What is the recommended treatment for bladder TCC greater than T2?

The recommended treatment for bladder transitional cell carcinoma (TCC) that is classified as greater than T2 is radical cystectomy with ileal conduit diversion. This surgical procedure is necessary because T2 and higher stages indicate that the tumor has invaded into the muscle of the bladder, which is associated with a worse prognosis and an increased risk of metastasis.

Radical cystectomy involves the complete removal of the bladder along with adjacent structures, which may include the prostate in males or the uterus and ovaries in females, depending on the extent of the disease. The ileal conduit is a type of urinary diversion created by using a segment of the ileum (part of the small intestine) to form a new pathway for urine to exit the body, as the bladder can no longer perform its function after removal.

Other treatment options, such as local radiation therapy or transurethral resection, are generally not appropriate for muscle-invasive bladder cancers since these methods are less effective at ensuring complete removal of the cancerous cells and preventing recurrence. The watch and wait approach is more suitable for non-muscle invasive cancers where monitoring is prioritized over immediate intervention. Thus, radical cystectomy with ileal conduit addresses the need for definitive treatment in cases of aggressive bladder cancer stages.