Urology Centre, Guy's Hospital, Guy's and St Thomas' NHS Trust, London, SE1 9RT, UK.
BMC Med. 2013 Jan 17;11:13. doi: 10.1186/1741-7015-11-13.
Bladder cancer is the commonest malignancy of the urinary tract. In this review, we look at the latest developments in the diagnosis and management of this condition. Cystoscopy and urine cytology are the most important tools in the diagnosis and follow-up of bladder cancer. Various alternatives have been investigated, either to reduce the frequency of cystoscopy, or improve its sensitivity for detection of tumors. These include urine-based markers and point-of-care tests. Narrow-band imaging and photodynamic diagnosis/blue-light cystoscopy have shown promise in improving detection and reducing recurrence of bladder tumors, by improving the completion of bladder resection when compared with standard resection in white light. The majority of patients with a new diagnosis of bladder cancer have non-muscle-invasive bladder cancer, which requires adjuvant intravesical chemotherapy and/or immunotherapy. Recent developments in post-resection intravesical regimens are discussed. For patients with muscle-invasive bladder cancer, both laparoscopic radical cystectomy and robot-assisted radical cystectomy have been shown to reduce peri-operative morbidity, while being oncologically equivalent to open radical cystectomy in the medium term. Bladder-preserving strategies entail resection and chemoradiation, and in selected patients give equivalent results to surgery. The development, advantages, and disadvantages of these newer approaches are also discussed.
膀胱癌是最常见的泌尿系统恶性肿瘤。在这篇综述中，我们探讨了该疾病诊断和治疗的最新进展。膀胱镜检查和尿液细胞学检查是诊断和随访膀胱癌的最重要工具。已经研究了各种替代方法，无论是减少膀胱镜检查的频率，还是提高其检测肿瘤的敏感性。这些方法包括基于尿液的标志物和即时检测方法。窄带成像和光动力诊断/蓝激光膀胱镜检查通过改善与标准白光切除相比膀胱切除的完成率，显示出在提高膀胱癌检测和降低复发率方面的潜力。大多数新诊断为膀胱癌的患者患有非肌肉浸润性膀胱癌，需要辅助膀胱内化疗和/或免疫治疗。讨论了术后膀胱内治疗方案的最新进展。对于肌层浸润性膀胱癌，腹腔镜根治性膀胱切除术和机器人辅助根治性膀胱切除术均已显示出降低围手术期发病率的作用，并且在中期与开放性根治性膀胱切除术在肿瘤学上等效。保膀胱策略包括切除和放化疗，并且在选定的患者中，与手术等效。还讨论了这些新方法的发展、优势和劣势。
