Bladder Cancer: Current Challenges and Future Directions

Abstract

Bladder cancer (BCa) is the most common malignancy of the urinary tract and one of the most prevalent cancers worldwide. While the clinical approach to BCa has remained largely unchanged for many years, recent discoveries have paved the way to a new era of diagnosis and management of the disease. BCa-specific mortality started to decrease in the regions with a wide range of activities leading to greater social awareness of the risk factors and the decline in carcinogenic exposure. The urologic community refines the role of transurethral surgery towards more rigorous and high-quality techniques. New agents have been approved for patients with BCG failure who faced radical cystectomy so far. Although radical removal of the bladder is the gold standard for muscle invasive cancer management, the extent and clinical value of lymphadenectomy is currently heavily challenged in randomized trials. Furthermore, alternatives to perioperative chemotherapy have arisen to increase the likelihood of complete treatment delivery and successful oncological outcomes. Finally, improvements in molecular biology and our understanding of tumorigenesis open the era of personalized medicine in bladder cancer. In the present review, the status and future directions in bladder cancer epidemiology, diagnosis and management are thoroughly discussed.

Keywords: BCG failure; perioperative chemotherapy; surgical treatment; urinary bladder cancer.

Figure 1

Lymph-vascular invasion of urothelial BCa. H&E stain, 50× magnification. Courtesy of M. Pyzlak, MD, PhD.

Figure 2

Micropapillary variant of urothelial bladder cancer, H&E stain. A phenomenon associated with dismal prognosis; (a) 100×; (b) 200×. Courtesy of M. Pyzlak, MD, PhD.