Urothelial cancer

Abstract

Overview Urothelial malignancy is one of the most common cancers in Western society and involves the bladder, urethra, ureters, and renal calyces. It is predominantly associated with smoking, industrial dyes, schistomiasis, radiation exposure, and certain geographical locations. Well‐defined molecular prognosticators have been identified and, in combination with improved staging techniques, have led to improved outcomes. Patients with nonmuscle invasive urothelial malignancy are best managed by surgical resection, often in combination with intravesical immunotherapy or chemotherapy. Muscle invasive disease is best managed by neoadjuvant cisplatin‐based chemotherapy followed by cystectomy; less robust patients are often effectively treated by cisplatin‐based chemoradiation. Patients with metastatic disease achieve response rates of up to 70% with MVAC (methotrexate, vinblastine, doxorubicin, and cisplatin) or GC combination chemotherapy but are infrequently cured. New approaches to the management of systemic disease are predicated on recent data reflecting the importance of unblocking checkpoints for immune function and correlate with expression of PD‐L1 (programmed death‐ligand 1).