Diagnosis and treatment of non-muscle-invasive bladder cancer

Abstract

Although there has been an overall reduction in the incidence of bladder cancer, the mortality rate has remained unchanged, hence survival is now worse. Most patients have non‐muscle‐invasive bladder cancer at presentation, which is not immediately life threatening, so efforts must be made to improve the early diagnosis and expeditious treatment of this disease.

Non-Muscle Invasive Bladder Cancer: A Review of the Current Trend in Africa

“…Retrospective analysis of most hospital-based studies in developing countries have shown that gross hematuria is the commonest presenting symptoms followed by irritative symptoms associated with UTI (Table 2, [7, 8, 12, 13, 15, 16-23]). A prospective study by (Edward et al) in UK involving 4,020 patients with hematuria showed macroscopic hematuria was associated with an 18.9% risk of urinary tract malignancy, while non-visible or microscopic hematuria was associated with a 4.8% risk of malignancy [9, 27].…”

“…The diagnosis of bladder cancer ultimately depends on cystoscopic examination of the bladder [1, 3, 9, 10] and histological evaluation of the resected tissue [2] although about 4% of cases will be found incidentally, usually during imaging to investigate non-urological symptoms [9]. However, the detection rate for white light cystoscopy (WLC) can be limited (as low as 60%) [1].…”

“…TURBT under regional or general anesthesia remains the gold standard for the management of NMIBC. The histological type and grade of the tumor, as well as the presence, depth, and type of the tumor invasion should be determined [1-4, 6, 9, 28, 33]. Bimanual examination of the bladder should be performed under anesthesia before prepping and draping unless the tumor is clearly small and noninvasive and should be repeated after the resection.…”

“…In agreement with published data, EAU guidelines strongly recommend re-TUR in patients with high-grade and T1 tumors and always when the pathologist has reported that the specimen contained no muscle tissue. Most authors perform the procedure between 2 and 6 weeks after initial TURB [1-4, 6, 9, 28, 33, 34]. Because of the frequent detection of persistent disease at the location of the original tumor, the deep resection of this site is advocated [15].…”

“…Patients with NMIBC should be placed into one of three risk categories (low, intermediate and high risk) for recurrence and progression based on their stage, grade, number and size of tumors, and whether CIS is present [9]. This allows the most appropriate management to be selected based on the patient’s risk category [9].…”