Bladder cancer arises from the lining of the urinary bladder. The typical age of onset is from 65-85 years, with a higher frequency in males. Tobacco use is the primary known contributor of bladder cancer, as well as occupational exposure to carcinogens, such as benzidine, and obesity. Once diagnosed, typically by cystoscopy and biopsy, the cancer is classified by how far it has spread; non-muscle invasive, muscle invasive, or advanced/metastatic. The majority of bladder cancers are transitional cell carcinoma, also known as urothelial carcinoma. Treatment is dependent upon the amount of invasion. Superficial non-muscle invasive tumors can be treated by transurethral resection of bladder tumor (TURBT) and immunotherapy by intravesicular delivery of BCG. Muscle invasive disease usually requires a partial or total cystectomy, as well as chemoradiotherapy.
This an exciting time for bladder cancer research, with new checkpoint inhibitor treatments in development, trials or already approved, including atezolizumab, pembrolizumab, nivolumab, avelumab and durvalumab. Despite this there remains an unmet need, as not all patients respond to these agents. Research into predictive biomarkers is just one interesting area being investigated to address this.