Guideline sources The following summarized guidelines for the evaluation and management of bladder cancer (BC) are prepared by our editorial team based on guidelines from the European Association of Urology (EAU 2023; 2021), the European Society of Medical Oncology (ESMO 2022; 2014), the American Urological Association (AUA/SUO/ASTRO/ASCO 2017), the American Urological Association (AUA/SUO 2016), and the U.S. Preventive Services Task Force (USPSTF 2011). 1 2 3 4 5 6 7 https://web.pathway.md/diseases/recvI2mkZpuJOXOaw 1/13 6/29/23, 3:18 AM Bladder cancer Pathway Calculator Calculator Calculator Eastern Cooperative Oncology G Karnofsky performance status s TNM class Guidelines 1. Screening and diagnosis Indications for screening: As per EAU 2023 guidelines, take into account the increased risk of developing BC in patients undergoing external-beam radiation therapy, brachytherapy, or a combination of those, during follow-up. Follow-up closely patients treated with radiation at a young age, as they are at the greatest risk and BC requires time to develop. B As per ESMO 2014 guidelines, do not obtain screening for BC on a population level for improving survival. D As per USPSTF 2011 guidelines, insufficient to recommend screening for BC in asymptomatic adults. A 2. Classification and risk stratification Risk factors: recognize that there are several risk factors connected with the risk of BC, with tobacco smoking as the most important one. B Staging: As per ESMO 2022 guidelines, classify patients with non-muscle-invasive BC into 4 risk categories (low risk, intermediate risk, high risk, and very high risk) based on tumor characteristics for further treatment and follow-up recommendations. B As per EAU 2021 guidelines, classify the depth of invasion (staging) according to the TNM classification. A Show 3 more As per AUA 2016 guidelines, assign a clinical stage and classify patients accordingly as low-, intermediate-, or high-risk at the time of each occurrence/recurrence. B 3. Diagnostic investigations History and physical examination: Use validated questionnaires to assess health-related quality of life in patients with muscle- invasive BC, both at baseline and post-treatment. A https://web.pathway.md/diseases/recvI2mkZpuJOXOaw 2/13 6/29/23, 3:18 AM Bladder cancer Pathway As per ESMO 2022 guidelines, evaluate painless hematuria in all patients as it is the most common presenting symptom in BC. B As per EAU 2021 guidelines, elicit a patient history, focusing on urinary tract symptoms and hematuria. A Elicit a full history and perform physical examination including an examination under anesthesia at the time of transurethral resection of bladder tumor before treatment consideration in patients with suspected invasive cancer. B Urinary tract imaging: As per ESMO 2022 guidelines, obtain cross-sectional upper tract imaging (CT/MRI urography) to screen for synchronous upper urinary tract urothelial carcinoma in cases of high-grade BC. B As per EAU 2021 guidelines: Obtain renal and bladder ultrasound and/or CT-intravenous urography in the initial evaluation of patients with hematuria. A Obtain CT urography in selected patients with bladder tumor (such as tumors located in the trigone, multiple- or high-risk tumors). A As per AUA 2016 guidelines: Obtain upper urinary tract imaging in the initial evaluation of patients with BC. B Consider obtaining upper tract imaging in patients with a history of non-muscle-invasive BC with a normal cystoscopy and positive cytology. E Imaging for staging: As per EAU 2023 guidelines: Obtain CT of the chest, abdomen, and pelvis for staging, including some form of CT urography with designated phases for optimal urothelial evaluation, in patients with confirmed muscle- invasive BC. A Obtain CT urography unless contraindicated for reasons related to contrast administration or radiation dose. Obtain MRI if CT urography is contraindicated. A As per ESMO 2022 guidelines: Obtain further imaging, such as contrast-enhanced CT of the chest-abdomen-pelvis or MRI of the abdomen-pelvis combined with chest CT, for regional and distant staging in patients with invasive disease ( T1). B Consider obtaining FDG-positron emission tomography-CT