De behandeling van blaaskanker vraagt om gecentraliseerde zorg

Quality of care for bladder cancer patients differs between Dutch hospitals. Improving the collaboration between hospitals, focussing on healthcare pathways and outcome measures will be helpful in establishing quick improvements. In this respect it is important to incorporate patient related outcome measures

De rol van circulerende tumorcellen bij het urotheelcarcinoom van de blaas

Patients with muscle-invasive urothelial cell carcinoma of the bladder have a 50 % chance to develop distant metastases despite curative local treatment. Reliable markers that predict the risk of developing metastases or that could be used to determine whether or not perioperative systemic treatment should be given are lacking. Circulating tumor cells (CTCs) are cancer cells that are present in the blood stream of patients with solid tumors and originate from tumor lesions that are present in the body. The enumeration of CTCs is an attractive option to assess the chance to develop distant metastases in individual patients. Here, we set out to review the most relevant literature to date regarding the clinical value of CTCs in bladder cancer. Moreover, the CirGuidance study is presented, which is the first interventional trial, which uses CTCs to guide treatment choices regarding the administration of neoadjuvant chemotherapy in patients with muscle-invasive urothelial cell carcinoma

DIAGNOSIS AND TREATMENT OF UROTHELIAL CARCINOMA OF THE BLADDER

Chapter 1 is a general introduction. Chapter 2 describes currently known methylation markers in urine for diagnosis of bladder cancer and their diagnostic accuracy. In Chapter 3 several methylation markers in urine are evaluated to use for diagnosis of bladder cancer and an optimal two gene panel is proposed. In chapter 4 several additives are tested to preserve urinary DNA prior to the analysis of methylation markers in urine. A protocol for preservation is proposed. In chapter 5 the two systems used for grading bladder cancer are tested to determine their reproducibility, both are poorly reproducible. In chapter 6, several measurents are used to determine whether a more objective method to determine bladder cancer grade is possible. In chapter 7 the value of an immediate instillation of mitomycin C after transurethral resection of a bladder tumor is evaluated in a randomised controlled trial. The study shows that an immediate instillation reduces the risk of recurrent bladder cancer. In chapter 8, we evaluate whether the value of an immediate instillation is different in several subgroups of patients. We found that an immediate instillation is effective in all risk groups. In Chapter 9, the timing of an immediate instillation of mitomycin C is investigated. We found that, altough it is recommended to administer an immediate instillation as soon a possible after transurethral resection of a bladder tumour, patients may still benefit from an instillation 1 day after transurethral resection. In chapter 10, interleukin-2 instillations are tested in patients with bladder cancer with and without a marker lesion. The study was closed prematurely so no soli conclusions can be made. However no clear benefit of a marker lesion was detected. In part 3 bladder preservation using brachytherapiy in high risk non muscle invasive bladder cancer, and muscle invasive bladder cancer is evaluatied. We found that brachytherapy is a good alternative to cystectomy in selected patients, without compromising survival. Additionally, the implantaion of the brachytherapey cathethers can safely be conducted using a robot-assisted laparoscopic approach

Urogenitale Oncologie: inspirerende decennia, uitdagende toekomst

Oratie handelt over het urogenitale stelsel, in het bijzonder maligne tumoren. Dit betreft onder andere kanker van de nier, de blaas, prostaat en testis. Komen maligne tumoren van deze organen vaak voor? Inderdaad, het prostaatcarcinoom is bij de man de meest voorkomende invasieve kanker en ook het blaascarcinoom staat in de top tien op de vijfde plaats. Bij vrouwen komt blaascarcinoom minder vaak voor en staat daarmee niet in de top tien. Het niercarcinoom is bij beide seksen een betrekkelijk weinig voorkomende tumor met ongeveer 1.200 nieuwe gevallen per jaar. Ook het testiscarcinoom is een betrekkelijk zeldzame kankersoort met ongeveer 1.000 nieuwe gevallen per jaar. Het is echter wel de meest voorkomende kanker bij jonge mannen en om onbekende redenen neemt de incidentie toe en is deze in de afgelopen 20 jaar verdubbeld. In de afgelopen 2 decennia zijn er bij het testiscarcinoom, blaascarcinoom, prostaatcarcinoom en het niercelcarcinoom grote sprongen voorwaarts gemaakt. Deze ontwikkelingen zullen beschreven worden. Hierbij zal de focus liggen op de rol van het Erasmus MC en de tot stand gebrachte samenwerkingsverbanden. Tenslotte zal bij elk voor deze tumortypes een blik op de toekomst gegeven worden