Bladder cancer

To review the diagnosis and management of bladder cancer with an emphasis on studies and developments over the past year.

Cystoscopy remains the mainstay in the detection and surveillance of bladder cancer, though fluorescent light may enhance detection. Efforts continue in the development of urinary bladder cancer markers. Superficial bladder cancer is still managed with transurethral resection and perioperative instillation of chemotherapy for most patients. The data support the use of intravesical bacillus Calmette-Guerin (including a maintenance regimen) for those at high risk for progression. The gold standard for management of muscle invasive disease is radical cystectomy. Research on the use of laparoscopy, the effect on patients' health-related quality of life, and the potential role for bladder preservation strategies is ongoing. The value of neoadjuvant versus adjuvant chemotherapy around the time of cystectomy is still debated. Methotrexate, vinblastine, doxorubicin, and cisplatin and gemcitabine and cisplatin remain the most commonly used chemotherapy regimens, but work is ongoing to develop new regimens, especially in patients who cannot take cisplatin.

We are encouraged by the progress in bladder cancer diagnosis and management, but considerably more work needs to be done to improve on the lives of our patients with this disease.