Local advanced or metastasized carcinoma of the urinary bladder: Current aspects of therapy

Of the additional factors investigated, only tumor size and hydronephrosis appear to be of prognostic significance. In the scope of molecular markers, the loss of expression of the epithelial cell-cell adhesion molecule E-cad herin signals an unfavorable clinical course. In cases of carcinoma of the urinary bladder without metastases (T2-4, N0, M0), radical cystectomy is th e therapy of choice. A preceding neoadjuvant systemic regimen of chemothera py with three cycles of M-VAC (methotrexate,vinblastine, adriamycin, cispla tin) significantly improves the survival rate. In patients with locally adv anced urinary bladder carcinoma, however, adjuvant systemic chemotherapy wi th M-VAC after cystectomy and lymphadenectomy offers no advantages for surv ival. Quality of life in patients with metastatic bladder cancer disease is improved by new cytotoxic drugs, i.e. gemcitabine or taxanes.