for the detection of lymph node and distant metastases. C As per AUA 2017 guidelines, obtain chest imaging and cross-sectional imaging of the abdomen and pelvis with IV contrast, if not contraindicated, as part of complete staging evaluation in patients with muscle-invasive BC. B Laboratory tests: obtain a comprehensive metabolic panel (CBC, LFTs, ALP and renal function) in patients with muscle-invasive BC. B https://web.pathway.md/diseases/recvI2mkZpuJOXOaw 3/13 6/29/23, 3:18 AM Bladder cancer Pathway 4. Diagnostic procedures Cystoscopy and ureteroscopy: As per EAU 2023 guidelines: Perform cystoscopy for the diagnosis of BC. A Describe all macroscopic features of the tumor (site, size, number, and appearance) and mucosal abnormalities during cystoscopy. Use a bladder diagram. A As per EAU 2021 guidelines, perform cystoscopy for the diagnosis of BC. A Show 2 more As per AUA 2016 guidelines, perform a thorough cystoscopic examination of the urethra and bladder at the time of resection to evaluate and document tumor size, location, configuration, number and mucosal abnormalities in patients with suspected BC. B Show 3 more Cytology: As per EAU 2023 guidelines, recognize that urinary cytology has high sensitivity in high-grade tumors, including carcinoma in situ. B As per ESMO 2022 guidelines, consider obtaining urine cytology to facilitate the diagnosis of high-grade urothelial carcinoma, but do not use it as the primary method of histological diagnosis. C Use the Paris system for reporting. As per EAU 2021 guidelines, obtain voided urine cytology as an adjunct to cystoscopy to detect high-grade tumor. A Show 3 more Biopsy and histopathology: As per EAU 2023 guidelines, record the following in the pathology report: depth of invasion (categories pT2a and pT2b, pT3a and pT3b, or pT4a and pT4b) margins with special attention paid to the radial margin, prostate, ureter, urethra, peritoneal fat, uterus, and vaginal vault total number of lymph nodes, the number of positive lymph nodes, and extranodal spread lymphovascular invasion presence of carcinoma in situ sampling sites and information on tumor size when providing specimens to the pathologist. A Show 2 more As per ESMO 2022 guidelines, diagnose BC based on cystoscopic examination of the bladder and histological evaluation of tissue obtained either with cold-cup biopsy or transurethral resection of the bladder tumor. Perform complete resection of all tumor tissue when possible. Include muscle tissue in the biopsies except when a Ta/LG is expected. B Show 2 more As per EAU 2021 guidelines, exclude an upper tract urothelial carcinoma, carcinoma in situ in the bladder (by mapping biopsies or photodynamic diagnosis-guided biopsies) and tumor in the https://web.pathway.md/diseases/recvI2mkZpuJOXOaw 4/13 6/29/23, 3:18 AM Bladder cancer Pathway prostatic urethra (by prostatic urethra biopsy) in patients with positive cytology but negative cystoscopy. A As per AUA 2017 guidelines, review the pathology by an experienced genitourinary pathologist if variant histology is suspected or if muscle invasion is equivocal (such as, micropapillary, nested, plasmacytoid, neuroendocrine, sarcomatoid, extensive squamous or glandular differentiation). B As per AUA 2016 guidelines: Consider performing prostatic urethral biopsies and random bladder biopsies in patients with a history of non-muscle-invasive BC with a normal cystoscopy and positive cytology. E Review the pathology of a patient with any doubt in regards to variant or suspected variant histology (such as micropapillary, nested, plasmacytoid, neuroendocrine, sarcomatoid), extensive squamous or glandular differentiation, or the presence/absence of lymphovascular invasion by an experienced genitourinary pathologist. B As per ESMO 2014 guidelines, perform biopsy of the prostatic urethra if the tumor is located at the trigone or bladder neck area, or if there is no bladder tumor and the procedure is performed to study a positive cytology, since the tumor could be located in the urothelium lining the prostatic urethra or the ducts. B Molecular testing: As per EAU 2023 guidelines: Insufficient evidence to support the use of tumor mutational burden, molecular