Epidemiology, Staging, Grading, and Risk Stratification of Bladder Cancer

ContextUnderstanding the epidemiology and risk factors for non–muscle invasive bladder cancer (NMIBC) can assist in the prevention and early detection of the disease. Furthermore, staging, grading, and risk stratification are critical for determining the most appropriate management strategies for NMIBC based on risk of recurrence and progression.ObjectiveTo provide community urologists with an overview of the epidemiology of NMIBC as well as current approaches to staging, grading, and risk stratification.Evidence acquisitionA committee of internationally renowned leaders in bladder cancer management, known as the International Bladder Cancer Group (IBCG), identified current key influencing guidelines and published English-language literature related to the epidemiology, staging, and grading of NMIBC available as of March 2008. The IBCG met on four occasions to review the main findings of the identified literature and the current clinical practice guidelines of the European Association of Urology (EAU), the First International Consultation on Bladder Tumors (FICBT), the National Comprehensive Cancer Network (NCCN), and the American Urological Association (AUA).Evidence synthesisBased on this review, the IBCG provided a summary on the epidemiology of NMIBC and recommendations for the staging, grading, and risk stratification of the disease.ConclusionsUrologists should record the smoking habits of patients and monitor for possible occupational exposure to urothelial carcinogens. The tumour-node-metastases (TNM) classification for tumour staging and both the World Health Organization (WHO) 1973 and 2004 grading systems should be applied for appropriate staging and grading of NMIBC. Urologists should also consider the use of the European Organisation for Research and Treatment of Cancer (EORTC) risk tables for risk stratification of NMIBC based on risk of disease recurrence and progression.