Developments in diagnosis and prognosis of superficial bladder cancer.
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[S.l. : s.n.]
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RU Radboud Universiteit Nijmegen, 23 augustus 2007
Promotores : Witjes, J.A., Kiemeney, L.A.L.M., Schalken, J.A.
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SubjectNCEBP 1: Molecular epidemiology; UMCN 1.2: Molecular diagnosis, prognosis and monitoring
Non-muscle invasive bladder encompasses the relatively innocent low risk tumours, but also the potentially lethal high risk tumours. Low risk tumours have a high chance of recurrence, but high risk tumours have both a high risk of recurrence and progression. Progression to muscle-invasive disease implies a much higher mortality. So frequent surveillance is necessary for all patients within this spectrum. This surveillance is done by cystoscopy and cytology. In this thesis, new markers in diagnosis and prognosis of non-muscle invasive (superficial) bladder cancer are being evaluated. The NMP22® BladderChek® Test, UroVysion® , and quantitative cytology are being studied as diagnostic markers. The most promising test seems to be UroVysion® (FISH). Quantitative cytology, a bladder wash marker earlier developed in the Radboud University Nijmegen Medical Centre, is adapted and now can be performed on urine. The p53 tumour suppressor gene is evaluated in two large retrospective studies, unfortunately the earlier promising results could not be confirmed. A pilot studying the effect of the presence of HPV DNA on the clinical outcome of patients did not indicate it as a valuable marker for patients with non-muscle invasive bladder cancer. Most likely it is not a single marker that will predict recurrence or even progression in this disease, but a panel of markers. Currently the Radboud University Nijmegen Medical Centre is studying a high density single nucleotide polymorphism (SNP) array, detecting genomic instability characteristic for bladder cancer. Furthermore, more efforts should be undertaken to develop a prognostic marker, that can predict which patient will show progression and therefore should be treated more vigorously. Because at this moment patients are still dying from a disease that can be treated so good, if we prevent progression to occur
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