Bladder cancer

Lancet. 2009 Jul 18;374(9685):239-49. doi: 10.1016/S0140-6736(09)60491-8. Epub 2009 Jun 10.


Bladder cancer is a heterogeneous disease, with 70% of patients presenting with superficial tumours, which tend to recur but are generally not life threatening, and 30% presenting as muscle-invasive disease associated with a high risk of death from distant metastases. The main presenting symptom of all bladder cancers is painless haematuria, and the diagnosis is established by urinary cytology and transurethral tumour resection. Intravesical treatment is used for carcinoma in situ and other high grade non-muscle-invasive tumours. The standard of care for muscle-invasive disease is radical cystoprostatectomy, and several types of urinary diversions are offered to patients, with quality of life as an important consideration. Bladder preservation with transurethral tumour resection, radiation, and chemotherapy can in some cases be equally curative. Several chemotherapeutic agents have proven to be useful as neoadjuvant or adjuvant treatment and in patients with metastatic disease. We discuss bladder preserving approaches, combination chemotherapy including new agents, targeted therapies, and advances in molecular biology.

Publication types

  • Review

MeSH terms

  • Adenocarcinoma / epidemiology
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Carcinoma, Squamous Cell / epidemiology
  • Carcinoma, Transitional Cell / epidemiology
  • Chemotherapy, Adjuvant
  • Combined Modality Therapy
  • Cystectomy
  • Cystoscopy
  • Diagnosis, Differential
  • Hematuria / etiology
  • Humans
  • Molecular Biology
  • Neoadjuvant Therapy
  • Neoplasm Staging
  • Prostatectomy
  • Risk Factors
  • Sensitivity and Specificity
  • Survival Rate
  • United States / epidemiology
  • Urinary Bladder Neoplasms* / diagnosis
  • Urinary Bladder Neoplasms* / epidemiology
  • Urinary Bladder Neoplasms* / etiology
  • Urinary Bladder Neoplasms* / therapy
  • Urinary Diversion