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Worldwide, bladder cancer is common in both men and women. In most cases, the cancer occurs in the superficial layers of the bladder and can be surgically removed. However, in many people the cancer returns. Drugs placed directly into the bladder tissue following surgery are therefore often used to try to prevent the cancer recurring. Bacillus Calmette‐Guérin (BCG) is a live attenuated bacterium used for immunization against tuberculosis, and is safe and effective for that purpose; it has also been licensed by the US FDA and other national regulatory agencies for use in superficial bladder‐cancer treatment. The review found that BCG treatment was effective in preventing cancer recurrence following surgery. Further studies into making treatment more effective are needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: October 23, 2000

Expert-reviewed information summary about tests used to detect or screen for bladder cancer.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: March 9, 2018

Treatment of bladder cancer depends on the stage of the cancer. Treatment options include different types of surgery (transurethral resection, radical and partial cystectomy, and urinary diversion), radiation therapy, chemotherapy, and immunotherapy. Learn more about how bladder cancer is treated.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: May 3, 2018

NMIBC is a cancer (tumour) of the inner lining of the bladder that can be removed from the inside using small instruments and a light source, so‐called endoscopic surgery. These tumours can come back over time and spread into the deeper layers of the bladder wall. We know that different types of medicines that we can put into the bladder help prevent this. Investigators have looked at the use of an electrical current to make medicines work better. In this review, we wanted to discover whether using an electrical current was better or worse than not using an electrical current.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: September 12, 2017

Transurethral resection (TUR) is the usual treatment method for patients who, when examined with a cystoscope, are found to have abnormal growths on the urothelium (stage Ta) and/or in the lamina propria (stage T1). However post‐operation tumour recurrence is a major clinical problem. Intravesical Bacillus Calmette‐Guérin or epirubicin following surgery are therefore often used to try to prevent the cancer recurrence. This review found that intravesical Bacillus Calmette‐Guérin is more efficacious than epirubicin to prevent cancer recurrence. However, Bacillus Calmette‐Guérin appears to induce greater local and systemic adverse effects than epirubicin.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: May 11, 2011

When bladder cancer has spread beyond the bladder and is unresectable or metastatic, the possibility of cure is severely diminished. Treatment at this stage of the disease aims to reduce the disease‐related symptoms and to improve quality of life. Chemotherapy is the main treatment offered to patients with this condition and one drug that has recently shown activity is gemcitabine. This review aimed to determine the effectiveness and toxicity of gemcitabine by looking at the evidence published from randomised clinical trials. Patients receiving gemcitabine combined with cisplatin had a similar overall survival but less toxicity when compared to the well‐established chemotherapeutic treatment of MVAC (methotrexate, vinblastine, doxorubicin, cisplatin). This suggests that gemcitabine plus cisplatin may be considered an alternative chemotherapy schedule to MVAC for advanced bladder cancer but the evidence is limited to one trial only. For patients who have poor kidney function or poor performance status the combination of gemcitabine plus carboplatin may be considered.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: April 13, 2011

We reviewed the evidence on the effects of local treatment of the bladder with Bacillus Calmette‐Guérin (BCG) and interferon (IFN)‐alpha (α) for cancer of the superficial layers of the bladder (known as non‐muscle‐invasive bladder cancer).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: March 8, 2017

When bladder cancer is confined to the lining of the bladder it is treated surgically to remove the tumours. However, the tumours may recur and so another type of treatment is often used following surgery called intravesical therapy, whereby agents are instilled directly into the bladder to prevent tumour recurrence. These agents, such as Bacillus Calmette‐Guérin (BCG) may stimulate the body’s immune system to kill any residual cancer cells, or they may be anticancer drugs that act directly on the tumour cells. A relatively new drug used in this situation is gemcitabine. We searched the published literature for randomised clinical trials that evaluated intravesical gemcitabine in bladder cancer patients and found six trials. The first trial compared a single dose of gemcitabine with a placebo immediately following surgery and found no difference in the rate of tumour recurrence, although there was some concern over the trial methodology. Another study compared gemcitabine with the established anticancer drug mitomycin C and showed that gemcitabine was more active and less toxic. Three trials compared gemcitabine with intravesical BCG. The first enrolled patients with intermediate risk of recurrence and reported gemcitabine was as effective as BCG in preventing tumour recurrence and disease progression but with fewer side‐effects. The second trial enrolled untreated patients with a high risk of recurrence and found gemcitabine to be inferior to BCG in preventing recurrence but again was less toxic than BCG. The third trial recruited patients who had previously received BCG but had not responded and this study showed that gemcitabine was superior to BCG in reducing the rate of tumour recurrence. These small numbers of trials indicate that intravesical gemcitabine has activity in delaying tumour recurrence and may have a role in patients who are not suitable for, or who have failed, BCG therapy. The final study suggested that multiple doses of gemcitabine gave better tumour responses compared to a single dose, although the clinical significance of this is unclear.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: January 18, 2012

Standard treatments for invasive bladder cancer are either surgery (to remove the bladder and surrounding tissues) or radiotherapy (to kill the cancer cells). This review suggested that 54 out of every 100 patients who had chemotherapy after surgery were alive after three years, compared to 45 out of every 100 patients who received only surgery. Although these results are encouraging, there are not enough trials or patients for these results to be completely reliable. More randomised trials are needed. This review should encourage greater participation in ongoing randomised trials.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: April 19, 2006

