bladder cancer with sufficient specificity to replace cystoscopy. The enthusiasm for the telomerase test is not shared by Herr. The discussion of the histopathology of urothelial cancer is comprehensive and readable. It highlights the disagreement that arises among pathologists as to the grading and staging of bladder tumors and the ways in which the approach may affect clinical trials.

The recent and logical changes in the classification of bladder cancer are clarified, and a good case is made for a grade of T5, defined as direct invasion of the prostate by the bladder tumor, with a correspondingly adverse prognosis. Biopsy of the prostatic urethra during transurethral resection is advocated before orthotopic diversion. We have come to rely on the analysis of frozen sections of biopsy specimens of the prostatic urethra obtained at the time of cystectomy as an easier method of determining whether direct anastomosis to the urethra is contraindicated. The importance of a second transurethral resection to ensure the completeness of resection is stressed and is particularly pertinent in patients who might be treated for invasive lesions with the combination of a complete transurethral resection and adjuvant chemotherapy.

There is some difference of opinion over the management of stage T1 and T2 tumors (T2, but not T1, tumors invade muscle). A strong case is made for the use of intravesical chemotherapy in lieu of treatment with BCG, since the results are similar and there is less morbidity. Lamm's experience is different, and his view reflects the preference for the use of BCG that is prevalent in this country. As van der Meijden indicates, BCG is the treatment of choice for carcinoma in situ and stage T1G3 tumors (involving invasion of superficial layers), but chemotherapy is adequate for recurrent low-grade superficial tumors. He stresses the importance of prolonged follow-up in patients who are free of tumor two years after BCG treatment, since over one third of them will have a recurrent tumor within the next nine years. Lamm comments that recurrence can be further reduced by maintenance therapy.

Turner and Studer consider cystectomy the optimal treatment for patients with tumors that invade the muscle. They describe the indications for partial cystectomy but note that circumferential spread of tumor in the bladder wall limits the efficacy of this approach. I have found that biopsy of the cut edge of the remaining bladder wall at operation will occasionally show unexpected mural infiltration, mandating total cystectomy.

The authors advocate a cautious approach to the use of the orthotopic neobladder until long-term functional results become available. Skinner, in his commentary, advocates the use of molecular markers to predict progression and states that patients whose tumors have p53 mutations should be given adjuvant chemotherapy. The chapter on radiotherapy provides little evidence that this together with salvage cystectomy is a satisfactory alternative to cystectomy for tumors that invade the muscle. The 20 percent rate of failure of radiotherapy seems too high, given the survival rate of only 40 percent at five years in patients with stage T2 (superficial muscle invasion) and T3a (deep muscle invasion) disease, when a cure rate of 60 to 70 percent is possible with the use of cystectomy and orthotopic diversion, with urinary continence.

Several chapters deal with chemotherapy in conjunction with resection or radiation and for metastatic disease. The use of newer agents, such as gemcitabine, and genetic markers to identify resistance to specific cytotoxic agents is likely to enhance the already impressive results of treatment with combinations of cytotoxic agents. Finally, an excellent account of the ways in which smoking affects bladder cancer provides a sound basis for physicians to advise their patients about the hazards of cigarettes. The epilogue, which discusses ways of talking to patients, is something anyone training in urology would benefit from reading.

I enjoyed reading this book, which provides a contemporary account and readily available references on the management of bladder cancer for urologists, radiation therapists, medical oncologists, and residents.

Reviewed by Bernard Lytton, M.B., F.R.C.S.
Copyright © 1999 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

About the Author

Reginald R. Hall, Macmillan Lead Clinician, Northern Cancer Network in the North of England.

Product Details

• Hardcover: 384 pages
• Publisher: Hodder Arnold Publishers; 1st edition (March 15, 1999)
• Language: English
• ISBN-10: 0340740922
• ISBN-13: 978-0340740927
• Product Dimensions: 9.7 x 6.8 x 0.9 inches
• Shipping Weight: 2 pounds
• Amazon Best Sellers Rank: #3,217,846 in Books (See Top 100 in Books)