This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Bladder Cancer, Subject name: Surgery
[{'content': 'A 70 year old male chronic smoker is diagnosed of having cancer of the urinary bladder. It is confined to the trigone and extention is upto the submucosa. The management would be - \nSelect and explain. \nA. Complete Transurethral resction, B. Complete Transurethral resection with intravesical chemotherapy, C. Palliative Radiotherapy, D. Radical Cystectomy', 'role': 'user'}, {'content': "Answer: B \nExplanation: Ans. is 'b' i.e., Complete Transurethral resection with intravesical chemotherapy Management of bladder cancero Cystoscopy and transurethral resection or biopsy# initially, any pt. with hematuria is examined by cystoscopy and any tumor seen is removed by transurethral resection (if possible) or biopsied.o Further treatment decisions are made after tumor staging on histology. Such decisions are based on tumor stage (TNM), grade, size, multiplicity, and recurrence patterno First see the staging (TNM)o The primary bladder cancer is staged according to the depth of invasion into the bladder wall or beyond The urothelial basement membrane separates superficial bladder cancers into Ta (noninvasive) and T1 (invasive) tumors. The muscularis propria separates superficial disease from deeply (muscularis propria) invasive disease. Stage T2 and higher T stage tumors invade the muscularis propria, the true muscle of the bladder wall. If the tumor extends through the muscle to involve the full thickness of the bladder and into the serosa, it is classified as T3. If the tumor involves contiguous structures such as the prostate, the vagina, the uterus, or the pelvic sidewall, the tumor is classified as stage T4.# Tis Ca in situ# Ta Ca confined to mucosa# T1 Ca confined to submucosa# T2 Muscle invasion# T3 perivescical fat invasion# T4 invasion of adjacent structures (prostate, uterus, vagina, pelvic wall, abd. wall)o Now the histological grading.# There are 3 histological gradeso Grade I, II & IIIo There is a strong correlation between tumor grading and tumor recurrence progression and survival.Treatment options for bladder cancersCancer stageInitial treatment optionsTisComplete TUR followed by intravesical BCGTa (single, low-to- moderate grade, not recurrent)Complete TURTa (large, multiple, high grade, or recurrent)Complete TUR followed by intravesical chemo-or immunologyT1Complete TUR followed by intravesical chemo- or immunotherapy or radical cystectomyT2-T4Radical cystectomyNeoadjuvant chemotherapy followed by radical cytectomy followed by adjuvant chemotherapyConcomitant chemotherapy and irradiationAny T, N+, M+Systemic chemotherapy followed by selective surgery orirradiationo Intravesical therapy : Common agents used for intravesical therapy are# Mitomycin C# Thiotepa# BCGo Among these agents, BCG is the most effective.o The patient in question has T1 stage (Tumor upto submucosa)", 'role': 'assistant'}]