Treatment options

—superficial recurrence is common (60%) —poorly differentiated, worse prognosis

♦ Frequent recurrences/high-risk tumours

—intravesical chemotherapy: mitomycin C; doxorubicin —intravesical immunotherapy: BCG monitored by cystoscopy reduces recurrences; no long-term effect on survival

♦ Muscle-invasive, local tumour —radical radiotherapy —radical cystectomy

—occasionally radiotherapy followed by salvage cystectomy

♦ Metastatic disease —palliative chemotherapy

—usually relapse again after 2 years

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