Bladder cancer. Management of an increasingly common tumor.

The incidence of bladder cancer is slowly rising, which may be due in part to the increasing use of chemicals in every phase of our modern society. Improvements in detection will, it is hoped, allow earlier diagnosis, at a stage when it is highly likely that the entire tumor can be removed. Intravesical chemotherapy reduces the number and frequency of subsequent tumors and may be able to control the neoplastic process sufficiently to prevent progression and the need for cystectomy and/or radiation therapy. Unfortunately, advances in management of superficial tumors have not been matched for invasive tumors. Despite improvements in preoperative and postoperative care, introduction of the linear accelerator, and use of chemotherapy, about 50% of patients with stage B, C, or D bladder cancer die of the disease. Most patients with invasive tumors do not come to the attention of a physician until the tumor has progressed to this stage. Thus, a major task is to identify those harboring bladder cancer earlier, when the disease can be successfully managed.