Bladder cancer

Bladder cancer is the 9th most commonly diagnosed cancer worldwide, and is more prevalent in men. While nearly half of patients with bladder cancer are nonsmokers, cigarette smoking is the most significant causative risk factor.

Nearly all patients with bladder cancer report hematuria as the primary symptom. The diagnostic evaluation of bladder cancer involves cystoscopy and abdominal/pelvic imaging.

Transurethral resection of a bladder tumor (TURBT) is the procedure used to remove the tumor and stage the depth of invasion.

Guideline-directed risk stratification based on grade and stage after initial TURBT determines the frequency of cystoscopy and, in many patients, the number of doses and duration of intravesical (bladder-directed) therapy.

Muscle-invasive tumors are treated with systemic therapy and bladder removal or chemoradiation therapy. Systemic therapies for advanced disease include immune checkpoint inhibitors, antibody-drug conjugates, and other targeted therapies.

The focus of this topic is urothelial carcinoma (previously termed transitional cell carcinoma) of the urinary bladder, the most common histologic type of bladder cancer (accounting for >90%).[1]van Hoogstraten LMC, Vrieling A, van der Heijden AG, et al. Global trends in the epidemiology of bladder cancer: challenges for public health and clinical practice. Nat Rev Clin Oncol. 2023 May;20(5):287-304. http://www.ncbi.nlm.nih.gov/pubmed/36914746?tool=bestpractice.com Urothelial carcinoma arises from malignant transformation of the cells that line the urinary tract. Approximately 75% to 80% of tumors are stage 1 or less, localized to the mucosa (Ta) or lamina propria (stage 1), and collectively called nonmuscle-invasive bladder cancer.[1]van Hoogstraten LMC, Vrieling A, van der Heijden AG, et al. Global trends in the epidemiology of bladder cancer: challenges for public health and clinical practice. Nat Rev Clin Oncol. 2023 May;20(5):287-304. http://www.ncbi.nlm.nih.gov/pubmed/36914746?tool=bestpractice.com [2]Colombel M, Soloway M, Akazac H, et al. Epidemiology, staging, grading, and risk stratification of bladder cancer. Eur Urol Suppl. 2008 Oct;7(10):618-26. https://www.sciencedirect.com/science/article/abs/pii/S1569905608001097?via%3Dihub ​ Muscle-invasive bladder cancer (stage 2 or greater) includes organ-confined tumors that infiltrate the muscularis propria, perivesical fat (stage 3), and/or adjacent organs (stage 4).

Nonurothelial and urothelial with subtype (variant) histologies are rare causes of bladder cancer and associated with a poorer prognosis; these bladder cancer subtypes are not discussed in detail in this topic. Upper tract urothelial cell cancer is not covered in this topic.