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Chapter 090. Bladder and Renal Cell Carcinomas (Part 3)

Invasive Disease The treatment of a tumor that has invaded muscle can be separated into control of the primary tumor and, depending on the pathologic findings at surgery, systemic chemotherapy. Radical cystectomy is the standard, although in selected cases a bladder-sparing approach is used; this approach includes complete endoscopic resection; partial cystectomy; or a combination of resection, systemic chemotherapy, and external beam radiation therapy. In some countries, external beam radiation therapy is considered standard. In the United States, its role is limited to those patients deemed unfit for cystectomy, those with unresectable local disease, or as part of an experimental. | Chapter 090. Bladder and Renal Cell Carcinomas Part 3 Invasive Disease The treatment of a tumor that has invaded muscle can be separated into control of the primary tumor and depending on the pathologic findings at surgery systemic chemotherapy. Radical cystectomy is the standard although in selected cases a bladder-sparing approach is used this approach includes complete endoscopic resection partial cystectomy or a combination of resection systemic chemotherapy and external beam radiation therapy. In some countries external beam radiation therapy is considered standard. In the United States its role is limited to those patients deemed unfit for cystectomy those with unresectable local disease or as part of an experimental bladder-sparing approach. Indications for cystectomy include muscle-invading tumors not suitable for segmental resection low-stage tumors unsuitable for conservative management e.g. due to multicentric and frequent recurrences resistant to intravesical instillations high-grade tumors T1G3 associated with CIS and bladder symptoms such as frequency or hemorrhage that impair quality of life. Radical cystectomy is major surgery that requires appropriate preoperative evaluation and management. The procedure involves removal of the bladder and pelvic lymph nodes and creation of a conduit or reservoir for urinary flow. Grossly abnormal lymph nodes are evaluated by frozen section. If metastases are confirmed the procedure is often aborted. In males radical cystectomy includes the removal of the prostate seminal vesicles and proximal urethra. Impotence is universal unless the nerves responsible for erectile function are preserved. In females the procedure includes removal of the bladder urethra uterus fallopian tubes ovaries anterior vaginal wall and surrounding fascia. Previously urine flow was managed by directing the ureters to the abdominal wall where it was collected in an external appliance. Currently most patients receive either a continent .