Bladder cancer: epidemiology, diagnosis, and management.

PURPOSE: The purpose of this article is to present an overview of the epidemiology diagnosis, and management of bladder cancer, with a focus on the early stage of this disease. OVERVIEW: English-language articles published between 1990 and 2000, as well as selected abstracts published in non-English languages before 1990, were reviewed. Epidemiologic data clearly indicate that bladder cancer is much more common in men, White persons, and the elderly. Cigarette smoking appears to be the most significant environmental risk factor. Screening for the disease is currently not standard in the United States or Canada. Potential tests include urine cytology, hematuria dipstick, and the urinary biomarkers. Diagnosis is made most often on the basis of the findings of cystoscopy, tumor biopsy, and urine cytology. Transurethral resection (TUR) of the tumor is generally the first-line treatment for superficial disease. Cystectomy is the "gold standard" treatment for invasive disease in many countries, although trimodality therapy (TUR, radiation, systemic chemotherapy) has shown promise as a bladder-preserving strategy. Intravesical therapy is effective for preventing disease recurrence, although its role in slowing disease progression is uncertain. Chemotherapy and radiation also can be used with cystectomy to treat or prevent pelvic recurrence of invasive disease or to prolong life in patients with metastatic disease. CLINICAL IMPLICATIONS: Bladder cancer is a commonly occurring disease. Prevention efforts must focus on the avoidance or cessation of cigarette smoking and on public education relating to known environmental risk factors. Patient and disease factors must be considered in making treatment decisions and determining prognosis. Careful follow-up after treatment is essential. It is hoped that ongoing research on potential tumor markers and tumor-specific therapies ultimately will result in improved clinical outcomes for patients with this malignancy.