Bladder Cancer (Muscle-Invasive)

• Pathology report from the transurethral resection confirming muscle invasion, with grade and any variant histology such as squamous or micropapillary features.
• CT of the chest, abdomen and pelvis and, where available, pelvic MRI, to show nodal or distant spread.
• Kidney function (eGFR) and heart assessment, because they determine eligibility for cisplatin chemotherapy.
• Records of hydronephrosis or ureteric stents, and any previous BCG or pelvic radiotherapy.
• A summary of fitness for major surgery: other illnesses, medicines, mobility and nutrition.

1. What is the clinical stage, and have scans shown any spread?
2. Should I have chemotherapy before surgery, and am I fit for cisplatin?
3. Am I a candidate for bladder preservation, and what happens if it fails?
4. Which type of urinary diversion suits me, and what will daily life with it involve?
5. What are the risks of cystectomy for sexual function and recovery time?
6. How often will I need scans afterwards?

Muscle-invasive bladder cancer is a serious disease, but cure is possible when it is confined to the bladder. Treatment that combines chemotherapy with radical cystectomy, or in selected patients chemoradiotherapy, gives roughly half of patients or more long-term control when the disease has not spread. Survival falls when the tumour extends through the bladder wall or into lymph nodes, and is much lower if there are distant metastases. Age, fitness and kidney function influence which treatments can be used and how well they are tolerated.