Question

A lady who presented with hematuria was, on evaluation, found to have stage 2 (muscle-invasive) transitional cell carcinoma of the bladder. Which of the following is true?

• A. 70% chance of requiring cystectomy in 5 years
• B. Cystoscopic fulguration is required in case of recurrence
• C. A 10 year history of beedi smoking is not a risk factor
• D. There is no role of chemotherapy

Hint:

Stage 2 means muscle-invasive disease, which is treated by radical cystectomy.

Answer 1

The Correct Option is A

Begin by translating the stage into anatomy: a stage 2 urothelial carcinoma means the cancer has grown into the muscle wall of the bladder, classifying it as muscle-invasive disease rather than a superficial papillary lesion. The therapeutic pathway for muscle-invasive tumours diverges sharply from superficial ones. Superficial tumours are handled by transurethral resection plus intravesical therapy and surveillance, whereas muscle-invasive tumours demand definitive removal of the bladder, namely radical cystectomy, often combined with platinum-based chemotherapy beforehand. Because of this, a large proportion of these patients, around 70% within five years, end up undergoing cystectomy, validating the first choice. Now test the distractors. Fulguration through the cystoscope is a low-energy ablation reserved for small superficial recurrences, never adequate for muscle-invading cancer. Tobacco exposure in any form, including beedi, is the leading carcinogenic driver of bladder urothelial cancer, so calling it a non-risk-factor is incorrect. Finally, chemotherapy is integral both as neoadjuvant therapy and in metastatic settings, so denying its role is wrong. Only the statement about the high cystectomy rate survives scrutiny.\[\boxed{\text{70\% chance of requiring cystectomy in 5 years}}\]