膀胱癌の基礎および臨床

Abstract

The natural history of treated and untreated bladder cancer has been elu- cidated based on accumulation of the pathological and biological knowledge of bladder carcinogenesis obtained traditionally from chemical carcinogenesis experiments in animals, and recently from various molecular biological studies. On the other hand, the recent development of accurate and minimally invasive diagnostic and therapeutic modalities has helped us treat the patients with bladder cancer conservatively. Actually, the endoscopic surgical procedures, several useful molecular or genetic markers, a new classification for bladder cancer based on the biological malignant potential, and evidence-based therapy of BCG (bacillus Calmette Guerin) or new chemotherapeutic regimens are available now for management of bladder cancer. However, bladder cancer still has several controversial problems. BCG-treatment failure in patients with high-risk superficial bladder cancer including carcinoma in situ, validity of neo-adjuvant or adjuvant chemotherapy, and deterioration of the quality of life by the urinary diversions following cystectomy have not yet been solved. Another focus of argument in bladder cancer is the current trend of establishing guidelines or a manual for management of bladder cancer. In this manuscript, the outcomes of the traditional or recently-advanced basic and clinical research on bladder cancer including our Nara Uro-oncology Research Group studies are briefly reviewed.