Treatment of Small Cell Carcinoma of the Bladder by Stage

General Principles

The National Comprehensive Cancer Network recommends that small cell carcinoma of the bladder requires neoadjuvant chemotherapy using small cell lung cancer regimens followed by local treatment with either radical cystectomy or radiotherapy, regardless of stage, due to its highly aggressive nature and high metastatic potential 1
Primary chemotherapy regimens should mirror those used for small cell lung cancer, specifically platinum-based combinations (etoposide-cisplatin being most common), as recommended by the National Comprehensive Cancer Network 1
Coexistence with other bladder carcinoma types is common and should be identified on pathology, according to the National Comprehensive Cancer Network 1

For surgically resectable disease, the optimal approach is neoadjuvant chemotherapy (4 cycles of platinum-based regimen) followed by radical cystectomy with bilateral pelvic lymphadenectomy, as recommended by the National Comprehensive Cancer Network 1
Radical cystectomy should include bilateral pelvic lymphadenectomy encompassing at minimum the common iliac, internal iliac, external iliac, and obturator nodes, according to the National Comprehensive Cancer Network 1

Palliative radiotherapy may be used for tumor-related symptom relief, as suggested by the European Society for Medical Oncology 2, 3
Selected patients with T4b and/or N1 disease may still be candidates for cystectomy and lymph node dissection or definitive radiotherapy after chemotherapy response, according to the European Society for Medical Oncology 2, 3

After radical cystectomy, the National Comprehensive Cancer Network recommends urine cytology, creatinine, and electrolytes every 3-6 months for 2 years, then as clinically indicated 1
After bladder preservation, the European Society for Medical Oncology suggests cystoscopy and urinary cytology every 3 months during first 2 years, then every 6 months 2, 3
Imaging of chest, abdomen, and pelvis every 3-12 months for 2 years based on recurrence risk is recommended by the National Comprehensive Cancer Network 1