Bladder cancer and smoking. Part 2: diagnosis and management

This is the second article in a series of four on bladder cancer and smoking. The link between bladder cancer and smoking was discussed in part 1, and part 2 looks at diagnosis and management. The authors conducted a survey within their own workplace to identify whether patients had been given information about the role of smoking in the development of bladder cancer and drew on the results of this to identify areas where clinical practice needs to change. This article seeks to provide an overview of the management of bladder cancer: how the disease is manifested, and subsequent treatments to reduce the risk of recurrence and progression. Superficial bladder cancer is managed by surgery: transurethral resection. Additional treatment includes cytotoxic therapy with intravesical chemotherapy and immunotherapy agents. However, while treatments may be effective in reducing tumour recurrence, the chance of tumour progression from superficial to invasive disease remains high. Further risks are incurred from the side-effects of treatments on the individual's quality of life.