MANAGEMENT OF CARCINOMA OF THE BLADDER

Carcinoma of the bladder (CaB) is a common tumor of the genitourinary tract. In the United States in 1997, CaB was second in frequency of oc currence and third in mortality among genitourinary tumors. This tumor has a well-documented history of environmental and industrial causati ve factors. The strongest etiologic risk factors include the use of to bacco, which is thought to be responsible for half of the CaB diagnose d in men in the United States, and some arylamines. In the past 30 yea rs, there has been major improvement in the survival of patients with this disease. Multiple factors were responsible for this accomplishmen t and they include: 1) better understanding of the natural history of CaB, 2) development of immunohistochemical analysis helpful in definin g prognostic factors, 3) improved imaging and nonimaging diagnostic mo dalities helpful in making earlier diagnosis and better defining the t rue anatomical extent of the tumor, 4) development of more effective t herapy for carcinoma in situ, 5) major improvement in surgical techniq ues resulting in better treatment outcomes, and 6) the wide use of adj uvant chemotherapy. Major stress has been placed on the quality of lif e of patients treated for CaB. Quality of life was improved by optimiz ing surgical, radiation, and medical treatment techniques. The two mos t important factors producing this quality-of-life improvement include : 1) the use of organ-preserving therapy in properly selected patients that involves the use of a multimodality therapeutic approach with tr ansurethral resection, radiation therapy, and chemotherapy; and 2) the ability to treat selected men and women with radical cystectomy follo wed by orthotopic reconstruction that allows patients-nearly physiolog ic voiding. Current research efforts are directed toward better patien t selection for appropriate therapy which is expected to increase pati ent survival and improve quality of life. Of particular importance in the selection of this optimal therapy in patients with CaB is a wide a pplication in the clinical practice of important recent advances in mo lecular genetics.