Download Standard of care=intravesical Therapy transurethral resection

Bladder cancer is the second most common
cancer of the genitourinary tract.
The incidence is higher in whites than in
African Americans.
The average age at diagnosis is 65 years.
Cigarette smoking accounts for 50% of cases in men
and31% in women
Occupational exposure
Patients who have received cyclophosphamide
(Cytoxan).
Physical trauma to the urothelium induced by
infection,instrumentation, and calculi increases the
risk of malignancy .
The genetic factors
 Transitional
cell carcinoma is the second
most common genitourinary malignancy in US
and third most common cause of death
among genitourinary tumors.
 It is widely accepted that bladder cancer is
divided into Non-muscle invasive (Ta,T1) and
muscle invasive (T2-4).
 Carcinoma in situ (CIS) is non-invasive by
definition, but is a high-risk lesion.
transitional-cell carcinoma
90-95% 
squamos-cell carcinoma
adenocarcinoma
small-cell carcinoma
3% 
2% 
<1% 
superficial bladder cancer 75-85% 
pTa, pTis, pT1
muscle-invasive bladder cancer
10-15% 
pT2, pT3, pT4
metastatic bladder cancer
N+, M+
5% 
Histological grading is important 
G3
G2
G1
80% 50% 42%
45% 11%
2%
Relapse rate
Progression rate
 70%
of bladder tumors are superficial at
presentation, limited to the mucosa,
submucosa, or lamina propria, and are
managed conservatively by endoscopic
resection.
 60/70% of superficial tumors recur and
20/30% of recurrent tumors will progress to a
higher stage or grade.
Reuter V. .Diagnostic Surgical Pathology.
.1994:1767/805
Soloway MS. cancer. Urology 1985;26:18/26.

Of non-muscle
invasive bladder
tumors,70%
present as stage
Ta, 20% as T1, and
10% as CIS.
Standard of care=intravesical Therapy 
 transurethral resection
70% Relapse rate: 
 adjuvant therapy
 The
initial management of bladder TCC
involves transurethral resection of the tumor.
 The purpose of the initial resection
Remove the cancer,
provide accurate clinical staging.
(Adequate resection,bimanual examination and
imagings)
 The
use of laser resection or vaporisation of
bladder tumors is less documented.
 The holmium laser is used preference to the
neodymium:YAG, due to its low depth of
penetration (0.3—0.4mm vs. 4—6 mm).
 However it has increased levels of tissue
destruction with subsequent histological
compromise.
 Expensive
Bleeding is negligible
 No tissue available
 Perforationof a hollow, viscous organs

Radical cystectomy implies removal of the 
anterior pelvic organs: in men, the bladder
with its surrounding fat and peritoneal
attachments, the prostate, and the seminal
vesicles; in women, the bladder and
surrounding fat and peritoneal attachments,
cervix, uterus, anterior vaginal vault,
urethra, and ovaries.
This remains the “gold standard” of 
treatment for patients with muscle invasive
bladder cancer
Disease-free survival 5 years after surgery is 
based on tumor stage:
88% for patients with P0,Pa, or PIS disease; 
80% for patients with P1 disease;
81%for patients with P2 disease; 68% for 
patients with P3a and47% for those with P3b
disease; and 44% for patients withP4a disease
Recurrences after surgery usually occur
within the first 3 years.
External beam irradiation (5000–7000 cGy), 
delivered infractions over a 5- to 8-week
radical cystectomy in well-selected patients
with deeply infiltrating bladder cancers.
Treatment is generally well tolerated, but
approximately 15% of patients may have significant bowel, bladder, or rectal
complications. to
Five-yearsurvival rates for stages T2 and T3 
disease range from 18%to 41%.
Unfortunately, local recurrence iscommon, 
occurring in approximately 33–68% of
patients.
Consequently, radiation as monotherapy is 
usually offered only to those patients who
are poor surgical candidates due to advanced
age or significant comorbid problems
Approximately 15% of patients who present 
with bladder cancer are found to have
regional or distant metastases;
approximately 30–40% of patients with 
invasive disease develop distant metastases
despite radical cystectomy or definitive
radiotherapy.
Approximately 13–35% of patients receiving 
such regimens attain a complete.