Identification of the problem is essential in the management of invasive bladder cancer. Transurethral resection of the superficial lesion is acceptable, but fulguration of the superficial portion of a deep lesion is not. There is often a failure to distinguish the difference, not so often on first presentation, but with recurrent lesions. Patterns of care become established, and changes in direction in the course of the cancer demand that the urologist be continually vigilant. The progression to advanced bladder cancer under direct care should not be excused as biologic predeterminism.
Deeply invading bladder cancer is a pelvic cancer (Introductory Figure). Procrastination in employing suitable diagnostic methods to clearly outline the full extent of the process and therapeutic measures to encompass the lesion is a major obstacle to cure. Once cancer in the bladder penetrates into the muscle layer, the potential for spread to lymph nodes rises significantly (40%).1 If