Shaheen Alanee1, Isabel Alvarado-Cabrero2, Paari Murugan3, Rajeev Kumar4, Kenneth G Nepple5, Gladell P Paner6, Manish I Patel7, Maria Rosaria Raspollini8, Antonio Lopez-Beltran9, Badrinath R Konety10. 1. Urologic Oncology, Department of Urology, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA. brkonety@umn.edu. 2. Department of Pathology, Mexican Oncology Hospital, IMSS, CMN SXXI, Mexico City, Mexico. 3. Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA. 4. All India Institute of Medical Sciences, New Delhi, India. 5. Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA. 6. Departments of Pathology and Surgery (Urology), University of Chicago, Chicago, IL, USA. 7. Department of Urology, Westmead Hospital and Discipline of Surgery, University of Sydney, Sydney, Australia. 8. Histopathology and Molecular Diagnostics, University Hospital Careggi, Florence, Italy. 9. University of Cordoba, Córdoba, Spain. 10. Department of Urologic Surgery, University of Minnesota, Minneapolis, MN, USA.
Abstract
PURPOSE: To provide a comprehensive update of the joint consultation of the International Consultation on Urological Diseases (ICUD) for the diagnosis and management of non-urothelial cancer of the urinary bladder. METHODS: A detailed analysis of the literature was conducted reporting on the epidemiology, etiology, diagnosis, treatment and outcomes of non-urothelial cancer of the urinary bladder. An international, multidisciplinary expert committee evaluated and graded the evidence according to the Oxford System of Evidence-based Medicine modified by the ICUD. RESULTS: The major non-urothelial cancers of the urinary bladder are squamous cell carcinoma, adenocarcinoma, and neuroendocrine tumors. Several other non-urothelial tumors are rare but important to identify because of their aggressive behavior when compared to urothelial bladder tumors. Radical cystectomy and urinary diversion, preceded by neoadjuvant radiation or chemotherapy in some of these tumors, is the main method or treatment for resectable disease. Adjuvant therapy is not usually successful and no novel targeted or immunotherapeutic agents have been identified to provide benefit. Patients with small cell neuroendocrine tumors of the bladder should be offered chemotherapy before surgery. Because non-urothelial cancers are usually locally advanced and/or metastatic at the time of diagnosis, 5-year survival is generally poor. CONCLUSIONS: Non-urothelial cancers of the urinary bladder are rare and mostly lack established protocols for treatment. The prognosis of most of these tumors is poor because they are usually advanced at the time of diagnosis. A multimodal treatment approach should be considered to improve outcomes.
PURPOSE: To provide a comprehensive update of the joint consultation of the International Consultation on Urological Diseases (ICUD) for the diagnosis and management of non-urothelial cancer of the urinary bladder. METHODS: A detailed analysis of the literature was conducted reporting on the epidemiology, etiology, diagnosis, treatment and outcomes of non-urothelial cancer of the urinary bladder. An international, multidisciplinary expert committee evaluated and graded the evidence according to the Oxford System of Evidence-based Medicine modified by the ICUD. RESULTS: The major non-urothelial cancers of the urinary bladder are squamous cell carcinoma, adenocarcinoma, and neuroendocrine tumors. Several other non-urothelial tumors are rare but important to identify because of their aggressive behavior when compared to urothelial bladder tumors. Radical cystectomy and urinary diversion, preceded by neoadjuvant radiation or chemotherapy in some of these tumors, is the main method or treatment for resectable disease. Adjuvant therapy is not usually successful and no novel targeted or immunotherapeutic agents have been identified to provide benefit. Patients with small cell neuroendocrine tumors of the bladder should be offered chemotherapy before surgery. Because non-urothelial cancers are usually locally advanced and/or metastatic at the time of diagnosis, 5-year survival is generally poor. CONCLUSIONS:Non-urothelial cancers of the urinary bladder are rare and mostly lack established protocols for treatment. The prognosis of most of these tumors is poor because they are usually advanced at the time of diagnosis. A multimodal treatment approach should be considered to improve outcomes.
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