What are the guidelines for surgical treatment of bladder cancer?

Updated: Feb 23, 2021
  • Author: Kara N Babaian, MD, FACS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

Endoscopic TURBT is the first-line means of diagnosing, staging, and treating visible tumors. Electrocautery or laser fulguration of the bladder tumor is sufficient for low-grade, small-volume, papillary tumors. However, the EAU guidelines recommend resection of small tumors (< 1 cm) in a single piece that includes part of the underlying bladder wall. [69]

The EAU and NCCN guidelines offer similar recommendations for surgical treatment. [1, 69] Patients with bulky, high-grade, or multifocal tumors should undergo a second procedure to ensure complete resection and accurate staging 2-6 weeks after the initial TURBT.

Both guidelines state that a second resection should be performed at this time if these or other factors, such as an absence of muscle tissue in the initial specimen, indicate that the initial TURBT was incomplete. Resection of large tumors (>1 cm diameter) should be performed in fractions, including muscle tissue. [1, 69] Approximately 30% of stage T1 tumors are upgraded to muscle-invasive disease.


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