الفهرس 
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Abstract
Bladder cancer according to the first published national population based study for the period between 2008 and 2011 is the 3rd most common malignancy (6.9%) in Egypt. It comes after breast cancer (41 %and hepatocellular carcinoma (23.8%), with more predominance in males 78 % than females 22% (Ibrahim et al., 2014).
Pathological classification of urinary bladder carcinoma is transitional cell carcinoma, squamous cell carcinoma and other rare types (adenocarcinoma, sarcoma, lymphoma and carcinoid).
Bladder cancer tumors are further classified on Low-grade bladder tumor (well-differentiated) usually grows more slowly and is less likely to invade the muscular wall of the bladder.
High-grade bladder tumor (poorly differentiated) tends to grow more aggressively than a low-grade tumor and may be have strong tendency to invade the muscular wall of the bladder and spread to other parts of the body (Adult Treatment Editorial Board,2018).
Currently, the best diagnosis of the state of the bladder is by way of cystoscopy allows for a visual inspection of the bladder and to collect the samples of suspicious lesions to be taken for a biopsy , this procedure is sometimes called transurethral resection of bladder tumor (TURBT).
After diagnosis of bladder cancer, additional tests have been done to determine the extent of disease including CT scan, MRI, bone scan and chest x-ray.
The treatment of bladder cancer depends on how deeply the tumor invades into the bladder wall.
Superficial tumors (those not entering the muscle layer) can be ”shaved off by procedure is called transurethral resection of bladder tumor—TURBT—and serves primarily for pathological staging. In case of non-muscle invasive bladder cancer the TURBT is in itself the treatment, but in case of muscle invasive cancer, the procedure is insufficient for final treatment (CancerCenter, 2018).
Immunotherapy by intravesicular delivery of Bacillus Calmette–Guérin (BCG) is also used to treat and prevent the recurrence of superficial tumors (European Association of Urology, 2013).
BCG immunotherapy is effective in up to 2/3 of the cases at this stage, and in randomized trials has been shown to be superior to standard chemotherapy (Lamm et al., 1991) .The mechanism by which BCG prevents recurrence is unknown, but the presence of bacteria in the bladder may trigger a localized immune reaction which clears residual cancer cells (The original, 2013).
Patients whose tumors recurred after treatment with BCG are more difficult to treat (Witjes, JA, 2006) . Many physicians recommend cystectomy for these patients. This recommendation is in accordance with the official guidelines of the European Association of Urologists (EAU) (Babjuk et al., 2010) and the American Urological Association (AUA) (Bladder Cancer Clinical Guideline, 2007) .
Untreated, superficial tumors may gradually begin to infiltrate the muscular wall of the bladder. Tumors that infiltrate the bladder wall require more radical surgery, where part or the entire bladder is removed (a cystectomy) to treat an invasive tumor, a combination of radiation and chemotherapy in conjunction with transurethral (endoscopic) bladder tumor resection can be used. Review of available large data series on this so-called trimodality therapy has indicated similar long-term cancer specific survival rates, with improved overall quality of life as for patients undergoing radical cystectomy with urinary reconstruction. These patients are usually highly selected and do not have multi-focal disease or carcinoma in-situ, which is associated with a higher rate of recurrence, progression, and death from bladder cancer versus patients who undergo radical cystectomy (Smelser et al., 2017).
Micrometastatic dissemination is often not treatable with only major surgery and the concept of neoadjuvant chemotherapy has evolved. In these patients first receive chemotherapy in 3 or 4 cycles, and after that proceed to major surgery.
This retrospective study show the prognosis of all patients with bladder carcinoma according to their diagnosis and staging after receiving treatment after assessment of their response rate, overall survival, disease free and relapse free periods.
In our study as regarding the efficacy of different types of treatment show that radical cystectomy followed by adjuvant treatment had best OS and DFS inconstant to recent studies which show that neoadjuvant gemizar\ cisplatin followed by radical cystectomy this may due to most of our patients was not illegible to cisplatin and received radical RTH instead of radical cystectomy due to multiple comorbidities.