Non-muscle invasive bladder cancer

Urothelial carcinoma manifests along two divergent pathways: non-muscle invasive and muscle-invasive disease. Non-muscle invasive urothelial carcinoma is further classified as high-risk and low-risk disease. Low-risk disease is associated with low rates of recurrence and progression. In contrast, high-risk tumors have high rates of progression to muscle-invasive disease. Molecular differences characterize low- and high-risk non-muscle invasive bladder cancers and are related to their divergent clinical courses. It is critical to classify a patient's cancer as either high- or low-risk disease in order to direct discussions about treatment and prognosis. All patients with non-muscle invasive bladder cancer should undergo a complete TURBT. Perioperative intravesical chemotherapy is typically indicated following TURBT. Patients with low-risk disease may undergo surveillance or a full course of intravesical therapy. Patients with high-risk disease generally undergo adjuvant intravesical treatment with either an immunomodulator or chemotherapeutic agent in order to prevent recurrence and possibly limit their progression risk. Radical cystectomy plays a role in managing high-risk disease that is resistant to intravesical therapy.