Diagnosis and treatment of bladder cancer

The primary key to diagnosis of bladder cancer is cystoscopic examination of the bladder, followed by biopsy of suspicious lesions. Bimanual examination under anesthesia is also important for staging, and urinary cytology and intravenous urography provide valuable additional information. Surgical resection in the form of excisional transurethral biopsy is diagnostic, therapeutic and essential for accurate staging, and assessment of tumor grade is vital for determining prognosis and management strategies. Intravesical chemotherapy with Thiotepa, doxorubicin, mitomycin C or ethoglucid has been shown to reduce the incidence of short-term tumor recurrence by 17% but not long-term recurrence or rate of disease progression. Immunotherapy, as exemplified by Bacillus Calmette-Guérin (BCG), has achieved better results: long-term reduction in tumor recurrence, reduction in disease progression and prolongation of patient survival. Newer immunotherapies using interferon-alpha appear to produce response rates comparable to BCG but without the considerable toxicity of BCG. Further research with combination therapies and other immunotherapeutic agents should lead to improved treatment options in the future.