Loading
Bladder cancer went from 40 years of cisplatin to an ADC-immunotherapy combination that nearly doubled survival, and in 2026 the first blood-test-guided drug approval.
Urothelial carcinoma of the bladder is the tenth most common cancer worldwide and the most expensive to manage per patient, because three quarters present as non-muscle-invasive disease that recurs for years and demands lifelong cystoscopy. Smoking causes about half of cases. Muscle-invasive disease (25%) has required radical cystectomy with neoadjuvant cisplatin since the 2000s, and metastatic disease relied on platinum chemotherapy for four decades.
Between 2019 and 2026 the field was rebuilt. In metastatic disease, enfortumab vedotin plus pembrolizumab nearly doubled survival over chemotherapy (EV-302, 2023). The same pair then moved around surgery: EV-303 in cisplatin-ineligible patients (EFS HR 0.40, approved November 2025) and EV-304 in cisplatin-eligible patients (positive December 2025), after NIAGARA had already established perioperative durvalumab (approved March 2025). Adjuvant nivolumab (CheckMate 274) and ctDNA-guided adjuvant atezolizumab (IMvigor011, the first ctDNA-based approval, 2026) cover the post-cystectomy space. In non-muscle-invasive disease, the BCG-unresponsive population gained four bladder-sparing options (pembrolizumab, nadofaragene firadenovec, N-803 + BCG, and the gemcitabine-eluting device TAR-200), with the oncolytic virus cretostimogene filing in 2026, and durvalumab + BCG became the first systemic immunotherapy in BCG-naive disease (POTOMAC, May 2026). Erdafitinib remains the only targeted drug, for FGFR3-altered tumours after immunotherapy.
What is next: bladder preservation for complete responders to perioperative EV + pembrolizumab; sequencing after EV + pembrolizumab (platinum, HER2 ADCs such as disitamab vedotin, TROP2 and bispecific ADCs, sac-TMT); urine tumour DNA to reduce cystoscopy; resolving BCG shortages with recombinant strains and alternatives; and understanding why some intravesical immunotherapies (durvalumab, sasanlimab) add to BCG while others (atezolizumab) did not.
Averages across everyone diagnosed, often years ago. A median is the middle of a group: half the people counted lived longer than the figure shown, and some lived far longer. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
About 600,000 cases a year worldwide and the fourth most common cancer in men in the US.
Averages across everyone diagnosed, often years ago. A median is the middle of a group: half the people counted lived longer than the figure shown, and some lived far longer. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
Renal cell carcinoma comes from the kidney's filtering cortex, urothelial cancer from the lining of the collecting system and bladder, and the adrenal on top hosts cortical and medullary (neuroblastoma) tumours.
Same organ: Collecting duct carcinoma of the kidney, Renal medullary carcinoma (SMARCB1-deficient), TFE3-rearranged (translocation) renal cell carcinoma, Fumarate hydratase-deficient renal cell carcinoma (HLRCC-associated), Succinate dehydrogenase-deficient renal cell carcinoma, Mucinous tubular and spindle cell carcinoma of the kidney, Eosinophilic solid and cystic renal cell carcinoma, Clear cell papillary renal cell tumour, Urothelial carcinoma of the urethra, Squamous cell carcinoma of the urethra, Adenocarcinoma of the urethra (including clear cell adenocarcinoma), Melanoma of the urethra, Non-muscle-invasive bladder cancer, Muscle-invasive and advanced bladder cancer, Clear cell renal cell carcinoma, Papillary renal cell carcinoma, Chromophobe renal cell carcinoma, Renal cell carcinoma, Wilms tumour (nephroblastoma), Neuroblastoma (paediatric), Low-risk neuroblastoma (INRG very low and low risk, including stage MS), Intermediate-risk neuroblastoma, High-risk neuroblastoma, Adrenocortical carcinoma, Pheochromocytoma and paraganglioma (PPGL), Urethral cancer, Penile cancer, Localised penile cancer (organ-confined, node-negative), Node-positive and metastatic penile cancer, Localised adrenocortical carcinoma (ENSAT stage I to III, resectable), Advanced and metastatic adrenocortical carcinoma (ENSAT stage IV or unresectable), Hereditary pheochromocytoma and paraganglioma (SDHx, VHL, RET, NF1, MAX and TMEM127), Metastatic pheochromocytoma and paraganglioma
Most people reading this do not have advanced disease. The map describes what can happen over the whole course of the illness, across autopsy and registry series; today's staging scans find spread earlier, and each site has treatments, from focused radiotherapy for a few spots to drugs that reach the brain.
