Bladder cancer arises when abnormal cells in the bladder lining grow uncontrollably. This article covers risk factors, staging, and comprehensive treatment options from minimally invasive procedures to systemic therapies aimed at long-term control.

Bladder cancer most commonly originates as urothelial carcinoma in the bladder’s inner lining. Tobacco use, occupational exposures (aromatic amines), chronic irritation (stones, infections), and older age elevate risk. Early detection and precise staging guide personalized treatment plans that balance cancer control with bladder preservation.

Classification and Staging
Non–muscle‑invasive tumors (Ta, T1, carcinoma in situ) are confined to the mucosa or submucosa.
Muscle‑invasive disease (T2 or higher) penetrates the detrusor muscle and may spread to lymph nodes (N+) or distant organs (M+).

Diagnostic Workup
Hematuria prompts evaluation with cystoscopy and biopsy. CT urography assesses upper tracts. Urine cytology and novel biomarkers aid early detection of high‑grade lesions.

Treatment of Non–Muscle‑Invasive Bladder Cancer
Transurethral resection of bladder tumor (TURBT) removes visible lesions. Immediate postoperative intravesical chemotherapy reduces recurrence risk.
For high‑risk tumors or carcinoma in situ, induction and maintenance intravesical Bacillus Calmette–Guérin (BCG) immunotherapy lower progression and recurrence.

Treatment of Muscle‑Invasive Bladder Cancer
Radical cystectomy with pelvic lymph node dissection remains the gold standard. Neoadjuvant cisplatin‑based chemotherapy before surgery improves survival.
Bladder‑sparing trimodal therapy—TURBT followed by concurrent chemoradiation—offers an alternative for select patients desiring bladder preservation.

Advanced and Metastatic Disease
First‑line systemic therapy includes platinum‑based combinations (gemcitabine/cisplatin).
Second‑line checkpoint inhibitors (pembrolizumab, atezolizumab) target PD‑1/PD‑L1 and produce durable responses in a subset of patients.
FGFR3 inhibitors (erdafitinib) benefit patients harboring specific FGFR3 genetic alterations.

Follow‑Up and Survivorship
Surveillance cystoscopy every three months initially, then spacing out, detects recurrences early. Imaging monitors for upper tract or metastatic spread. Management of treatment‑related side effects and urinary diversion care are integral to quality of life.

Bladder cancer management requires a multidisciplinary approach combining endoscopic procedures, intravesical therapies, surgery, systemic treatments, and vigilant surveillance. Advances in targeted and immune therapies continue to expand options and improve patient outcomes.