[Current diagnostic and therapeutic approaches to invasive bladder cancer]

Bladder cancer is the second most common urological cancer (after prostate cancer, and before kidney and testicular tumors). After setting a diagnosis for bladder cancer, transitional cell carcinoma (TCC), 25% of pts have extravesical spread of the disease, and almost 50% dies in the follow-up period and after radical surgical procedures. About 30-40% pts develop a recurrence, even after radical cystectomy is preformed, and with negative lymph nodes. T2 stage is underestimated in 40-50% of cases, whereas lymph nodes are positive in 10% of cases in T1 stage of the disease. The aim of this study was to present modern diagnostic-therapeutic procedures, which are being used in multimodal treatment of invasive bladder tumors (surgery, chemotherapy, radiotherapy), indications for their use, and treatment outcome in regard to the stage of the disease.

Pathological diagnosis is a key factor for correct and on-time treatment. Pathological diagnosis is made by the biopsy of the tumor. Clinical diagnosis is made by using modern diagnostic procedures (ECHO, CT, MRI, PET scan), and tumor markers (DNA content, p-53, E-Catherine, pRb -retinoblastoma, BCL-2, PCNA, telomerase, NMP-22, BTA-test, etc.).

Treatment of bladder tumors is multimodal, multidisciplinary and includes surgery, chemotherapy and radiotherapy. In regard to indications and established protocols, surgery is partial, simple or radical cystectomy, followed by different types of urine derivation (wet stoma--Bricker's ileal conduit, dry stoma--Kock pouch, ureterosigmoidostomy--Mainz pouch II, or orthotopic ileal bladder substitution). The use of new operative procedures can be done only during the early stage of the disease. Orthotopic substitution of bladder with ileum, significantly improves the quality of life in these patients. Also, the use of new chemotherapeutics (Methotrexate, Vinblastine, Cisplatine, Gemcitabine, Taxol, alone or in combination) or radiotherapy together with surgery increases the survival rate, even in patients with invasive form of disease.

Using new diagnostic equipment, up-to date therapeutic procedures, bladder cancer becomes a curable disease (depending on the stage of the disease) with high survival rate and better quality of life.