Translational Medicine and Oncologists Meet

In urinary bladder, tumors with neuroendocrine differentiation account for less than 1% of primary malignances. Apart from low grade “typical” and intermediate grade “atypical” carcinoids which usually have a bit more favorable outcome for the patient, depending on whether or not there are distant metastases present, small cell neuroendocrine carcinomas (SCNEC) and large cell neuroendocrine carcinomas (LCNEC) are both extremely aggressive and have very poor prognosis. SCNEC is the most common with roughly 500 cases diagnosed annually, while carcinoids and LCNEC are far less common, as there are approximately 20 cases of each type recorded worldwide. Although carcinoids are slowly growing tumors, the final outcome of treatment would primarily depend on disease stage. SCNEC and LCNEC behave similarly, but because of their rarity most effective therapeutic strategies are still largely unknown. In a way LCNEC and SCNEC can be regarded as a systemic disease as micro-metastases may be present in clinically localized disease, so bladder-sparing protocols have a serious drawback because there is a high probability of residual or recurrentcarcinoma occurrence in the preserved bladder. Radical surgery currently seems to be the best option for patients with localized disease, and in combination with other therapeutic modalities it may provide long-term control. However, in approximately 50% of cases, distant metastases are already present at the time of diagnosis and in those patients surgery has limited power to improve the outcome. Also, advanced age along with other multiple co-morbidities typically contribute to poor survival.