Chemoprevention of urothelial carcinoma of the bladder
- Steven C Campbell, MD, PhD
Steven C Campbell, MD, PhD
- Glickman Urological and Kidney Institute
- Cleveland Clinic
- Section Editors
- Jerome P Richie, MD, FACS
Jerome P Richie, MD, FACS
- Section Editor — Cancer of the Urethra, Penis, and Ureter; Urologic Surgery; Prostate Cancer
- Elliott Carr Cutler Professor of Surgery
- Harvard Medical School
- Seth P Lerner, MD
Seth P Lerner, MD
- Section Editor — Bladder Cancer
- Beth and Dave Swalm Chair in Urologic Oncology
- Professor of Urology
- Baylor College of Medicine
Urothelial carcinoma of the bladder, the most common malignancy of the urinary tract, is the fourth most common malignancy in men and the tenth most common malignancy in women. (See "Epidemiology and risk factors of urothelial (transitional cell) carcinoma of the bladder", section on 'Risk factors'.)
The majority of cases of urothelial carcinoma of the bladder can be attributed to smoking and occupational and environmental carcinogen exposures, which cause diffuse changes in the urothelium and eventually result in bladder cancer. The identification of these risk factors provides an opportunity to minimize the incidence of bladder cancer through smoking cessation programs and decreasing exposure to workplace carcinogens [1-3].
Other potentially useful approaches include increasing cruciferous vegetable  and fluid intake , decreasing dietary fat , and losing weight . Any of these factors must be placed in the context of possible predisposing genetic factors, which are poorly understood .
Chemoprevention is the use of systemic agents to prevent or reverse these changes. Primary chemoprevention seeks to block the formation of de novo bladder cancers in healthy individuals, while secondary chemoprevention focuses on avoiding formation of additional tumors in patients who have already been treated for bladder cancer. Although chemoprevention is not routinely recommended in either primary or secondary settings, it is an area of active clinical investigation.
The chemoprevention of bladder cancer with systemic agents is reviewed here, with the focus primarily on agents for which epidemiologic or clinical trial data are available. The use of intravesical agents to prevent the recurrence of non-muscle invasive bladder cancer is discussed separately. (See "Treatment of primary non-muscle invasive urothelial bladder cancer".)
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