Bladder cancer

Urothelial carcinoma of the bladder is the most common malignancy affecting the urinary tract. This review examines the current standards in the diagnosis and management of this disease. Cystoscopy and urine cytology remain important tools in the diagnosis and follow-up of bladder cancer. Alternatives include photodynamic diagnosis and narrow band imaging. These have been investigated with the aim of improving both the sensitivity of detection of tumours and improving the quality of transurethral resection which has the ultimate aim of reducing recurrence rates when compared with standard resection in white light. We discuss intravesical chemotherapy, immunotherapy and adjuncts to improve drug delivery across the urothelium. For patients with muscle-invasive bladder cancer, laparoscopic radical cystectomy and robot-assisted radical cystectomy have been shown to reduce perioperative morbidity, and are oncologically equivalent to open radical cystectomy. It remains to be seen whether equivocal perioperative morbidity justify its on-going use. Bladder-preservation strategies entail resection and chemoradiation, and in selected patients give equivalent results to surgery.