Highlights & Basics
- Bladder cancer is the 9th most commonly diagnosed cancer worldwide, and is more prevalent in men. While nearly half of patients with bladder cancer are nonsmokers, cigarette smoking is the most significant causative risk factor.
- Nearly all patients with bladder cancer report hematuria as the primary symptom. The diagnostic evaluation of bladder cancer involves cystoscopy and abdominal/pelvic imaging.
- Transurethral resection of a bladder tumor (TURBT) is the procedure used to remove the tumor and stage the depth of invasion.
- Guideline-directed risk stratification based on grade and stage after initial TURBT determines the frequency of cystoscopy and, in many patients, the number of doses and duration of intravesical (bladder-directed) therapy.
- Muscle-invasive tumors are treated with systemic therapy and bladder removal or chemoradiation therapy. Systemic therapies for advanced disease include immune checkpoint inhibitors, antibody-drug conjugates, and other targeted therapies.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Images
Low-grade, noninvasive (Ta) papillary urothelial carcinoma. Note adjacent satellite tumor, illustrating the field effect
Low-grade urothelial carcinoma seeding in the prostatic urethra; illustrated is the loop electrode used to resect bladder tumors
Low-grade tumors surrounded by small satellite tumors with small, uniform fronds. In the foreground is a solid tumor on a broad base, a typical appearance of high-grade tumors. Low- and high-grade tumors often occur in the same patient
Methylene blue-stained tumor at the right bladder neck. Staining with 0.2% methylene blue (or use of the now Food and Drug Administration-approved hexaminolevulinate blue-light fluorescence cystoscopy) can help identify tumors not seen otherwise
Carcinoma in situ of the bladder; this can appear as a rough, erythematous patch in the bladder, but often the urothelium appears normal; random biopsy or biopsy of areas stained by 0.2% methylene blue, illustrated here, is needed to make the diagnosis
European Organisation for Research and Treatment of Cancer (EORTC) scoring system: weighting used to calculate recurrence and progression scores. CIS, carcinoma in situ
European Organisation for Research and Treatment of Cancer (EORTC) risk tables: probability of recurrence and progression according to score
Citations
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American Urological Association. Treatment of non-metastatic muscle-invasive bladder cancer: AUA/ASCO/ASTRO/SUO guideline. Apr 2024 [internet publication].[Full Text]
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