A 65-year-old man presents with a 3-month history of painless total haematuria. He is a heavy smoker (40 pack-years). Cystoscopy reveals a papillary lesion on the posterior wall of the bladder. Transurethral resection of the bladder tumour (TURBT) histology shows transitional cell carcinoma, grade 2, invading the lamina propria but not the muscularis propria. Staging CT shows no lymphadenopathy or distant metastases. What is the correct staging and recommended adjuvant treatment after TURBT?
- A T2 G2; radical cystectomy
- B Ta G2; intravesical mitomycin C single instillation only
- C T3 G2; neoadjuvant chemotherapy and radiotherapy
- D T1 G2; intravesical BCG immunotherapy ✓
Explanation
Invasion of the lamina propria without involvement of the muscularis propria corresponds to T1 disease (non-muscle-invasive bladder cancer, NMIBC). T1 G2 (intermediate/high-risk NMIBC) requires intravesical BCG immunotherapy after complete TURBT to reduce recurrence and progression risk; BCG induces a local immune response that eradicates residual microscopic tumour and reduces progression to muscle-invasive disease. Ta is confined to the urothelium (papillary, above the basement membrane). T2 involves the muscularis propria and requires radical cystectomy. T3 extends beyond the bladder wall.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.