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November 17, 2020

Bladder Cancer

Author Affiliations
  • 1David Geffen School of Medicine at UCLA, Los Angeles, California
JAMA. 2020;324(19):2006. doi:10.1001/jama.2020.17601

Bladder cancer, also known as urothelial cancer, is a tumor of the cells that line the inside of the urinary bladder.

About half of tumors on the bladder lining are not very dangerous. These tend to come back (recur) often but rarely grow deeper and become life-threatening. The other half of tumors on the bladder lining are more dangerous and may become life-threatening. Tumors that grow deeper than the first layer of the bladder lining can spread throughout the body (metastasize) and become deadly. A common symptom of bladder cancer is painless blood in the urine in older individuals.

Treatment of Early Disease

Treatment begins with removal of the tumor with an instrument placed into the bladder through the urethra (transurethral resection of the bladder, or TURBT). This provides the doctor with important information about the tumor and how deeply it has grown into the bladder wall.

Depending on the aggressiveness of the tumor and how deeply it has grown into the bladder wall, some patients need medication put into the bladder over many weeks to help stop the tumor from coming back or growing deeper into the bladder wall. These treatments in the bladder are either chemotherapy or a special type of medication that helps the body’s immune system fight the tumor. All patients need to be monitored closely for signs of tumor recurrence.

Treatment of Invasive Disease

Patients with tumors that grow into the wall of the bladder need aggressive treatment with either bladder removal (radical cystectomy) or chemotherapy combined with radiation therapy. Before surgery, some patients receive medication, such as chemotherapy, for several months to help obtain the best results from surgery. During surgery, the surgeon creates a new pathway for urine to leave the body (ileal conduit or neobladder). Treatment of invasive disease, especially with radical cystectomy and urinary diversion, has important short-term and long-term effects on quality of life and sexual function that should be discussed with a clinician prior to treatment.

Treatment of Advanced Disease

Bladder cancer that has spread is metastatic disease. The most important treatment for metastatic bladder cancer is medication. The primary medications used are chemotherapy and immunotherapy. These drugs usually can help extend the life span of patients with metastatic bladder cancer.

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Article Information

Conflict of Interest Disclosures: Dr Chamie reported being a consultant for Merck and UroGen. No other disclosures were reported.

Source: Andrew T. Lenis AT, Lec PM, Chamie K. Bladder cancer: a review. JAMA. Published November 17, 2020. doi:10.1001/jama.2020.17598