الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Bladder Cancer is a major burden of disease. It is the ninth common cancer, the eleventh diagnosed cancer, and the fourteenth leading cause of deaths due to cancer worldwide.
The epidemiology of bladder cancer shows geographical, sex and age variations in its incidence, and it is an example of a cancer where environmental and occupational risk factors are important in its etiology.
In Egypt, bladder cancer has long been the most commonly diagnosed cancer because of its association with schistosomiasis, a disease caused by parasitic worms (S. haematobium) in the urinary tract, and endemic in this region. The relative frequency of bladder cancer in Egypt is 18.3%
Muscle-invasive UCB (cT2-T4) is still an aggressive epithelial tumor with a high rate of local recurrence and systemic dissemination despite surgery. After radical cystectomy (RC) and pelvic lymph node (LN) dissection (PLND) prognosis depends mainly on pathological stage and nodal status. Five-year survivals range from >80for patients with pT2 stage (organ-confined disease), to 25% to 35% in patients with pT3-T4 stage (nonorgan-confined) or node-positive disease. This poor prognosis is, in part, due to presence of occult micrometastases at diagnosis.
Perioperative chemotherapy is expected to eradicate subclinical disease and thereby improve survival. Adjuvant chemotherapy can be used especially in node positive and extravesical extention. But the standard of care should combine neoadjuvant, cisplatin-based combination chemotherapy followed by RC with extended PLND.
There is another treatment approach for muscle invasive bladder cancer (MIBC) is organ preservation and it is a reasonable option for patients seeking an alternative to cystectomy and a palliative option for those who are medically unfit for surgery.
Immunotherapy for advanced bladder cancer is a new era and many drugs received FDA approval like nivolumab, Atezolizumab and Durvalumab. Intravesical BCG was the first immunotherapy that received FDA approval for treatment of non-muscle invasive bladder cancer.