[Therapeutic strategies in patients with bladder tumors according to histopathological findings]

The therapeutic strategy in patients with bladder carcinoma depends on general conditions, i.e. age of the patient, history, i.e. primary tumor versus recurrent tumor and on the histopathological finding according to the transurethral resection. Exophytic tumor, tumor burden as well as deep muscle layer have to be investigated combined with urinary cytology. Independent prognostic factors are depth of infiltration, differentiation grade, concomitant carcinoma in situ (TIS), lymph node metastases or distant metastases. Carcinoma in situ is characterized by an intraepithelial growth, poorly differentiated tumor cells and an completely disturbed growth pattern (Fig. 1). Those histopathological findings are of great importance for further therapy. Patients with poorly differentiated superficial bladder carcinoma or patients with carcinoma in situ are treated by adjuvant chemo- or immunotherapy. Radical cystectomy is indicated in all cases of recurrent T1 G3 carcinoma or persistent carcinoma in situ. The histopathological investigation of regional lymph nodes is of great prognostic value and influences the therapeutic strategy. Patients with positive lymph nodes (N2-N3) should not be considered for radical cystectomy because these patients will have no survival benefit. Histopathological examination of distant metastases are without prognostic or therapeutic value because these patients are normally treated by systemic chemotherapy.