Bladder cancer is a heterogenous neoplasm that ranges from non-life-threatening, low-grade, superficial papillary lesions to high-grade invasive tumors that often metastasizes at the presentation.

It is the most common cancer involving the urinary system and it is the 11th most commonly diagnosed in the world.

Microscopic or gross painless hematuria is the most common presenting complaint.


  • Alternative treatment in patients unfit for or opposed to radical surgery or for local palliative treatment inpatients with metastatic disease
  • Preoperative RT prior to cystectomy may be considered in patients with invasive tumors 
  • May consider adjuvant pelvic irradiation for patients with pT3/pT4 pN0-2 disease who recently underwent radical cystectomy with ileal conduit
  • Intraoperative RT may be considered in patients with tumors extending to the abdominal and/or pelvic wall 
  • Palliative RT combined with radiosensitizing chemotherapy is recommended especially for patients with metastasis or disease recurrence
  • Recommended dose: 1.8-2.0 Gy daily fractionation
    • Conventional or accelerated hyperfractionation of 39.6–50.4 Gy may be applied to the whole bladder with or without pelvic nodal irradiation
  • Absence of hydronephrosis and extensive carcinoma in situ is a factor for positive treatment response


  • For muscle-invasive bladder cancer, radical radiotherapy is given using a radiosensitiser (eg Mitomycin + Fluorouracil or Cisplatin plus Fluorouracil or Cisplatin plus Paclitaxel or Cisplatin alone)
    • Low-dose Gemcitabine may also be considered
  • Conventional fractional radiation therapy with a radiosensitizer may be used as palliative therapy in patients with advanced or metastatic disease
    • Recommended regimens include Cisplatin (preferred), taxanes (Docetaxel, Paclitaxel), Fluorouracil monotherapy, Fluorouracil + Mitomycin, low-dose Gemcitabine, or Capecitabine monotherapy
  • Concurrent chemoradiotherapy is an alternative option to radical cystectomy in patients with recurrent Ta-T1 disease (without extensive Tis) with history of BCG therapy and ineligible for cystectomy
    • Also recommended for patients in need of added tumor cytotoxicity
Editor's Recommendations
Most Read Articles
21 Nov 2020
Ivermectin confers benefits in the treatment of COVID-19, with a recent study showing that its use helps reduce the risk of death especially in patients with severe pulmonary involvement.
6 days ago
Mental health comorbidities are common among patients with type 2 diabetes mellitus and may lead to worse outcomes, a recent study has found.
Roshini Claire Anthony, 13 Nov 2020

Diabetes is a key risk factor for heart failure (HF), which is the leading cause of hospitalization in patients with or without diabetes. SGLT-2* inhibitors (SGLT-2is) have been shown to reduce the risk of hospitalization for HF (HHF) regardless of the presence or absence of diabetes.

3 days ago
Vitamin D deficiency may be a contributing factor to the mortality rate among patients with the novel coronavirus disease (COVID-19), reports a new study.