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Annual for Hospital Pharmacy

Current approaches in the treatment of bladder cancer

Olga Antonova, Valentina Belcheva

Abstract

Bladder cancer is the most common malignancy of the urinary system. The main reasons for its appearance are urinary tract infections and arylamines which are in direct contact with the wall of the bladder. The treatment of bladder cancer depends mainly on the histological characteristics of the tumor, invasion depth in the bladder wall and the cancer recurrence. The bladder cancer treatment is surgical removal of the tumor, combined with radiotherapy, chemotherapy or immunotherapy. In the treatment of superficial non-invasive bladder cancer, chemotherapy is used prophylactically as adjuvant intravesical therapy after endoscopic resection of the tumor. The most frequently used chemotherapeutic drugs are mitomycin, epirubicin, doxorubicin, and thiotepa. More than half of the patients with invasive bladder cancer die due to distant metastases. These metastases develop early in the process of tumor invasion. A combination of local treatments and systemic chemotherapy is used to reduce the number and depth of the micrometastases. The reduction of the size of the primary tumor is achieved by neoadjuvant chemotherapy with methotrexate, vinblastine, adriamycin and cisplatin. The main method of treatment of the patients with advanced metastatic bladder cancer is chemotherapy. Two modes of chemotherapy are applied: M-VAC (Methotrexate, Vinblastine, Adriamycin, Cisplatin) and CMV (cisplatin, methotrexate, vinblastine). Another approach used in the treatment of the bladder cancer is immunotherapy, which stimulate the immune system of the patient to fight cancer. For example intravesical administration of BCG (Bacillus Calmette-Guérin) is used as an immunostimulant in treatment of bladder carcinoma in situ (CIS), This approach decreases the disability as a consequence of the therapeutic cystectomy.

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DOI: http://dx.doi.org/10.14748/.v1i1.1879

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