Bladder cancer.
OBJECTIVE
This article will review the diagnosis and management of bladder cancer at each stage, from superficial to metastatic disease with an emphasis on recent developments over the last year.


RESULTS
Bacille Calmette-Guerin is the most effective therapy for carcinoma in situ. All patients who receive intravesical therapy with bacille Calmette-Guerin should be considered for ongoing maintenance therapy. The management of muscle invasive disease in the United States centers on radical cystectomy with bilateral pelvic lymphadenectomy. Areas of research include the optimal role for bladder preservation therapy, a growing experience in centers with laparoscopy, the effect of urinary diversion on quality of life, and the optimal standard for pelvic lymphadenectomy at surgery. The role of combination chemotherapy for advanced bladder cancer continues to evolve. Many questions remain unanswered including the relative value of neoadjuvant versus adjuvant chemotherapy for locally advanced disease and optimal chemotherapy regimen.


CONCLUSIONS
The detection of bladder cancer continues to rely on direct visualization with cystoscopy. Efforts are underway to improve the utility of urinary markers and cystoscopy through fluorescence endoscopy. The management of superficial bladder cancer is based on transurethral resection of the tumor with perioperative intravesical instillation of chemotherapy strongly suggested for most patients. Risk stratifying patients with high-risk superficial bladder cancer remain a challenge and area of future research.
Gwynn
Eric S
ES
Department of Urology, Wake Forest University Health Sciences, Winston-Salem, North Carolina 27157, USA.
Clark
Peter E
PE
D000283:Administration, Intravesical; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001500:BCG Vaccine / Q000008:administration & dosage / Q000627:therapeutic use; D002278:Carcinoma in Situ / Q000628:therapy; D002295:Carcinoma, Transitional Cell / Q000175:diagnosis / Q000473:pathology / Q000628:therapy; D003131:Combined Modality Therapy; D015653:Cystectomy; D019468:Disease Management; D006801:Humans; D007167:Immunotherapy; D008197:Lymph Node Excision; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D009362:Neoplasm Metastasis; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000628:therapy
D001500:BCG Vaccine