CONCEPTS CANCER IN THE TREATMENT OF BLADDER-CLINICAL AND EXPERIMENTAL

Assessment of optimal management of a patient with bladder cancer will be dependent on tumor grade, stage and multiplicity as well as the patient's medical status. Thus the urologist should attempt to assess the extent of urothelial abnormality and obtain as accurate a stage as possible. Despite endoscopy, biopsy, and bimanual examination under anesthesia, the precise depth of invasion is often inaccurate when dealing with a tumor which has invaded into the muscle. Newer techniques such as endoscopic ultrasound and CAT scan may allow the clinician to improve his accuracy in gauging the stage of invasive tumors. Selected site cold cup biopsies are advantageous in determining the extent of urothelial abnormalities, e.g. dysplasia, carcinoma in situ (CIS). Prognosis is largely de-pendent on the depth of tumor invasion, with the likelihood of dissemination much greater once the tumor has invaded into the muscular wall of the bladder. Thus those patients with stage Ta, Tl or Tis are managed endoscopically with supplemental intravesical chemotherapy and those with T2 or greater lesions are treated with radiation and/or extirpative surgery