Treatment of bone tumours

Very early disease – the bladder papilloma of yesteryear terminology – can be treated by resection alone, but the urologist will repeat serial follow-up cystoscopies to be sure there is no recurrence at increasing intervals over many years. Where there is a superficial ‘carpet’ of tumour across the lining of the bladder some instillations of toxic chemicals (e.g. the chemotherapeutic agents doxorubicin or mitomycin C) or BCG, (the attenuated tubercle bacillus species) into the bladder may be very useful in clearing the disease.

 

For more advanced disease (where there is involvement of the bladder muscular wall) but no evidence of spread beyond the bladder, then there are several treatment options.

 

In the younger and fitter patient then cystectomy (the removal of the bladder with reconstruction of some substitute conduit for the urine) is the standard best treatment. For the older patient who would not stand this large operation, then radical radiotherapy (an external beam course lasting 5-6.5 weeks) is chosen.

The modern radiation system is with high energy linear accelerators and using conformal technology The long term follow-up of radically radiated patients is not as good as surgery (perhaps 40% cure) but, recently, the use of chemotherapy together with both surgery and radiotherapy has led to improved results all round and may allow conservative therapy to substitute operation in some cases – for one has always got radical cystectomy to fall back on if follow-up cystoscopy shows persisting tumour (but against this argument one may be risking that usually sound first principle of oncology which is to go for first time cure).

 

Many clinical trials are currently in progress. There is no doubt that modern chemotherapy, using drugs such as cis-platinum and gemcitabine can cause a good regression in transitional carcinoma of the bladder and for younger and fitter patients many would now employ it in conjunction with local therapy (surgery or radiotherapy), but frequently in a clinical trial context.

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