Bladder Cancer

Abstract

Bladder cancer is a highly prevalent disease associated with substantial morbidity, mortality and cost. Environmental or occupational exposures to carcinogens, and especially tobacco, are the main risk factors for bladder cancer. Most bladder cancers are diagnosed after patients complain of macroscopic haematuria, and cases are confirmed after transurethral resection of bladder tumour (TURBT), which also serves as the first stage of treatment. Bladder cancer develops via two distinct pathways, giving rise to non-muscle-invasive papillary tumours and non-papillary (solid) muscle-invasive tumours. Both subtypes have unique pathological features and different molecular characteristics. Indeed, The Cancer Genome Atlas project identified genetic drivers of muscle-invasive bladder cancer (MIBC) as well as subtypes of MIBC with unique characteristics and therapeutic responses. For non-muscle-invasive bladder cancer (NMIBC), intravesical therapies (primarily Bacillus Calmette–Guérin (BCG)) with maintenance are the main treatments to prevent recurrence and progression after initial TURBT; additional therapies are needed for those who do not respond to BCG. For localized MIBC, optimizing care is important as is the goal to reduce morbidity of removing the bladder. In metastatic disease, advancements in genetic understanding and immunotherapy are being translated into novel therapies