Overview of the initial approach and management of urothelial bladder cancer
- 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
- Derek Raghavan, MD, PhD, FACP, FASCO
Derek Raghavan, MD, PhD, FACP, FASCO
- Section Editor — Bladder Cancer
- President, Levine Cancer Institute
- Carolinas HealthCare System
- Charlotte, NC
Bladder cancer is the most common malignancy involving the urinary system. Urothelial (formerly called transitional cell) carcinoma is the predominant histologic type in the United States and Europe, where it accounts for approximately 90 percent of all bladder cancers. In other areas of the world, non-urothelial carcinomas are more frequent. Less commonly, urothelial cancers can arise in the renal pelvis, ureter, or urethra. (See "Epidemiology and risk factors of urothelial (transitional cell) carcinoma of the bladder", section on 'Epidemiology'.)
The spectrum of urothelial bladder cancer at presentation includes non-muscle-invasive, muscle-invasive, and metastatic disease. The extent of disease reflects its natural history and determines treatment and prognosis.
This topic provides an overview of the initial approach to and management of urothelial carcinoma of the bladder. More detailed discussions of these issues are found in the associated topics, as noted below.
The management of urothelial tumors arising at other sites is discussed separately, as are other types of bladder cancer:
●(See "Urethral cancer".)
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- Babjuk M, Böhle A, Burger M, et al. EAU Guidelines on Non-Muscle-invasive Urothelial Carcinoma of the Bladder: Update 2016. Eur Urol 2016.
- https://www.auanet.org/education/guidelines/bladder-cancer.cfm (Accessed on July 05, 2016).
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- Babjuk M, Oosterlinck W, Sylvester R, et al. EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder. Eur Urol 2008; 54:303.
- Bochner BH, Dalbagni G, Sjoberg DD, et al. Comparing Open Radical Cystectomy and Robot-assisted Laparoscopic Radical Cystectomy: A Randomized Clinical Trial. Eur Urol 2015; 67:1042.
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- DIAGNOSIS AND STAGING
- Initial evaluation
- NON-MUSCLE INVASIVE DISEASE
- Risk stratification
- - Transurethral resection
- - Intravesical therapy
- - Surveillance
- Indications for cystectomy
- MUSCLE-INVASIVE DISEASE
- Radical cystectomy
- - Urinary diversion
- - Neoadjuvant and adjuvant chemotherapy
- Combined-modality approaches for bladder preservation
- Other bladder-sparing approaches
- Posttreatment surveillance
- METASTATIC DISEASE
- Primary tumor
- INFORMATION FOR PATIENTS