Nonmuscle-invasive Bladder Cancer
Treatment of nonmuscle-invasive bladder cancers (Ta, Tis, T1) is based on risk stratification. Essentially all patients are initially treated with a transurethral resection (TUR) of the bladder tumor followed by a single immediate instillation of intravesical chemotherapy (mitomycin C is typically used in the United States).[1,2,3,4,5,6,7]
Subsequent therapy after the treatment above is based on risk and typically consists of one of the following:[6,7,8,9]
- Surveillance for relapse or recurrence (typically used for tumors with low risk of recurrence or progression).
- A minimum of 1 year of intravesical treatments with bascillus Calmette-Guérin (BCG) plus surveillance for relapse (typically used for tumors at intermediate or high risk of progression to muscle-invasive disease).
- Additional intravesical chemotherapy (typically used for tumors with a high risk of recurrence but low risk of progression to muscle-invasive disease).
Muscle-invasive Bladder Cancer
Standard treatment for patients with muscle-invasive bladder cancers whose goal is cure is either neoadjuvant multiagent cisplatin–based chemotherapy followed by radical cystectomy and urinary diversion or radiation therapy with concomitant chemotherapy.[10,11,12,13] Other treatment approaches include the following:
- Radical cystectomy followed by multiagent cisplatin–based chemotherapy.
- Radical cystectomy without perioperative chemotherapy.[14,15,16]
- Radiation therapy without concomitant chemotherapy.
- Partial cystectomy with or without perioperative chemotherapy.
Many patients newly diagnosed with bladder cancer are candidates for participation in clinical trials.
Reconstructive techniques that fashion low-pressure storage reservoirs from the reconfigured small and large bowel eliminate the need for external drainage devices and, in many patients, allow voiding per urethra. These techniques are designed to improve the quality of life for patients who require cystectomy.