الفهرس 
INTRODUCTION AND AIM OF THE WORKOnly 14 pages are availabe for public view
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Abstract
Non muscle invasive bladder cancer (NMIBC) are not uniform and the response to intravesical adjuvant therapy is heterogenous.
Treatment of NMIBC is guided by an estimation of the risk of tumor recurrence and progression so that, stratification of patients into risk groups allows one to select more appropriate schedules for follow-up and treatment that correlates with risk.
Several factors have been identified as reliable predictors of disease recurrence and progression for NMIBC. These factors include stage, grade, multifocality, recurrence at 3 months, presence of CIS and size of the initial tumor (>3 cm). Pathologic substaging of T1 lesions also appears to be associated with the likelihood of muscle invasion.
There have been few attempts to construct a predictive index and use it to categorize superficial bladder tumors into different risk group such as Herr et al., Parmar et al., Allard et al., Millan Rodriguez et al., Ali-El-Dein et al. and EORTC Risk Tables.
It is note worthy that multiplicity of the predictive indices mean that none of them is ideal. Although there are some indices that are more accurate, yet they are more sophisticated than the simple indices. One example of these sophisticated indices is that index advocated by Ali-El-Dein and associates.
The prognostic significance of bladder cancer molecular markers such as p27 and p53 were evaluated by a number of investigators. Although some markers noted to be associated with tumor stage, the clinically relevant prognostic information provided by these markers remains to be clarified.
TURBT is recommended for all patients with NMIBC.
The main therapeutic options after initial transurethral resection are observation, repeat resection, intravesical therapy with immunomodulatory or chemotherapeutic agents or a combination of these methods and cystectomy.
Repeat TURBT is recommended in high-grade T1 tumours or if initial resection is incomplete and/or when there is no muscle in the specimen.
The type of intravesical therapy is based on the risk groups.
Immediate cystectomy may be offered to patients at highest risk of tumor progression (multiple recurrent high-grade tumors, high-grade T1 tumors, high-grade tumors with concomitant CIS).
In patients with BCG failure, cystectomy is recommended.
Because of the risk of recurrence and progression, patients need to be followed. However, the frequency and duration of cystoscopies and upper urinary tract investigations should reflect the degree of risk.