Background: A 61-year-old woman with a substantial history of smoking presented with gross hematuria. Cystoscopic evaluation revealed a large bladder tumor.
Investigations: Cystoscopic evaluation, histological examination, crosssectional imaging.
Diagnosis: High-grade muscle-invasive transitional cell carcinoma (clinical stage T2N0M0, later confirmed as pathologic stage T3aN0M0).
Management: Transurethral resection of the bladder tumor, clinical trialbased neoadjuvant treatment with paclitaxel, carboplatin and gemcitabine, and radical cystectomy.