Diagnostic and Prognostic Factors in Non-Muscle-Invasive Bladder Cancer and Their Influence on Treatment and Outcomes

Abstract

Objectives This paper explores the diagnostic and staging procedures available for bladder cancer, the prognostic factors for recurrence and progression of non-muscle-invasive tumours, and the indications for intravesical therapy and cystectomy in patients with non-muscle-invasive, recurrent disease. Methods The authors reviewed the literature on diagnosis of bladder cancer, prognostic factors for recurrence and progression of non-muscle-invasive disease, and the indications for intravesical therapy and cystectomy. Results The presence of malignant cells at urinary cytology suggests a high-grade tumour in the urinary tract, but negative urinary cytology does not exclude a low-grade cancer. Transurethral resection of the bladder (TURB) is undertaken in non-muscle-invasive bladder tumours to aid diagnosis and to remove visible lesions and is more effective when guided by blue-light fluorescence than by white light. Repeated TURB may be required because of the risk of residual tumour after initial TURB. A tool from the European Organisation for Research and Treatment of Cancer (EORTC) can be used to assess an individual patient's risk of bladder cancer recurrence and progression. Further treatment options are intravesical chemotherapy, intravesical bacille Calmette-Guérin (BCG) immunotherapy, and cystectomy. Immediate cystectomy is advocated by many specialists for patients with non-muscle-invasive tumour who are at high risk of progression or who do not respond to BCG therapy. Conclusions Urinary cytology and TURB (preferably under the guidance of fluorescence cystoscopy if carcinoma in situ is suspected) are the mainstays of bladder cancer diagnosis and staging. The likelihood of recurrence or progression can be assessed using a tool developed by the EORTC that is based on common prognostic factors. Patients with disease progression can be offered cystectomy.