A 58 year old male presents with hematuria. He s diagnosed of having bladder cancer which extends muscle deep. The best treatment is -
Ans. is 'b' i.e., Neoadjuvant chemotherapy followed by radical cystectomy Management of bladder cancero Cystoscopy and transurethral resection or biopsy# initially, any pt. with hematuria is examined by cystoscopy and any tumor seen is removed by transurethral resection (if possible) or biopsied.o Further treatment decisions are made after tumor staging on histology. Such decisions are based on tumor stage (TNM), grade, size, multiplicity, and recurrence patterno First see the staging (TNM)o The primary bladder cancer is staged according to the depth of invasion into the bladder wall or beyond The urothelial basement membrane separates superficial bladder cancers into Ta (noninvasive) and T1 (invasive) tumors. The muscularis propria separates superficial disease from deeply (muscularis propria) invasive disease. Stage T2 and higher T stage tumors invade the muscularis propria, the true muscle of the bladder wall. If the tumor extends through the muscle to involve the full thickness of the bladder and into the serosa, it is classified as T3. If the tumor involves contiguous structures such as the prostate, the vagina, the uterus, or the pelvic sidewall, the tumor is classified as stage T4.# Tis Ca in situ# Ta Ca confined to mucosa# T1 Ca confined to submucosa# T2 Muscle invasion# T3 perivescical fat invasion# T4 invasion of adjacent structures (prostate, uterus, vagina, pelvic wall, abd. wall)o Now the histological grading.# There are 3 histological gradeso Grade I, II & IIIo There is a strong correlation between tumor grading and tumor recurrence progression and survival.Treatment options for bladder cancersCancer stageInitial treatment optionsTisComplete TUR followed by intravesical BCGTa (single, low-to- moderate grade, not recurrent)Complete TURTa (large, multiple, high grade, or recurrent)Complete TUR followed by intravesical chemo-or immunologyT1Complete TUR followed by intravesical chemo- or immunotherapy or radical cystectomyT2-T4Radical cystectomyNeoadjuvant chemotherapy followed by radical cytectomy followed by adjuvant chemotherapyConcomitant chemotherapy and irradiationAny T, N+, M+Systemic chemotherapy followed by selective surgery orirradiationo Intravesical therapy : Common agents used for intravesical therapy are# Mitomycin C# Thiotepa# BCGo Among these agents, BCG is the most effective.o The patient in question has T1 stage (Tumor upto submucosa)
Intravesical Chemotherapy
Neoadjuvant chemotherapy followed by radical cystectomy
Radiotherapy
Tranurethral resection
Bladder Cancer