The management of lymph node metastasis from bladder cancer

Aim. The presence of pelvic tymph node metastasis from bladder cancer has traditionally been associated with a very poor prognosis. The aim of this paper is to review the literature with regard to the management of patients with nodal disease, particutarty gross nodal metastasis and suggest a strategy for management of these patients. Methods. We performed a literature search in the PubMed database and the reference lists of relevant papers describing the management of locally advanced bladder cancer. Findings. There are no randomised studies relating specifically to the management of nodal metastasis in Madder cancer. It is clear however that a significant number of patients with micrometastatic nodal disease may be cured. Few studies exist which address the management of patients with gross nodal disease and consist of series from a limited number of institutions. In patients with gross nodal disease detected pre-operatively or at the time of surgery, a muttimodatity approach consisting of surgery, chemotherapy and possibly radiotherapy seems appropriate. The prognosis of such patients retates to the pathological stage of the primary tumour and the degree of tymph node involvement. In addition a good response to neoadjuvant chemotherapy may identify patients who are likety to survive longer. Conclusions. The prognosis for patients with gross nodal disease from bladder cancer is poor although cure may be possible in a small number of patients. In such cases a multimodatity approach is appropriate and management decisions should be made on an individual patient basis. (c) 2004 Elsevier Ltd. Atl. rights reserved.