A 60-year-old man presents with painless haematuria. Cystoscopy reveals a papillary tumour on the posterior wall of the bladder. Transurethral resection reveals grade 2 urothelial carcinoma invading the muscularis propria (T2). The most appropriate treatment is:
- A Intravesical BCG immunotherapy
- B Repeat TURBT every 3 months
- C Radical cystectomy with neoadjuvant chemotherapy ✓
- D External beam radiotherapy alone
Correct answer: C. Radical cystectomy with neoadjuvant chemotherapy
Explanation
Muscle-invasive bladder cancer (T2 and above) requires radical cystectomy (removal of bladder, prostate or uterus/ovaries, and lymph nodes). Neoadjuvant cisplatin-based chemotherapy improves overall survival by approximately 5-8% and is recommended before cystectomy. Intravesical BCG is appropriate for high-grade non-muscle-invasive (T1/CIS) tumours, not T2. Repeat TURBT alone is inadequate for muscle-invasive disease. External beam radiotherapy can be considered in patients unfit for surgery.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.