Question

A lady who presented with hematuria was, on evaluation, found to have stage 2 (muscle-invasive) transitional cell carcinoma of the bladder. Which of the following is true?

• A. 70% chance of requiring cystectomy in 5 years
• B. Cystoscopic fulguration is required in case of recurrence
• C. A 10 year history of beedi smoking is not a risk factor
• D. There is no role of chemotherapy

Hint:

Stage 2 means muscle-invasive disease, which is treated by radical cystectomy.

Answer 1

The Correct Option is A

Step 1: Stage the tumour. Stage 2 transitional (urothelial) cell carcinoma of the bladder is muscle-invasive disease, where the tumour has invaded into the detrusor (muscularis propria) but is confined to the bladder.
Step 2: Decide the standard treatment. Muscle-invasive bladder cancer is managed by radical cystectomy (with urinary diversion), with or without neoadjuvant chemotherapy. The likelihood of needing cystectomy in such patients is high, on the order of 70% within 5 years, which makes option A correct.
Step 3: Eliminate the other options. Cystoscopic fulguration is a treatment for superficial (non-muscle-invasive) tumours, not for muscle-invasive recurrence, so option B is false. Smoking, including beedi smoking, is the single most important modifiable risk factor for urothelial carcinoma, so option C is false. Platinum-based chemotherapy (neoadjuvant and for metastatic disease) has a well-established role, so option D is false.
Step 4: Conclusion. The only true statement is the high probability of requiring cystectomy within 5 years.