Ranks ninth in worldwide cancer incidence. Egypt, Western Europe, and North America have the highest incidence rates and Asian countries the lowest rates. More than 90% of new cases occur in people ≥55 years of age.
Gross or microscopic hematuria is the primary symptom of bladder cancer. Screening for hematuria appears to markedly improve the prognosis of bladder cancer.
Cystoscopy and urinary cytology are key to making the diagnosis. Low-grade tumors are papillary and easy to visualize, but often have negative cytology. High-grade tumors are often flat or in situ and difficult to visualize, but typically have a positive cytology.
Complete transurethral resection is the treatment of choice for tumors that have not invaded the detrusor muscle, but recurrence is high. Seeding after surgery is reduced by intravesical instillation of chemotherapy.
High-grade disease is potentially lethal and requires aggressive treatment and close follow-up. Treatment of choice for carcinoma in situ and high-grade tumors not invading muscle is immunotherapy using tuberculosis vaccine bacille Calmette-Guérin.
Muscle-invasive tumors are treated with neoadjuvant chemotherapy, cystoprostatectomy, and extended pelvic lymphadenectomy. Neoadjuvant chemotherapy and thorough pelvic node dissection both significantly increase 5-year survival. Precautions should be taken to prevent wound seeding during cystoprostatectomy.
Combination cisplatinum-based chemotherapy such as methotrexate, vinblastine, doxorubicin, and cisplatin produces response in ≥50% of cases. Less toxic combinations, such as cisplatin with either gemcitabine or taxol, have similar efficacy and less toxicity, and all 3 together appear to have better efficacy than cisplatin and gemcitabine. New immunotherapies have created great excitement with the promise to bring the benefit of immunotherapy to patients with advanced disease.
Over 90% of cancers of the urinary bladder are urothelial carcinoma (previously termed transitional cell carcinoma; UC). Nonmuscle-invasive tumors are most common. Low-grade tumors are papillary and generally easy to visualize. High-grade tumors are often flat or in situ, and can be difficult to visualize. If muscle invasion occurs, transurethral resection is insufficient and radical cystoprostatectomy is usually advised.
History and exam
University of Arizona
DL is an author of a number of references cited in this monograph.
Dr Donald Lamm would like to gratefully acknowledge Dr Mary Heeley, the previous contributor to this monograph. MH declares that she has no competing interests.
Consultant Urological Surgeon
Homerton University Hospital NHS Foundation Trust
JM declares that he has no competing interests.
North Hampshire Hospital
HM has received honoraria from GE Healthcare and Kyowa Kirin UK.
Clinical Instructor of Urology
The James Buchanan Brady Urologic Institute
The Johns Hopkins Medical Institutions
TG declares that he has no competing interests.
Consultant Urological Surgeon
Honorary Senior Lecturer
Department of Urology
The Royal Free & University College Medical School
AK declares that he has no competing interests.
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