Bladder Cancer

Abstract

ImportanceBladder cancer is a common malignancy in women and is the fourth most common malignancy in men. Bladder cancer ranges from unaggressive and usually noninvasive tumors that recur and commit patients to long-term invasive surveillance, to aggressive and invasive tumors with high disease-specific mortality.ObservationsAdvanced age, male sex, and cigarette smoking contribute to the development of bladder cancer. Bladder tumors can present with gross or microscopic hematuria, which is evaluated with cystoscopy and upper tract imaging depending on the degree of hematuria and risk of malignancy. Non–muscle-invasive tumors are treated with endoscopic resection and adjuvant intravesical therapy, depending on the risk classification. Enhanced cystoscopy includes technology used to improve the detection of tumors and can reduce the risk of recurrence. Patients with high-risk non–muscle invasive tumors that do not respond to adjuvant therapy with the standard-of-care immunotherapy, bacille Calmette-Guérin (BCG), constitute a challenging patient population to manage and many alternative therapies are being studied. For patients with muscle-invasive disease, more aggressive therapy with radical cystectomy and urinary diversion or trimodal therapy with maximal endoscopic resection, radiosensitizing chemotherapy, and radiation is warranted to curb the risk of metastasis and disease-specific mortality. Treatment of patients with advanced disease is undergoing rapid changes as immunotherapy with checkpoint inhibitors, targeted therapies, and antibody-drug conjugates have become options for certain patients with various stages of disease.Conclusions and RelevanceImproved understanding of the molecular biology and genetics of bladder cancer has evolved the way localized and advanced disease is diagnosed and treated. While intravesical BCG has remained the mainstay of therapy for intermediate and high-risk non–muscle-invasive bladder cancer, the therapeutic options for muscle-invasive and advanced disease has expanded to include immunotherapy with checkpoint inhibition, targeted therapies, and antibody-drug conjugates.

MicroRNAs: Their Role in Metastasis, Angiogenesis, and the Potential for Biomarker Utility in Bladder Carcinomas

“…Distinct molecular subtypes have different prognostic, predictive, and therapeutic implications and inform decisions regarding the most appropriate course of action. NMIBC comprises around 70% of BLCA, with five-year recurrence free survival rates of 43% for low risk and 33% for intermediate risk, but up to 21% of high risk progressing to MIBC [2]. NMIBCs is usually nonaggressive, though recurs requiring long term invasive management and surveillance, whereas 75% of newly diagnosed MIBCs do not metastasize; nonetheless, if they do, they become clinically aggressive and invasive with high mortality rate [3].…”

Engineered CRISPR/Cas13d Sensing hTERT Selectively Inhibits the Progression of Bladder Cancer In Vitro

“…About 50% of bladder cancer patients will develop metastases within two years after diagnosis of bladder cancer (Sternberg et al, 2013). For bladder cancer patients with advanced metastasis, chemotherapy is the main treatment (Lenis et al, 2020). However, severe adverse reactions are caused due to poor specificity of chemotherapy drugs (Lenis et al, 2020).…”

“…For bladder cancer patients with advanced metastasis, chemotherapy is the main treatment (Lenis et al, 2020). However, severe adverse reactions are caused due to poor specificity of chemotherapy drugs (Lenis et al, 2020). Thus, finding a highly specific targeted therapy for bladder cancer is of great value for bladder cancer patients.…”

Betulinic Acid Restricts Human Bladder Cancer Cell Proliferation In Vitro by Inducing Caspase-Dependent Cell Death and Cell Cycle Arrest, and Decreasing Metastatic Potential

“…More than 70% of bladder cancer patients are non-muscle-invasive bladder cancer, and there is a high probability that it can be successfully treated through surgery. However, more than half of people with aggressive tumors that invade muscles develop metastasis and cause bladder cancer-related mortality [3][4][5]. Radical cystectomy is the standard therapy for bladder cancer, and various strategies such as radiation therapy, immunotherapy, chemotherapy, and their combination therapy are widely used in the clinic to treat bladder cancer [6,7].…”