What helpsEnfortumab vedotin with pembrolizumab, which nearly doubled survival over chemotherapy (EV-302); erdafitinib for FGFR3 alterations; HER2 and TROP2 ADCs in trials.
Background: Minimal / molecular residual disease (MRD). Also on OnCo: Atlas of advanced disease · How cancer spreads: the metastasis stages.
Also on OnCo: Symptoms and red flags · Early detection roadmap.
Non-muscle-invasive: transurethral resection (TURBT) then intravesical BCG; novel intravesical agents for BCG-unresponsive disease; durvalumab + BCG for high-risk disease (2026).
Muscle-invasive: neoadjuvant chemotherapy ± durvalumab → radical cystectomy → ctDNA-guided atezolizumab or nivolumab; perioperative enfortumab vedotin + pembrolizumab for cisplatin-ineligible patients (EV-303), with EV-304 positive in cisplatin-eligible patients.
Enfortumab vedotin (an antibody-drug conjugate) + pembrolizumab (immunotherapy); erdafitinib for FGFR3 alterations; platinum chemotherapy + nivolumab.
Cystoscopy (white or blue light) and TURBT with muscle in the specimen; re-resection for T1; CT urography; urine cytology; surveillance cystoscopy every 3-12 months by risk.
TURBT with single immediate intravesical chemotherapy instillation; intermediate risk adds 1 year of intravesical chemotherapy (gemcitabine/mitomycin) or BCG.
TURBT then BCG induction and 1-3 years maintenance; durvalumab + BCG approved May 2026 (POTOMAC); radical cystectomy for very high-risk (T1 + CIS, variant histology).
Radical cystectomy remains the oncologic gold standard; bladder-sparing options: TAR-200 (Inlexzo, 2025), N-803 + BCG (Anktiva, 2024), nadofaragene firadenovec (2022), pembrolizumab (2020); cretostimogene in registration.
Perioperative EV + pembrolizumab (EV-304, positive 2025; filing) or neoadjuvant durvalumab + gemcitabine-cisplatin with adjuvant durvalumab (NIAGARA, approved 2025), then radical cystectomy with lymph node dissection; trimodality bladder preservation (TURBT + chemoradiation) for selected patients.
Perioperative EV + pembrolizumab with cystectomy (EV-303, approved Nov 2025); or cystectomy alone / chemoradiation.
Adjuvant nivolumab for high-risk pathology (CheckMate 274); or ctDNA-guided adjuvant atezolizumab (IMvigor011, approved 2026).
Enfortumab vedotin + pembrolizumab (EV-302); if contraindicated, platinum-gemcitabine followed by avelumab maintenance (JAVELIN Bladder 100) or nivolumab + gemcitabine-cisplatin (CheckMate 901).
Erdafitinib if FGFR3-altered (THOR); platinum chemotherapy if not yet given; disitamab vedotin ± toripalimab (HER2, China); sacituzumab govitecan (US indication withdrawn 2024); trials of TROP2/HER2/bispecific ADCs and sac-TMT.
Trials recruiting now, the landmark trials, the trials held by this cancer's subtypes, the key papers and what they mean, the latest literature, and the milestones year by year.
Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes.
The decisions you may face, the aids that walk through them, the warnings on record, the first sixty days and the questions to ask.
Everything in development, the medicines held by this cancer's subtypes, the open problems and what is being done about them, the roadmaps, and what changed on this record.
Every connected record, the notes, the JSON, Markdown and RDF twins, and where the record came from and when it was checked.