The standard treatment for invasive bladder cancer is surgery (to remove the bladder and surrounding tissues), and/or radiotherapy (to kill the cancer cells). This review suggests that 50 out of 100 patients will be alive at five years, when they are given chemotherapy using a platinum drug in combination with other drugs, before having surgery and/or radiotherapy. This is compared to 45 out of every 100 patients who were given surgery and/or radiotherapy without chemotherapy. This benefit of platinum‐based combination chemotherapy was seen in all types of patients and encourages its use for the treatment of invasive bladder cancer. However, chemotherapy based on a single platinum drug did not help patients live longer, and is not recommended.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: January 26, 2004

Apical vaginal prolapse is a descent of the uterus or (after hysterectomy) the upper vagina (vault). Various surgical treatments are available and there are no guidelines to recommend which is the best.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: October 1, 2016

Cancer is a leading cause of death worldwide. Gynaecological cancers (i.e. cancers affecting the ovaries, uterus, cervix, vulva and vagina) are among the most common cancers in women, with a higher incidence in developing countries. Globally, a woman's risk of developing cancer of the cervix, ovaries or uterus by the age of 65 is 2.2%; cancers of the vulva and vagina are less common. The biology of recurrent ovarian cancer differs from that of other gynaecological cancers; it is often responsive to chemotherapy and is not included in this review.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: February 4, 2014

What is the issue? Metastatic breast cancer occurs when the cancer has spread to areas of the body beyond the breast and nearby lymph nodes. Although metastatic breast cancer is generally not curable, it is widely accepted that women with metastatic disease should receive some form of chemotherapy to help ease the severity of disease symptoms, while hopefully extending survival time. Chemotherapy containing platinum is known to be effective for treating a number of cancer types including lung, testicular, head and neck, bladder and ovarian cancers, but it also known to cause more adverse effects (such as nausea and vomiting, hair loss, anaemia, kidney damage and leukopenia (low white blood cells)) than other chemotherapy options. The two platinum agents most commonly used for treating metastatic breast cancer are carboplatin and cisplatin.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: June 23, 2017

Worldwide, cancer of the womb 'endometrial cancer' is the fifth commonest cancer among women up to 65 years of age and has a higher incidence in developed countries than developing countries. For women with cancer of the womb, removal of the womb (hysterectomy) and removal of both fallopian tubes and ovaries is considered current standard treatment. Other treatments include radiotherapy and chemotherapy. Traditionally, surgery for cancer of the womb is performed through a laparotomy (open cut in abdomen).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: September 12, 2012

Cervical cancer is the second most common cancer among women up to 65 years of age and is the most frequent cause of death from gynaecological cancers worldwide. Cervical cancer is staged (classified using a universally adopted system called International Federation of Gynecology and Obstetrics (FIGO) staging) according to how advanced the disease is and whether the cancer has spread beyond the cervix. Stage I cervical cancer is confined to the cervix. Stage I is divided into stage IA and IB. Stage IA is the earliest stage of cervical cancer where the cancer is so small it cannot be seen with the naked eye. Stage IA is subdivided further to stages IA1 and IA2. Stage IA2 means the cancer has grown between 3 and 5 mm into the cervical tissues, but it is still less than 7 mm wide.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: May 29, 2014

Cervical cancer is the second most common cancer among women. A woman's risk of developing cervical cancer by 65 years of age ranges from 0.69% in developed countries to 1.38% in developing countries. In Europe, about 60% of women with cervical cancer are alive five years after diagnosis. Standard treatment for selected early cervical cancer is radical hysterectomy, involving removal of the cervix, uterus (womb) and supporting tissues (parametrium), together with the pelvic lymph glands (nodes) and a top part of the vagina (cuff). Traditionally, radical hysterectomy has been performed as open surgery for more than a century. In recent years this operation has also been performed laparoscopically (key hole surgery) to reduce the size of the abdominal incision.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: October 1, 2013

Women with stage I (early) endometrial cancer have a low risk of recurrence of their disease. Less than 10% of women treated with surgery alone have a recurrence after surgery. This risk is significantly higher (and may be double) for some women with high risk factors including aggressive cell types (grade 3) and deep invasion of the muscle (stage IC). External beam radiotherapy (EBRT) after surgery reduces the risk that the cancer will initially recur in the pelvis by around two‐thirds compared to surgery alone, but does not reduce the risk of death.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: April 18, 2012

Radiotherapy has been successfully used to treat cervical cancer for nearly a century as cervical tissue is very sensitive to radiation. Improved survival and local control rates of the disease have made the combination of external beam radiotherapy (EBRT) and intracavity brachytherapy (ICBT) the standard treatment for locally advanced uterine cervix cancer. ICBT is divided into three modalities, low dose rate (LDR), high dose rate (HDR), and medium dose rate (MDR). Many studies have concluded that the LDR was superior to the HDR as the post‐treatment repair of normal tissue was better. Nevertheless, due to some potential advantages of HDRs in modern afterloading ICBT, HDR ICBT has increasingly been used, instead of LDR ICBT, over the past 20 years.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: October 9, 2014

Late effects of cancer treatment can cause serious, disabling, and life-threatening chronic health conditions that adversely affect the health of aging childhood cancer survivors. Learn about subsequent neoplasms and the cardiovascular, cognitive, psychosocial, digestive, endocrine, immune, musculoskeletal, reproductive, and urinary late effects of pediatric cancer treatment in this expert-reviewed summary.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: January 2, 2018

Expert-reviewed information summary about tests used to detect or screen for prostate cancer.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: February 22, 2018

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