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Bladder cancer

Abstract

Bladder cancer is a highly prevalent disease and is associated with substantial morbidity, mortality and cost. Environmental or occupational exposures to carcinogens, especially tobacco, are the main risk factors for bladder cancer. Most bladder cancers are diagnosed after patients present with macroscopic haematuria, and cases are confirmed after transurethral resection of bladder tumour (TURBT), which also serves as the first stage of treatment. Bladder cancer develops via two distinct pathways, giving rise to non-muscle-invasive papillary tumours and non-papillary (solid) muscle-invasive tumours. The two subtypes have unique pathological features and different molecular characteristics. Indeed, The Cancer Genome Atlas project identified genetic drivers of muscle-invasive bladder cancer (MIBC) as well as subtypes of MIBC with distinct characteristics and therapeutic responses. For non-muscle-invasive bladder cancer (NMIBC), intravesical therapies (primarily Bacillus Calmette–Guérin (BCG)) with maintenance are the main treatments to prevent recurrence and progression after initial TURBT; additional therapies are needed for those who do not respond to BCG. For localized MIBC, optimizing care and reducing morbidity following cystectomy are important goals. In metastatic disease, advances in our genetic understanding of bladder cancer and in immunotherapy are being translated into new therapies.

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Figure 1: Types and stages of bladder cancer.
Figure 2: Pathogenesis pathways.
Figure 3: Molecular subtypes of bladder cancer.
Figure 4: Diagnosing bladder cancer.
Figure 5: Anatomical extent of standard lymphadenectomy in bladder cancer.
Figure 6: Emerging immunotherapies for bladder cancer.

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Introduction (O.S. and Y.L.); Epidemiology (J.D.); Mechanisms/pathophysiology (M.A.K.); Diagnosis, screening and prevention (M.B.); Management (M.A.); Quality of life (M.E.N.); Outlook (Y.L.); Overview of the Primer (O.S. and Y.L.).

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Correspondence to Yair Lotan.

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Competing interests

M.B. has received speaker honoraria from and consulted for Ipsen, Astellas Pharma, Janssen, Bayer and Takeda, and has received study grants from Ipsen and Janssen. Y.L. has served as a consultant for Photocure, Pacific Edge and MDxHealth and has conducted research studies with Abbott, Photocure, Cepheid, Pacific Edge and MDxHealth. All other authors declare no competing interests.

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Sanli, O., Dobruch, J., Knowles, M. et al. Bladder cancer. Nat Rev Dis Primers 3, 17022 (2017). https://doi.org/10.1038/nrdp.2017.22

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