In one comparative study, postoperative adjuvant chemotherapy was noted to provide benefit to patients with deeply invasive or node-positive bladder cancer after they had undergone cystectomy. For metastatic disease that is discovered after bladder removal, some investigators have used adjuvant chemotherapy to decrease the subsequent distant relapse rate. However, most patients die within two years after the onset of metastatic disease. The most active agents include cisplatin, methotrexate, doxorubicin, cyclophosphamide, and vinblastine. Data suggest that paclitaxel may be effective in invasive bladder cancer.
Studies combining it with cisplatin are under way.
Clearly, to improve the quality of life of these patients and increase cure rates requires a multidisciplinary team consisting of urologic surgeons, radiation and medical oncologists, and allied professionals involved in rehabilitation efforts. Transitional Cell Carcinoma of the Renal Pelvis and Ureter Transitional cell carcinoma of the renal pelvis accounts for about five to 10 percent of renal neoplasms. Gross, painless hematuria in which blood is present throughout the urine stream is a presenting feature. Urinary cytology, cystoscopy, and retrograde pyelography with brush biopsy usually establish the nature and location of the lesion. Treatment is surgical and usually involves a radical nephroureterectomy plus removal of the cuff of the bladder containing the ipsilateral ureteral orifice.