Bladder cancer

Bladder cancer is the 10th most common cancer worldwide and is more prevalent in men. While nearly half of patients with bladder cancer are nonsmokers, cigarette smoking is the most 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 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 chemo-radiation therapy.

New therapies promise to bring the benefit of immunotherapy and antibody-drug conjugates to patients with advanced disease.

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