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Answer 5
  1. Chemotherapy with cisplatin and etoposide. There is no consensus on the standard treatment approach for small cell carcinoma of the bladder due to the rarity of the disease and lack of prospective clinical trials. Patients are treated similarly to small cell malignancies from other primary sites (eg, lung). Although there have been some long-term survival observations of superficial small cell bladder cancer treated with transurethral resection and intravesical bCG, surgery alone is not recommended for more advanced stages. In a retrospective analysis of 64 cases of small cell carcinoma of the bladder, investigators found no survival difference between patients who had cystectomy and those who did not.15 In a retrospective review, 5-year disease-free survival was 36% for patients treated with surgery alone and 78% for patients treated with chemotherapy followed by surgery. There was a higher complete pathologic response for patients receiving cisplatin and etoposide versus MVAC chemotherapy.16 PET scan has not yet been proven to add further information on bladder cancer staging or restaging; thus, it cannot be recommended at this time.

    15. Cheng L, Pan X, Yang XJ, et al. Small cell carcinoma of the urinary bladder: a clinicopathologic analysis of 64 patients. Cancer 2004;101:957-62.

    16. Siefker-Radtke AO, Dinney CP, Abrahams NA, et al. Evidence supporting preoperative chemotherapy for small cell carcinoma of the bladder: a retrospective review of M.D. Anderson Cancer experience. J Urol 2004;172:481-4.

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