Surgical Management of Bladder Carcinoma

Rafael Carrion, MD, John Seigne, MB

Disclosures

Cancer Control. 2002;9(4) 

In This Article

Results of TURBT: Tumor Control

TURBT effectively provides tissue for the diagnosis and staging of bladder cancer. The effectiveness of TURBT as a therapy of bladder cancer is primarily dependant on the biological behavior of the bladder tumor rather than the surgical resection itself. Thus, small, solitary, low-stage and low-grade (Ta grade I-II) tumors are effectively excised and have a low recurrence rate following TURBT, whereas T1 grade III tumors recur frequently (60%) despite the fact that they are completely excised ( Table 1 ).[17,18,19] Clearly, patients with these high-risk tumors have the most potential to benefit from adjuvant intravesical therapy. In the case of invasive tumors (T2 or greater), the limitations of endoscopic resection are 3-fold. First, complete resection of the tumor is difficult because of extension into and through the muscle wall. Second, the field defect is not treated; therefore, there is a high risk of tumor recurrence (or a new occurrence) elsewhere in the bladder. Third, muscle-invasive bladder cancer is associated with a significant rate of metastatic disease that is neither evaluated nor treated by local surgery within the bladder.[8,12,13,17,18,19,20,21] Endoscopic resection alone of select T2 tumors can provide long-term control. The recent summary experience reported at one institution showed a 10-year disease-specific survival of 76%.[22] However, because of the limitations noted above, bladder-sparing approaches for invasive bladder cancer generally combine radiation and chemotherapy.

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