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10 slides generated from the cancer page, with a quiz from the open benchmark and speaker notes that cite the sources. Arrow keys move between slides; Print gives one slide per page.
Most bladder cancers are found while still confined to the lining. They are scraped out through the urethra and, when higher risk, treated with BCG instilled into the bladder; the challenge is the frequent recurrences and the patients whose tumours stop responding to BCG.
Non-muscle-invasive bladder cancer includes papillary tumours confined to the mucosa (Ta) or lamina propria (T1) and flat carcinoma in situ. It is diagnosed by cystoscopy and removed by transurethral resection, with a single immediate dose of intravesical chemotherapy for low-risk tumours. Intermediate- and high-risk disease receives induction and maintenance intravesical BCG, the oldest cancer immunotherapy in use, which halves recurrence and reduces progression. Tumours that recur despite adequate BCG are called BCG-unresponsive; radical cystectomy is the standard, and bladder-sparing alternatives have arrived: pembrolizumab (KEYNOTE-057), nadofaragene firadenovec, nogapendekin alfa inbakicept with BCG, the gemcitabine-releasing device TAR-200 and the oncolytic virus cretostimogene. Worldwide BCG shortages have pushed dose-reduction and chemotherapy substitutes into practice. Blue-light cystoscopy improves detection of flat lesions.
| Setting | Approach | Guideline |
|---|---|---|
| Diagnosis and resection | Cystoscopy, transurethral resection with muscle in the specimen, blue-light or enhanced imaging for carcinoma in situ; re-resection of T1 tumours. | not mapped |
| Low risk | Single immediate instillation of mitomycin or gemcitabine after resection; surveillance cystoscopy. | not mapped |
| Intermediate and high risk | Induction and one to three years of maintenance BCG; intravesical chemotherapy when BCG is unavailable; early cystectomy for the highest-risk T1 disease. | not mapped |
| BCG-unresponsive | Radical cystectomy, or bladder-sparing treatment: pembrolizumab, nadofaragene firadenovec, nogapendekin alfa inbakicept with BCG, TAR-200, cretostimogene in trials and early approvals. | not mapped |