Cancer Yola膀胱癌约拉ppt课件.ppt

Prognostic factors for NMIBC Weighting used to calculate recurrence and progression scores Prognostic factors for NMIBC Probability of recurrence and progression according to total score Treatment Treatment of NMIBC Treatment Transurethral resection of bladder tumor (TURBT) is the first-line treatment to diagnose, to stage, and to treat visible tumors. Patients with bulky, high-grade, or multifocal tumors should undergo a second procedure to ensure complete resection and accurate staging. Approximately 50% of stage T1 tumors are upgraded to muscle-invasive disease. Electrocautery or laser fulguration of the bladder tumor is sufficient for low-grade, small-volume, papillary tumors. Treatment High-grade T1 tumors that recur despite BCG have a 50% likelihood of progressing to muscle-invasive disease. Cystectomy performed prior to progression yields a 90% 5-year survival rate. The 5-year survival rate drops to 50-60% in muscle-invasive disease. Patients with unresectable large superficial tumors, prostatic urethra involvement, and BCG failure should also undergo radical cystectomy. Radical cystectomy in NMIBC Treatment BCG immunotherapy is used in the treatment of Ta, T1, and CIS urothelial carcinoma of the bladder decrease the rate of recurrence and progression it is the most effective intravesical therapy Mechanism: Immune response against BCG surface antigens cross-reacted with putative bladder tumor antigens Typically, BCG is administered weekly for 6 weeks. Another 6-week course may be administered if a repeat cystoscopy reveals tumor persistence or recurrence. Intravesical BCG immunotherapy (Bacillus Calmette-Guérin immunotherapy) Treatment Valrubicin has recently been approved as intravesical chemotherapy for CIS that is refractory to BCG. Other forms of adjuvant intravesical chemotherapy for bladder cancer include intravesical triethylenethiophosphoramide (thiotepa [Thioplex]), mitomycin-C, doxorubici