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 specific issues are found in associated topics, as indicated 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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- DIAGNOSIS AND STAGING
- Initial evaluation
- - Primary tumor
- - Regional lymph nodes and distant metastases
- 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