Dr. med. Dirk Manski

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Bladder cancer (4/7): Treatment Options

Review Literature: EAU guidelines: superficial bladder cancer (Babjuk et al, in 2008 and 2013). Advanced bladder cancer (Stenzl et al, 2009 and Witjes et al, 2013).

Flowchart of the treatment options of superficial bladder cancer, depending on the risk classification according to tab. , and tab. .
(1) Fluorescence cystoscopy if high grade cells are present in the urine cytology or with high grade tumors in history. Second TURB for all tumors except small Ta low grade (→ follow-up) or solitary CIS (→ immediate BCG)
(3) advanced or endoscopically unmanageable tumor and depending on age.
bladder cancer therapy flowchart

Superficial bladder cancer:

TURB with complete resection of the tumor, single shot Mitomycin after TURB, repeat resection of the scar after 4–6 weeks.

Adjuvant intravesical therapy:

Adjuvant intravesical therapy with mitomycin C or BCG depending on the risk profile according to tab. , and tab. . Repeat resection of the scar after the first treatment cycle.

With a negative histology:

intravesical maintenance therapy.

In low-grade recurrence:

further intravesical chemotherapy and repeat TURB.

In high-grade tumor recurrence:

radical cystectomy.

Invasive bladder cancer (T2–4 M0):

Radical cystectomy. Consider neoadjuvant chemotherapy for advanced bladder cancer.

After cystectomy with R0, N0, M0:.

regular cancer follow-up

After cystectomy with R1, N + or from T3b:

(neo) adjuvant chemotherapy with gemcitabine and cisplatin. Tight tumor follow-up.

urothelial carcinoma of the prostate:

radical cystoprostatectomy, orthotopic urinary diversion is not possible.

Alternatives to cystectomy:

especially in patients with high surgical risk.

Bladder carcinoma at the bladder dome:

Partial cystectomy with pelvic dissection.

Repeat radical TURB:

if a R0 resection is reached, close follow up with repeat biopsies.

Radiochemotherapy:

Radical TURB with adjuvant radiochemotherapy.

Bladder cancer with distant metastases:

Cisplatin-containing chemotherapy or immunotherapy with checkpoint inhibitors.





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