Diagnosis and management of urothelial carcinoma of the bladder

Bladder carcinoma is the fourth most common cancer in men and the ninth most common cancer in women in the United States. In 2010, approximately 70,000 new cases of bladder carcinoma (52,000 in men and 18000 in women) and approximately 14000 deaths were expected in the United States. More than 90% of bladder carcinomas are classified as urothelial carcinoma (UC), which arise from the urothelium. This epithelium, also known as transitional cell epithelium, lines the urinary tract, which extends from the renal pelvis through the ureters, bladder, and urethra. Urothelial carcinoma of the bladder may present as a non-muscle-invasive, muscle-invasive, or metastatic malignancy. In noninvasive tumors, treatment by cystoscopic resection and intravesical therapy is directed at reducing recurrences and preventing progression to a more advanced stage. The goal in invasive tumors is a combination of radical cystectomy and perioperative cisplatin-based combination chemotherapy to enhance outcomes by reducing the high risk of distant recurrences. Outcomes in metastatic UC are dismal with current cisplatin-based combination chemotherapy, and progressive disease after frontline chemotherapy is characterized by a short survival. Therefore, clinical trials should be the focus for metastatic UC. It is important for primary care physicians to recognize the early signs and symptoms of bladder carcinoma, initiate the proper work-up, and refer promptly to a urologist to evaluate suspicious signs and symptoms.