The Changing Face of Urothelial Bladder Cancer

Survival for patients undergoing radical cystectomy for urothelial bladder cancer has remained relatively unchanged throughout the past three decades [1]. This is despite improvements in surgical technique, supportive care during surgery, administration of systemic therapy, and lastly, despite evidence of an associated survival benefit, neoadjuvant chemotherapy [2]. While the reason for this lack of improvement in survival outcomes remains unclear, advances have been made in our understanding of bladder cancer that may allow better stratification within the disease itself. Molecular markers are beginning to be identified that may be implicated in worse outcomes, response to chemotherapy, or outlining which patients have progression of disease. These developments are in infant stages, but recent advances may shape future management. Notable among these advances is the classification of morphologic subtypes within urothelial bladder cancer by the World Health Organization. The recognition of variant histology within urothelial carcinoma is changing the way institutions opt to manage such patients. However, there is poor consensus among experts regarding the most appropriate management strategy and the extent to which this should vary by individual variants.