Transitional cell carcinoma of the bladder
Treatment
The choice of treatment depends on the stage of the tumor, the severity of the symptoms, and the presence of other medical conditions.
Stage 0 and I treatments:
- Surgery to remove the tumor without removing the rest of the bladder
-
Chemotherapy or immunotherapy directly into the bladder
Stage II and III treatments:
- Surgery to remove the entire bladder (radical cystectomy)
- Surgery to remove only part of the bladder, followed by radiation and chemotherapy
- Chemotherapy to shrink the tumor before surgery
- A combination of chemotherapy and radiation (in patients who choose not to have surgery or who cannot have surgery)
Most patients with stage IV tumors cannot be cured and surgery is not appropriate. In these patients, chemotherapy is often considered.
CHEMOTHERAPY
Chemotherapy may be given to patients with stage II and III disease either before or after surgery to help prevent the tumor from returning.
Chemotherapy may be given as a single drug or in different combinations of drugs. These drugs include:
- Carboplatin
- Cisplatin
- Cyclophosphamide
- Docetaxel
- Doxorubicin
- Gemcitabine
- Ifosfamide
- Methotrexate
- Paclitaxel
- Vinblastine
The combination of gemcitabine and cisplatin is as effective as an older treatment called MVAC (methotrexate, vinblastine, doxorubicin, and cisplatin) with fewer side effects. Many centers have replaced MVAC with this new combination. Paclitaxel and carboplatin is another effective combination that is frequently used.
For early disease (stages 0 and I), chemotherapy is usually given directly into the bladder. Several different types of chemotherapy medications may be delivered directly into the bladder. They include:
- Doxorubicin (Adriamycin)
- Mitomycin-C (Mutamycin)
- Thiotepa (Thioplex)
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