This document outlines treatment options for invasive bladder carcinoma at different stages. The main treatment modalities are surgery including transurethral resection and radical cystectomy, radiation therapy, chemotherapy, and biologic therapy. Surgical options range from transurethral resection to radical cystectomy depending on the stage. Radiation therapy can involve external beams or internal radiation implants. Chemotherapy regimens include MVAC and CMV. Biologic therapies use BCG or interferon alpha. New treatments under study include chemoprevention and photodynamic therapy. Treatment selection varies based on the stage of cancer.

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