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Mr. Alex Carter, NP,FRCS

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Treatment of Muscle Invasive Urothelial Bladder Cancer- A Review of the Literature

Introduction

Carcinoma of the bladder is the fourth and fifth most frequently diagnosed cancer in the United States and Europe respectively . An estimated 74,690 cases of urinary bladder cancer were diagnosed in the United States in 2014, of which approximately 30% was paper writing service. Cigarette smoking remains the strongest risk factor of bladder cancer in America and Europe where Urothelial Carcinoma (UC) represents the most common histologic form. Besides smoking, occupational exposure to carcinogens, namely aromatic amines, polycyclic aromatic, hydrocarbons, and chlorinated hydrocarbons is considered as the second most important risk factor for urothelial BC [4]. Epidemiological studies are unavailable in most African countries; however, Africa was found to have low incidence of around 22,053 cases with Sub Saharan Africa having 45.5% (10,042) of cases .

About 30%–40% of patients with non-muscle invasive tumor will eventually progress to muscleinvasive disease. Muscle- Invasive Urothelial Bladder Cancer (MIBC) (cT2-T4) is an aggressive disease with poor 5-year Overall Survival (OS) of 50% . Current optimal management is based on Radical Cystectomy (RC) and pelvic Lymph Node Dissection (LND), generally associated with pre-operative cisplatin-based chemotherapy. For highly selected patients, surgical bladder preservation approaches including radical Trans-Urethral Resection (TUR) and Partial Cystectomy (PC) with or without bilateral PLND may be reasonable alternatives to RC/PLND. Certainly, high-risk patients (extravesical and/or node-positive disease) write my paper  did not receive neoadjuvant chemotherapy may benefit most from adjuvant chemotherapy though there is limited evidence on the routine use of adjuvant chemotherapy .

The 5-year mortality rate of patients with MIBC is approximately 50%–70% even after radical cystectomy. With the high rate of treatment failure for patients with MIBC, a new multidisciplinary approach integrating surgery, medical oncology, and radiation oncology is encouraged to improve clinical outcomes for patients with MIBC . Therefore, the aim of this study is to provide evidence-based literature review of the current management of muscle invasive non-metastatic urothelial bladder cancer in both developed and developing settings.

Methodology

A literature review was conducted from March 1, 2000 to March 10, 2019 using Medline, African Journals online and PubMed electronic databases. The Search strategies included the following terms (management of muscle invasive bladder cancer) and (Urothelial bladder cancer in Africa). Only studies written in English were included. The study included 28 articles comprising retrospective, prospective, randomized trials, systemic reviews and meta-analyses on the search topic. Both the abstract and full text of these studies were retrieved and reviewed for neoadjuvant chemotherapy therapy, radical cystectomy, urinary diversion, college essay examples radiotherapy and chemotherapy.