1. Treatment Options for Invasive
Bladder Carcinoma
Ahmad Abid Bin Abas 07-5-02

2. Treatment Modalities
• Surgery :
1) Transurethral Resection with fulguration.
2) Radical Cystectomy
3) Segmental Cystectomy
4) Urinary Diversion (Ileal conduit,orthotopic
neobladder)

3. (TUR)
• http://passingtravelers.com/13099-2/cancer-after-the-initial-diagnosis

4. Radical Cystectomy

5. Urinary Diversion
• http://kidney.niddk.nih.gov/kudiseases/pubs/urostomy/

6. Treatment Modalities
• Radiation Therapy :
1) External Radiation
(Machine outside the body)
2) Internal Radiation
(Radioactive substance sealed in needles,
seeds, wires, or catheters)

7. Treatment Modalities
• Chemotherapy
1) (MVAC) - 2-3 cycles of
methotrexate,vinblastine, adriamycin plus
cisplatin.
2) (CMV) - cisplatin, methotrexate plus
vinblastine

8. Treatment Modalities
• Biologic Therapy (Immunotherapy)
1) An immune-stimulating bacterium.-Bacille
Calmette-Guerin (BCG)
2) A synthetic version of an immune system
protein. (Interferon alpha)

9. New Treatment Modalities still in
Clinical Trials
• Chemoprevention . (drugs,vitamins etc..)
• Photodynamic Therapy (PDT)
(drug + laser beam)

10. Treatment Options by Stage 0
Stage 0 (Papillary Carcinoma and Carcinoma in
Situ)
• Transurethral resection with fulguration.
• Transurethral resection with fulguration
followed by intravesical biologic therapy or
chemotherapy.
• Segmental cystectomy or radical cystectomy.

11. Treatment Options by Stage I
• * same modalities as stage 0 but more options
as follow :
• Radiation implants with or without external
radiation therapy.

12. Treatment Options by Stage II
• Radical cystectomy with or without surgery to
remove pelvic lymph nodes.
• Combination chemotherapy followed by radical
cystectomy.
• External radiation therapy combined with
chemotherapy.
• Radiation implants before or after external
radiation therapy.
• Transurethral resection with fulguration.
• Segmental cystectomy.

13. Treatment Options by Stage III
• Radical cystectomy with or without surgery to
remove pelvic lymph nodes.
• Combination chemotherapy followed by radical
cystectomy.
• External radiation therapy combined with
chemotherapy.
• External radiation therapy with radiation
implants.
• Segmental cystectomy.

14. Treatment Options by Stage IV
• Radical cystectomy with surgery to remove pelvic
lymph nodes.
• External radiation therapy (may be as palliative
therapy to relieve symptoms and improve quality
of life).
• Urinary diversion as palliative therapy to relieve
symptoms and improve quality of life.
• Cystectomy as palliative therapy to relieve
symptoms and improve quality of life.
• Chemotherapy alone or after local treatment
(surgery or radiation therapy).

15. References
• http://www.mayoclinic.com/health/bladder-
cancer/DS00177/DSECTION=treatments-and-
drugs
• http://www.cancer.gov/cancertopics/pdq/trea
tment/bladder/Patient/page5