Feature Article

Bladder cancer: assessment and management

Paul Sved, John Boulas



A common urological cancer, bladder cancer has a broad spectrum of aggressiveness and risk. While low grade noninvasive bladder cancers rarely progress to invasive or metastatic disease, high grade lesions have a much greater propensity to invade the bladder wall and ultimately metastasise.

Key Points

  • Patients with transitional cell carcinoma (TCC) of the bladder usually present with painless macroscopic or microscopic haematuria.
  • Patients may also present with irritative voiding symptoms such as urinary frequency and urgency.
  • Patients with TCC of the bladder are also at risk of renal and ureteric TCC.
  • Initial investigations comprise urine culture and cytology, full blood count, coagulation studies, and serum urea, electolytes and creatine, plus intravenous pyelography or computed tomography urography.
  • Cystoscopy is mandatory in all cases of gross haematuria and many cases of microscopic haematuria.
  • Patients with noninvasive TCC can usually be managed endoscopically (resection or fulguration) with the addition of intravesical therapies.
  • Muscle-invasive TCC is a dangerous disease that must be managed aggressively by either cystectomy or radiation therapy.