American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the standard treatment for bladder cancer?

1. Calmette-Guerin therapy only

2. TURBT plus chemotherapy

3. Radical cystectomy only

4. Immunotherapy alone

The correct answer is: TURBT plus chemotherapy

The standard treatment for bladder cancer, particularly for non-muscle invasive types, is often transurethral resection of bladder tumor (TURBT) followed by chemotherapy. TURBT serves both as a diagnostic procedure and as a means to remove visible tumors from the bladder wall. Once the tumors are evaluated and depending on the risk stratification, adjuvant intravesical chemotherapy (commonly with agents like mitomycin C or gemcitabine) may be used to reduce the risk of recurrence and progression. This combined approach is favored due to its effectiveness in treating the cancer while preserving the bladder and maintaining a higher quality of life for patients. The additional chemotherapy helps to target any residual cancer cells that may remain after TURBT, thereby lowering the chance of the cancer returning. While other methods, such as immunotherapy or radical cystectomy, may be applicable in certain cases or at more advanced stages of bladder cancer, they are not considered the standard treatment for the broader range of patients with bladder cancer, especially in the early stages or those with non-muscle invasive disease. Thus, TURBT plus chemotherapy is recognized as a fundamental part of the management strategy for bladder cancer.