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Question 2#

Which of the following is true about bladder cancer?

a. For patients with bladder cancer invading into the bladder muscle (T2 lesion) immediate radiotherapy followed by surgery offers the best chance of cure
b. Patients with limited lymph node involvement may be cured by surgery alone
c. Continent neobladders have yet to be successfully utilized in patients undergoing cystectomy
d. Intravesical chemotherapy prior to surgery is routinely used for bladder cancers invading into the bladder muscle (T2 lesion)

Correct Answer is B

Comment:

For patients who have disease invading into bladder muscle (T2), immediate (within 3 months of diagnosis) cystectomy with extended lymph node dissection offers the best chance of survival. Patients with limited lymph node involvement may be cured with surgery alone. Patients have multiple reconstructive options, including continent and noncontinent urinary diversions. The orthotopic neobladder has emerged as a popular urinary diversion for patients without urethral involvement. This diversion type involves the detubularization of a segment of bowel, typically distal ileum, which is then refashioned into a pouch that is anastomosed to the proximal urethra (neobladder) or to the skin (continent cutaneous diversion). Patients with non-muscle-invasive bladder cancer (confined to the bladder mucosa or submucosa) can be managed with transurethral resection alone and adjuvant intravesical (instilled into the bladder) chemotherapy/immunotherapy.