Long-Term Survival with Aggressive Surgery in Advanced Bladder Cancer
Physicians from Switzerland advocate the removal of pelvic lymph nodes in patients undergoing an attempted curative cystectomy (removal of the bladder) to improve long-term survival, according to a recent article reported in the
Journal of Urology.
The bladder is a muscular organ located in the lower abdomen that serves to store urine. Ninety percent of bladder cancers originate in the inner lining of the bladder, which is composed of specific cells called transitional cells. This type of cancer is called transitional cell carcinoma (TCC). Treatment options for TCC depend on a number of factors, including the location and extent of cancer, and may include surgery, radiation, chemotherapy and/or biologic therapy (treatment utilizing the body’s immune system to fight cancer).
Advanced TCC means that the cancer has spread from the site of origin to different sites throughout the body.
Pelvic lymph nodes are one of the first sites to which bladder cancer spreads. However, through current detection methods, small amounts of lymph node involvement are often not detected. Thus, many physicians may not remove lymph nodes at the time of cystectomy. These remaining cancer cells are responsible for cancer recurrences following surgery and can travel further throughout the body. Recently, physicians from Switzerland assessed data and outcomes of 452 patients with bladder cancer treated between 1984 and 1997. Although all patients had undetectable lymph node involvement prior to cystectomy, all had their pelvic lymph nodes removed. Laboratory analysis showed that nearly 20% of these patients had cancer that had spread to the lymph nodes. Five years following surgery, approximately 30% of patients that had spread to the lymph nodes were still alive. Patients with 5 or fewer involved lymph nodes, no spread of cancer outside the lymph node wall and small amounts of cancer cells in their lymph nodes had significantly improved outcomes over those with more spread.
These results indicate that a significant percentage of patients with TCC who have nodal involvement may achieve long-term survival. Physicians researching this data advocate the removal of pelvic lymph nodes in patients with TCC who will undergo attempted curative cystectomy, even if there is no clinical evidence of nodal involvement prior to surgery. Patients with TCC may wish to speak with their physician about the risks and benefits of pelvic nodal removal at the time of cystectomy or the participation in a clinical trial evaluating novel surgical strategies. Sources of information regarding ongoing clinical trials include comprehensive, easy-to-use listing services provided by the National Cancer Institute cancer.gov