Bladder cancer, 1992

Although the incidence of bladder cancer has not changed in the last 40 years, treatment has greatly decreased morbidity. Invasive disease, however, remains fatal. Bladder cancer is not common in the general population, and current laboratory tests of urine are not adequate for screening the population at large. However, bladder cancer is not uncommon in certain high-risk groups, and urine studies in these patients can be helpful. Hematuria and/or an irritative voiding pattern in an elderly man or a patient otherwise at high risk for bladder cancer should be evaluated carefully. Fortunately, most bladder cancers are superficial when discovered and can be treated with local therapy with or without intravesicular chemotherapy. Cystectomy is still the treatment of choice for invasive disease, but preliminary reports of new methods of radiation therapy and chemotherapy show promising results.