<prompt> 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 -Complete Transurethral resctionComplete Transurethral resection with intravesical chemotherapyPalliative RadiotherapyRadical Cystectomy  <response>: 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 TNMo 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. wallo 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 recurrentComplete TURTa large, multiple, high grade, or recurrentComplete 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, MSystemic 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 