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:
- Urinary bladder. In: AJCC Cancer Staging Manual, 7th, Springer, New York 2010. p.497.
- and Genetics of Tumors of the Urinary System and Male Genital Organs. In: World Health Organization Classification of Tumors, Epstein JI, Eble JN, Sesterhenn I, Sauter G (Eds), IARC Press, Lyon, France 2004. p.93.
- 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).
- Hall MC, Chang SS, Dalbagni G, et al. Guideline for the management of nonmuscle invasive bladder cancer (stages Ta, T1, and Tis): 2007 update. J Urol 2007; 178:2314.
- 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.
- Solsona E, Iborra I, Collado A, et al. Feasibility of radical transurethral resection as monotherapy for selected patients with muscle invasive bladder cancer. J Urol 2010; 184:475.
- Ghahestani SM, Shakhssalim N. Palliative treatment of intractable hematuria in context of advanced bladder cancer: a systematic review. Urol J 2009; 6:149.
- Ok JH, Meyers FJ, Evans CP. Medical and surgical palliative care of patients with urological malignancies. J Urol 2005; 174:1177.
- Zebic N, Weinknecht S, Kroepfl D. Radical cystectomy in patients aged > or = 75 years: an updated review of patients treated with curative and palliative intent. BJU Int 2005; 95:1211.
- Konski A, Feigenberg S, Chow E. Palliative radiation therapy. Semin Oncol 2005; 32:156.
- 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