Contents

1.Overview

2. Risk factors for urothelial carcinoma of bladder

3. Diagnosis of urothelial carcinoma of bladder

3.1 Signs and symptoms of urothelial carcinoma of bladder

3.1.1 Symptoms

3.1.2 Signs

3.2 Imaging examination

3.2.1 Ultrasonography

3.2.2 CT examination

3.2.3 MRI examination

3.2.4 IVU

3.2.5 Chest plain X-ray film/CT plain scan

3.2.6 Bone scintigraphy

3.2.7 Positron emission tomography-CT (PET-CT)

3.3 Urine cytology and tumor marker in urine

3.3.1 Urine cytology

3.3.2 Bladder tumor markers in urine

3.4 Cystoscopy and biopsy

3.4.1 Cystoscopy

3.4.2 Fluorescent cystoscopy

3.4.3 Narrow band imaging (NBI)

3.4.4 Diagnostic transurethral resection of bladder tumors (TURBt)

4. Histopathology and staging of urothelial carcinoma of bladder

4.1 Histopathology of urothelial carcinoma of bladder

4.2 Histological grading, immunohistochemistry and molecular classification of bladder cancer

4.2.1 Histological grading

4.2.2 Application of immunohistochemistry detection and molecular classification

4.3 Staging system of urothelial carcinoma of bladder

5. Treatment principles of urothelial carcinoma of bladder

6. Treatment of NMIBC (Ta, T1 and Tis)

6.1 Risk grouping system on NMIBC

6.2 TURBt and complications

6.3 Transurethral laser surgery of bladder tumor

6.4 Photodynamic therapy (PDT)

6.5 Partial cystectomy

6.6 Radical cystectomy

6.7 Postoperative complications of TURBt

6.7.1 Bladder perforation

6.7.2 Postoperative bleeding

6.7.3 Urethral stricture

6.8 Secondary TURBt for NMIBC

6.9 Postoperative intravesical therapy for TURBt

6.10 Treatment of bladder cancer in situ

6.11 Treatment of recurrent tumor after TURBt

6.12 Management for patient with positive urine cytology, negative cystoscopy

6.13 Follow-up for patients with NMIBC

7. Treatment of MIBC

7.1 Radical cystectomy

7.1.1 Indication and contraindication of radical cystectomy

7.1.2 Indication of salvage (palliative) cystectomy

7.1.3 Extent of radical cystectomy

7.1.4 Pelvic lymphadenectomy

7.1.5 Surgical approaches of radical cystectomy

7.1.6 Complications and survival rate of radical cystectomy

7.2 Partial cystectomy

7.3 Neoadjuvant/adjuvant therapy

7.3.1 Neoadjuvant chemotherapy

7.3.2 Neoadjuvant RT for patients with MIBC

7.3.3 Adjuvant chemotherapy for patients with MIBC

7.4 Comprehensive treatment for preservation of the bladder for patients with MIBC

7.5 External beam radiotherapy (EBRT)

7.6 Urinary diversion

7.6.1 Orthotopic neobladder

7.6.2 Ileal conduit

7.6.3 Cutaneous ureterostomy

7.6.4 Other methods of urinary diversion

8. Treatment of metastatic urothelial carcinoma of bladder

8.1 Surgery for patients with oligometastatic bladder urothelial carcinoma

8.2 Systemic chemotherapy

8.2.1 First-line systemic chemotherapy for metastatic bladder urothelial carcinoma

8.3 Immunotherapy for metastatic bladder urothelial carcinoma

9. RT for bladder cancer

10. Comprehensive treatment for patients with uncurable bladder cancer

10.1 Palliative cystectomy

10.2 Symptomatic treatment

10.2.1 Bleeding and pain of bladder

10.2.2 Upper urinary tract obstruction

11. Follow-up for MIBC

12. Non-urothelial carcinoma of bladder

12.1 SCC of bladder

12.2 Adenocarcinoma of bladder

12.2.1 Primary non-urachus adenocarcinoma of bladder

12.2.2 Urachal adenocarcinoma

12.3 Small cell carcinoma of bladder

13. Quality of life of patients with bladder cancer

Bladder cancer, which originating from urothelium, is one of the most common malignant tumors in the urinary system. The incidence rate is the eleventh in all malignant tumors worldwide, 9.0/100,000 for men, and 2.2/100,000 for women. The incidence rate is the seventh for men and after tenth for women on malignant tumors; the mortality rate is 3.2/10 million for men and 0.9/10 million for women, and the mortality for men ranks the 9th in male malignant tumors. Regional, racial and gender differences are associated with the pathogenesis of bladder cancer, which are observed in all age groups. The highest incidence is between 50 and 70 years old, which increases with age. Between 2010−2014, the median diagnosis age was 73 years old, and the median age at death was 79 years old based on statistics data from US Surveillance, Epidemiology, and End Results (SEER) database.

The incidence of bladder urothelial carcinoma in China was 6.61/100,000; and the population-standardized incidence was 3.03/ 100,000 according to the statistics of China Cancer Registry Center in 2009. The incidence for men and women is 11.41/100,000 and 3.51/100,000, respectively. The incidence of bladder cancer is 3.3 times for men over the women. The mortality of the disease is 2.60/100,000, 3.75/100,000 for men and 1.24/100,000 for women, respectively. The ratio of patients with urothelial carcinoma of bladder for men and women is about 2.97:1.

In 2016, it is expected to have 80,500 new cases of bladder urothelial carcinoma in China, 62,100 for men (which ranks the 6th in incidence of male malignant tumors in China) and 18,400 for women; there are 32,900 deaths per year for patients with bladder cancer, including 25,100 males (which ranks the 11th in mortality in male malignant tumor in China) and 7,800 female patients.

 

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