Overview of Standard Therapy of Non-Muscle-Invasive Bladder Cancer

Bladder cancer (BC) is one of the most frequently diagnosed cancers worldwide. This chapter will focus on clinical presentation, diagnostics, and a brief recap of pathology followed by the standard treatment options and follow-up. Painless gross hematuria is the most common presenting symptom and warrants further diagnostic procedures. The present gold standard in diagnostics is cystoscopy, complemented with urinary cytology and imaging to evaluate the upper urinary tract. To establish both accurate pathological diagnoses and completely remove all visible lesions as part of treatment, transurethral resection of the bladder tumor (TURBT) is performed. In approximately 75% of patients, the BC is confined to the mucosa (stage Ta, CIS [carcinoma in situ]) or submucosa (stage T1), meaning the BC is non-muscle-invasive (NMIBC). Furthermore, the histological grading is established. The combination of pathological factors (stage and grading) and clinical factors determines the risk of disease recurrence and progression. Several models have been developed to stratify patients into risk groups, which further determine the appropriate treatment schedule with intravesical installations (chemotherapy or Bacillus Calmette-Guèrin [BCG]) following the TURBT. In case of low-risk disease, a single postoperative intravesical chemotherapy is sufficient treatment, whereas for the higher risk groups treatment can consist of up to 1 year of chemotherapy or up to 3 years of BCG. In very-high-risk disease or in case of disease recurrence during BCG, this may require treatment with radical cystectomy. Additionally, the risk group stratification determines the follow-up frequency of cystoscopy. Urinary molecular markers may play a significant role in follow-up in the future.