Abstract
Bladder cancer is the commonest malignancy of the urinary tract. In this review, we look at the latest developments in the diagnosis and management of this condition. Cystoscopy and urine cytology are the most important tools in the diagnosis and follow-up of bladder cancer. Various alternatives have been investigated, either to reduce the frequency of cystoscopy, or improve its sensitivity for detection of tumors. These include urine-based markers and point-of-care tests. Narrow-band imaging and photodynamic diagnosis/blue-light cystoscopy have shown promise in improving detection and reducing recurrence of bladder tumors, by improving the completion of bladder resection when compared with standard resection in white light. The majority of patients with a new diagnosis of bladder cancer have non-muscle-invasive bladder cancer, which requires adjuvant intravesical chemotherapy and/or immunotherapy. Recent developments in post-resection intravesical regimens are discussed. For patients with muscle-invasive bladder cancer, both laparoscopic radical cystectomy and robot-assisted radical cystectomy have been shown to reduce peri-operative morbidity, while being oncologically equivalent to open radical cystectomy in the medium term. Bladder-preserving strategies entail resection and chemoradiation, and in selected patients give equivalent results to surgery. The development, advantages, and disadvantages of these newer approaches are also discussed.
Highlights
Bladder cancer is the commonest malignancy of the urinary tract, with the incidence being four times higher in men than in women [1]
In cases where physicians would perform a cystoscopy even if there was a low risk of progression (1%) or recurrence (5%), the use of NMP22 did not aid clinical decision-making [23]; if the thresholds were increased to 3% and 8% for progression and recurrence, respectively, NMP22 could help distinguish which patients would need cystoscopy or not
Bacille Calmette-Guérin treatment and electromotive drug administration of mitomycin C Di Stasi et al reported that intravesical, sequential bacille Calmette-Guérin (BCG), followed by electromotive administration (EMDA) of MMC (EMDA-MMC) given to patients with high-risk superficial bladder led to higher disease-free interval, lower recurrence and progression rates, and improved overall survival (OS) and disease-specific survival (DFS) rates, compared with BCG alone
Summary
Bladder cancer is the commonest malignancy of the urinary tract, with the incidence being four times higher in men than in women [1]. Bacille Calmette-Guérin treatment and electromotive drug administration of mitomycin C Di Stasi et al reported that intravesical, sequential BCG, followed by electromotive administration (EMDA) of MMC (EMDA-MMC) given to patients with high-risk superficial bladder led to higher disease-free interval, lower recurrence and progression rates, and improved overall survival (OS) and disease-specific survival (DFS) rates, compared with BCG alone. Muscle-invasive bladder cancer Minimally invasive techniques in radical cystectomy Open radical cystectomy (ORC) is the current gold-standard treatment for MIBC and for high-risk recurrent NMIBC. Long-term data from Massachusetts General Hospital, USA, has shown that combined multimodal therapy in the form of concurrent cisplatin-based chemotherapy and radiotherapy after maximal TURBT achieves complete response and preserves the native bladder in more than 70% of patients, while offering long-term survival rates comparable with contemporary cystectomy series [57]. These studies suggest that this approach could be a real alternative to radical surgery in select patients with muscle-invasive disease
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