Todd M Morgan1, Peter E Clark. 1. Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Abstract
PURPOSE OF REVIEW: To review the diagnosis and management of all stages of bladder cancer with an emphasis on studies and developments within the last year. RECENT FINDINGS: Cystoscopy remains the gold standard for diagnosis of bladder tumors, though fluorescent light and urinary biomarkers can both improve the sensitivity of cancer detection. Management of high-risk patients with nonmuscle invasive cancer continues to be controversial, with a number of risk assessment tools developed to help stratify patients to cystectomy or bladder-sparing regimens. Intravesical therapy is utilized both as a one-time perioperative regimen and as a weekly regimen, and research continues in the development of agents for bacillus Calmette-Guerin-refractory superficial bladder cancer. In patients undergoing cystectomy, evidence supports the need for an adequate lymphadenectomy. Although there are limited data on robotic assisted radical cystectomy, initial reports suggest that an appropriate lymph node dissection can be performed. The role of bladder-sparing modalities as well as the use of adjuvant and neoadjuvant therapies is still debated. Trials investigating these therapies continue to seek to improve both oncologic outcomes and quality of life for patients with invasive bladder cancer. SUMMARY: Progress continues in bladder cancer diagnosis and management, and we anticipate that future work will further advance the care of patients with this disease.
PURPOSE OF REVIEW: To review the diagnosis and management of all stages of bladder cancer with an emphasis on studies and developments within the last year. RECENT FINDINGS: Cystoscopy remains the gold standard for diagnosis of bladder tumors, though fluorescent light and urinary biomarkers can both improve the sensitivity of cancer detection. Management of high-risk patients with nonmuscle invasive cancer continues to be controversial, with a number of risk assessment tools developed to help stratify patients to cystectomy or bladder-sparing regimens. Intravesical therapy is utilized both as a one-time perioperative regimen and as a weekly regimen, and research continues in the development of agents for bacillus Calmette-Guerin-refractory superficial bladder cancer. In patients undergoing cystectomy, evidence supports the need for an adequate lymphadenectomy. Although there are limited data on robotic assisted radical cystectomy, initial reports suggest that an appropriate lymph node dissection can be performed. The role of bladder-sparing modalities as well as the use of adjuvant and neoadjuvant therapies is still debated. Trials investigating these therapies continue to seek to improve both oncologic outcomes and quality of life for patients with invasive bladder cancer. SUMMARY: Progress continues in bladder cancer diagnosis and management, and we anticipate that future work will further advance the care of patients with this disease.
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