CLINICAL GUIDELINES FOR DIAGNOSING, TREATMENT AND MONITORING PATIENTS WITH BLADDER CANCER – CROATIAN ONCOLOGY SOCIETY AND CROATIAN UROLOGY SOCIETY, CROATIAN MEDICAL ASSOCIATION

Autori:

Marija Gamulin, Ira Pavlović Ružić, Mislav Grgić, Marijana Jazvić, Mladen Solarić, Dag Zahirović, Robert Zorica, Tomislav Omrčen, Marija Petković, Mate Matić, Željko Fučkar, Boris Ružić, Josip Pasini, Marijan Šitum, Gordana Đorđević, Damir Miletić, Tade Tadić, Željko Kaštelan, Davor Librenjak, Ivan Gilja, Katarina Vilović, Božo Krušlin, Hrvoje Kuveždić

Sažetak

Urotelni rak najčešći je rak mokraćnog mjehura. Hematurija je najčešći simptom pri prezentaciji bolesti. Dijagnoza raka mokraćnog mjehura postavlja se uglavnom transuretralnom resekcijom nakon čega slijedi patohistološka dijagnoza. Nužno je utvrditi je li rak zahvatio mišićni sloj (mišićnoinvazivni rak) ili nije (mišićnoneinvazivni rak). Odluka o terapijskome modalitetu ovisi o kliničkom stadiju bolesti, prognostičkim čimbenicima i čimbenicima rizika. Za mišićnoneinvazivni rak mokraćnog mjehura uglavnom se preferira transuretralna resekcija tumora mokraćnog mjehura s intravezikalnom instilacijom Calmette-Guérinova bacila (BCG) ili bez nje. Za invazivni je rak metoda izbora radikalna cistektomija. Radioterapija se rabi u radikalne i palijativne svrhe. Metastatska bolest najčešće se liječi kemoterapijom metotreksat/vinblastin/doksorubicin/cisplatinom (MVAC) ili gemcitabin/cisplatinom (GC). Svrha je ovog članka predstavljanje kliničkih uputa s ciljem standardizacije postupaka i kriterija postavljanja dijagnoze, liječenja te praćenja bolesnika s rakom mokraćnog mjehura u Republici Hrvatskoj.

Summary

Urothelial cancer is the most common bladder cancer. Hematuria is the most common presenting symptom in patients with bladder cancer. The most common diagnostics of bladder cancer is performed by transurethral resection of bladder after which pathohistological diagnosis is set. It is necessary to determine whether the cancer penetrated in muscle layer (muscle-invasive cancer) or not (muscle-noninvasive cancer). Decision on therapeutic modality depends on the clinical stage of disease and on prognostic and risk factors. For muscle non-invasive bladder cancer transurethral resection is preferred with or without intravesical instillation of Bacillus Calmette-Guérin (BCG). For invasive cancer the method of choice is radical cystectomy. Radiotherapy is used in radical and palliative purposes. Metastatic disease is most frequently treated by chemotherapy metotrexate/vinblastine/doxorubicine/cisplatin (MVAC) or gemcitabine/cisplatin (GC). The purpose of this article is to present clinical recommendations to set standards of procedures and criteria in diagnostics, treatment and follow up of patients with bladder cancer in the Republic of Croatia.