Management of Bladder Cancer

Abstract

Bladder cancer is the fourth most common cancer in men and the tenth most common in women. Patients commonly present with painless hematuria. Urinary frequency, urinary tract infection, upper tract obstruction, and pain are also possible; however, the physical examination of the patients is often unremarkable. Clinical diagnosis depends on urine cytology, bladder ultrasonography, and office cystoscopy. This review describes the epidemiology, pathology and natural history, clinical presentation and workup, staging and grading, non–muscle-invasive bladder cancer, bladder preservation strategies, nontraditional approaches, chemotherapy for metastatic disease, immunotherapy, and predictive factors of response to chemotherapy for bladder cancer. Figures show representative images of urothelial cell carcinoma, diagrams showing a cystoscopy for a man and bladder cancer staging, urinary diversion, and computed tomographic scans of a patient with hepatic metastases from bladder cancer before and after treatment with gemcitabine-cisplatin. Tables list the tumor-node-metastasis staging system for bladder cancer, the histologic classification of tumors of the urinary tract (WHO 1973 versus WHO 2004), risk group stratification based on the European Organization for Research and Treatment of Cancer Scoring System, types of bacillus Calmette-Guérin failure/recurrence and treatment recommendations, unfavorable factors for bladder preservation chemoradiation, consensus criteria for patients unfit for cisplatin-based regimens, and first-line combination chemotherapy regimens. This review contains 5 highly rendered figures, 7 tables, and 80 references.