Book Review

Bladder Cancer: Biology, diagnosis, and management

N Engl J Med 2000; 342:1297-1298April 27, 2000

Article

Bladder Cancer: Biology, diagnosis, and management
Edited by Konstantine N. Syrigos and Donald G. Skinner. 410 pp., illustrated. New York, Oxford University Press, 1999. $129.50. ISBN: 0-19-263038-5

The management of bladder cancer is a common and complex clinical challenge. In the United States, it is the fourth most common cancer in men and the eighth most common in women. Rates vary widely among North American men, however, from 28 cases per 100,000 person-years in Connecticut to only 12 cases per 100,000 person-years in British Columbia. Observations from almost 50 years ago implicated work in the dyestuffs industry and work in the rubber industry as occupational causes; subsequently, increased risks of bladder cancer associated with a range of other industries have emerged.

The disease is intriguing to both biologists and oncologists. The most common presentation is with a papillary tumor, one that is noninvasive or that extends only into the lamina propria. There is a pattern of recurrence of this tumor after local resection, but progression to deeper invasion into the bladder muscle and metastasis are uncommon. Clonality studies have suggested that recurrences derive from previous tumors rather than representing new primary tumors. The frequency of recurrence can be reduced by intravesical chemotherapy or by what is usually described as immunotherapy with intravesical bacille Calmette–Guérin (BCG). This form of bladder cancer is rarely life-threatening. Muscle-invasive tumors, in contrast, are frequently associated with metastases, either at presentation or as part of a pattern of recurrence after local therapy. Certain patterns of mutation appear characteristic of these phenotypes; the hemizygous deletion of chromosome 9 is an early event in superficial papillary cancers, and mutation of p53 is a feature of more advanced, poorly differentiated tumors and appears to be associated with a high risk of metastatic recurrence and a poor prognosis.

There are particular therapeutic challenges associated with these distinct patterns. Superficial tumors with a good prognosis can be managed by simple resection. However, superficial tumors that are poorly differentiated or associated with extensive carcinoma in situ often respond to BCG immunotherapy but may recur at an advanced stage, and there is controversy about how early cystectomy should be offered in the course of this type of bladder cancer. Localized muscle-invasive tumors are treated by cystectomy or, in some centers, by radical radiotherapy, often in combination with chemotherapy. There have been important advances in surgery, with the development of continent urinary-diversion techniques. However, this type of surgery is a far from trivial prospect in the elderly, and two thirds of all cases of bladder cancer present in patients 65 years of age or older. For patients with muscle-invasive disease, the most common pattern of metastasis is to regional lymph nodes, but distant spread to lungs, liver, and bone is typical. Metastatic disease is sensitive to combination chemotherapy, but although a response is seen in about two thirds of patients, long-term remissions are rare.

The problems of clinical practice in the field of bladder cancer have begun to stimulate translational research, and this book has the worthy goal of presenting both short reviews of applied clinical research in bladder cancer and up-to-date summaries of issues relating to assessment and management.

The book has some of the faults of any multiauthored book. Many chapters have similar introductions; controversies, such as whether to perform cystectomy or to use an organ-conservation approach based on radiotherapy, are dealt with by simply presenting each perspective in a separate chapter. There is considerable overlap between two chapters dealing with the pathology of bladder cancer. Also, the sequence of chapters is occasionally bewildering; it would seem more logical to present the chapters on intravesical chemotherapy and immunotherapy in apposition to the chapter on surgical management of superficial bladder cancer rather than after the chapters on management of muscle-invasive and metastatic disease. Similarly, the discussion of urinary reservoirs and conduits would have been better placed near the discussion of surgical treatment of muscle-invasive disease. These minor points, however, are more than counterbalanced by the excellence of the individual contributions. The last two chapters discuss unusual but useful topics: one is on palliative care, with a wealth of detailed advice about the management of symptoms, and the second is on the role of the research nurse, who is rapidly becoming an essential component of the multidisciplinary team.

This book will have immense appeal to the clinician involved in multidisciplinary management of bladder cancer. Particularly valuable are the chapters on treatment, which will do much to encourage and improve communication between members of the management team. The enthusiasm of the editors for translational research is evident and clearly appropriate at the start of a decade that is likely to witness a revolution in the molecular characterization and treatment of cancers.

Alan Horwich, M.B., B.S., Ph.D.
Royal Marsden Hospital, Sutton SM2 5PT, United Kingdom

Citing Articles (1)

Citing Articles

1. 1

   M. E. Moustapha, M. A. Motaleb, I. T. Ibrahim. (2011) Synthesis of 99mTc-oxybutynin for M3-receptor-mediated imaging of urinary bladder. Journal of Radioanalytical and Nuclear Chemistry 287:1, 35-40
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