Non-invasive bladder cancer: etiology, diagnosis and treatment

Mantas Fabijonavičius1, Aistė Pučinskaitė1

1Faculty of Medicine, Vilnius University, Vilnius, Lithuania


Non-invasive bladder cancer (NMIBC) is a neoplasm in the bladder wall that has not spread to the bladder muscle and it is most common in patients aged 50-70 years. The most important risk factor affecting the development of  bladder cancer is long-term tobacco smoking. Other risk factors: exposure to aromatic amines or chlorinated hydrocarbons, as well as ionizing radiation. Diagnosis of bladder cancer begins with gathering detailed medical history of the patient and physical examination. The most common complaint is visible blood in urine. Imaging may be useful in the diagnosis of NMIBC when the tumor is papillary. However, cystoscopy remains the gold standard for diagnosis, and findings after biopsy or resection must be confirmed histologically. Transurethral bladder resection (TUR-VU) is the initial stage of NMIBC treatment that confirms an accurate histological diagnosis of the tumor. The subsequent step of treatment is adjuvant therapy consisting of single intravesical chemotherapy and intravesical BCG immunotherapy. Single intravesical chemotherapy after TUR-VU surgery destroys tumor cells circulating in the bladder, cells remaining at the resection site, and small unnoticed tumors. Treatment of NMIBC is continued, as indicated, with intravesical BCG immunotherapy. BCG immunotherapy is a widespread but relatively new adjuvant treatment for NMIBC. BCG reduces the risk of tumor recurrence and progression. The best effect is achieved by administering BCG in induction and maintenance mode for 1 to 3 years.

Keywords: Non-muscle-invasive Bladder Cancer, photodynamic diagnosis, BCG immunotherapy.