title: The management of lymph node metastasis from bladder cancer.
abstract: OBJECTIVE
  The presence of pelvic lymph 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, particularly 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.
  
  
  RESULTS
  There are no randomised studies relating specifically to the management of nodal metastasis in bladder 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 multimodality approach consisting of surgery, chemotherapy and possibly radiotherapy seems appropriate. The prognosis of such patients relates to the pathological stage of the primary tumour and the degree of lymph node involvement. In addition a good response to neoadjuvant chemotherapy may identify patients who are likely 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 multimodality approach is appropriate and management decisions should be made on an individual patient basis.
authors.affiliation: Department of Urology, Leicester Hospital, Gwendolen Road, Leicester LE5 4PW, UK. msimms@gertrude42.freeserve.co.uk
authors.forename: M S
authors.initials: MS
authors.lastname: Simms
authors.forename: G
authors.initials: G
authors.lastname: Mann
authors.forename: R C
authors.initials: RC
authors.lastname: Kockelbergh
authors.forename: J K
authors.initials: JK
authors.lastname: Mellon
mesh_terms: D003131:Combined Modality Therapy; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D009367:Neoplasm Staging; D010388:Pelvis; D011379:Prognosis; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000628:therapy*