الفهرس 
Introduction and aim of the workOnly 14 pages are availabe for public view
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Abstract
Bladder cancer is the commonest malignancy of the urinary tract. The most common bladder tumor pathologies are urothelial, squamous cell, and adenocarcinoma. Within the WHO system, urothelial cancer is classified as either low- grade or high-grade based upon the degree of nuclear anaplasia and architectural abnormalities. The most important element in the pathologic staging of urothelial cancer is the extent of invasion into deeper layers of the bladder and surrounding tissues.
This information has major implications for both prognosis and treatment and is incorporated into the Tumor, Nodes, Metastasis (TNM) staging system. In this review, we had known about the latest developments in the diagnosis and management of urothelial bladder cancer. 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. 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
Bladder cancer is a chemosensitive disease, and systemic chemotherapy plays a role in its management. Cisplatin-based combination chemotherapy prolongs survival in the metastatic setting, and methotrexate, vinblastine, doxorubicin, and cisplatin or combination gemcitabine/cisplatin is the current standard of care. However, long-term survival in patients with metastatic disease is rare, and treatment is still palliative in nature.
With the advancement in radiotherapy techniques as a direct result of the great advancement in computer science and communication revolution, radiotherapy can improve the tumor control probability and decrease the normal tissue complication probability. The precision and accuracy of radiotherapy techniques and procedures are continuously improving. The image-guided and adaptive radiotherapy ensure the precise dose delivery.We need to undertake controlled prospective randomized studies using modern radiotherapy techniques to test the efficacy of such techniques in improving survival and minimizing immediate and late toxicities.
Finally, Urothelial tumors represent a spectrum of diseases with a range of prognoses. After a tumor is diagnosed anywhere within the urothelial tract, the patient remains at risk for developing a new lesion at a different, or at the same location and with a similar or more advanced stage. Continued monitoring for recurrence is an essential part of management because most recurrences are superficial and can be treated endoscopically. Within each category of disease, more refined methods to determine prognosis and guide management, based on molecular staging, are under development with the goal of optimizing each patient’s likelihood of cure and chance for organ preservation.