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Current Perspectives on Palliative Therapy in Cancer of the Bladder¹

Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio 44106

Palliative therapy eliminates or reduces symptoms in the patient with advanced cancer, with the full knowledge that prognosis is ultimately hopeless. Palliation in general is designed either to relieve local bladder symptoms or to relieve pain or other symptoms related to disseminated metastases. Conservative intravesical therapy by the Helmstein hydrostatic balloon technique or by intravesical formalin appears to be the most effective method for relief of local symptoms without major risk to the patient. Angiocatheter conclusion of the hypogastric arteries may be used as adjunctive therapy in reducing bladder hemorrhage in selected patients. Repeated endoscopic resection and/or fulguration of local tumors can also provide significant palliation if the disease is sufficiently localized. Supravesical diversion with or without palliative cystectomy should be reserved for patients not responding to conservative local therapy. In patients with diffuse pain from systemic metastases, the Brompton protocol has been extremely effective in terms of long-term analgesia and promotion of a sense of well-being. If distant metastases are sufficiently localized, focal irradiation can temporarily relieve local pain or discomfort. Relief of symptoms of uremia in the terminally ill patient with bladder carcinoma should not be recommended except in unusual circumstances. Systemic chemotherapy would theoretically be the most effective method of treatment of systemic metastases, but effective drug therapy is as yet not available for most patients with this disease.

¹ Presented at the National Bladder Cancer Conference, November 28 to December 1, 1976, Miami Beach, Fla.

² Presenter.