subtypes, immune or other gene expression signatures for the management of patients with urothelial cancer. Evaluate for FGFR2/3 genetic alterations for the potential use of erdafitinib in patients with locally advanced or metastatic urothelial carcinoma progressed after platinum-containing chemotherapy (including within 12 months of neoadjuvant or adjuvant platinum-containing chemotherapy). B As per ESMO 2022 guidelines, do not obtain molecular diagnostics such as The Cancer Genome Atlas classification and PD-L1 status for all tumors. D 5. Medical management Management of non-muscle-invasive cancer (general principles): follow a risk-stratified approach with transurethral resection of the bladder tumor and intravesical chemotherapy or BCG in intermediate- and high-risk patients with non-muscle-invasive BC. A Management of non-muscle-invasive cancer, intravesical chemotherapy: As per EAU 2021 guidelines, offer one immediate chemotherapy instillation in patients with low- risk tumors and in patients with small papillary recurrences (presumably Ta LG/G1) detected > 1 year after previous transurethral resection of the bladder. A Show 8 more https://web.pathway.md/diseases/recvI2mkZpuJOXOaw 5/13 6/29/23, 3:18 AM Bladder cancer Pathway As per SUO/AUA 2016 guidelines, consider administering a single postoperative instillation of intravesical chemotherapy (such as mitomycin C or epirubicin) within 24 hours of transurethral resection of bladder tumor in patients with suspected or known low- or intermediate-risk BC. C Show 4 more Management of non-muscle-invasive cancer, intravesical BCG immunotherapy: As per EAU 2021 guidelines, offer 1-year full-dose BCG treatment (induction plus 3-weekly instillations at 3, 6 and 12 months) or instillations of chemotherapy (the optimal schedule is not known) for a maximum 1 year in patients with intermediate-risk tumors (with or without immediate instillation). Decide on the final treatment option based on individual patient's risk of recurrence and progression and the efficacy and side effects of each treatment modality. A Show 3 more As per SUO/AUA 2016 guidelines, administer a 6-week induction course of BCG in high-risk patients with newly diagnosed carcinoma in situ, high-grade T1, or high-risk Ta urothelial carcinoma. B Show 2 more Management of non-muscle-invasive cancer (salvage therapy): consider offering pembrolizumab or nadofaragene firadenovec in patients unresponsive to BCG and ineligible for or refusing cystectomy. C Offer a multidisciplinary approach in these patients. C Management of muscle-invasive cancer, general principles: As per EAU 2023 guidelines: Differentiate between urachal and non-urachal subtypes of adenocarcinoma for treatment decisions. E Evaluate patients being candidates for curative treatment, such as cystectomy or bladder preservation, by at least an oncologist, a urologist, a radiation oncologist (in case adjuvant radiotherapy or bladder preservation is considered), and a neutral healthcare professional, such as a specialist nurse. E As per ESMO 2022 guidelines, ensure multidisciplinary care via tumor board discussions and/or directed consultations with a medical oncologist, radiation oncologist, and urologist for the optimal management of BC. B As per SUO/ASTRO/ASCO/AUA 2017 guidelines: Discuss curative treatment options with patients with newly diagnosed muscle-invasive BC before determining a plan of therapy based on both patient comorbidity and tumor characteristics. Evaluate patients using a multidisciplinary approach. B Take into account unique clinical characteristics of patients with variant histology that may require divergence from standard evaluation and management for urothelial carcinoma. E Management of muscle-invasive cancer, bladder-preserving therapy: As per EAU 2023 guidelines, do not offer bladder-preserving therapy in patients with carcinoma in situ. D Show 7 more As per ESMO 2022 guidelines: https://web.pathway.md/diseases/recvI2mkZpuJOXOaw 6/13 6/29/23, 3:18 AM Bladder cancer Pathway Consider offering bladder-preserving therapy with radiotherapy as part of multimodal therapy for muscle-invasive BC in patients seeking an alternative to radical cystectomy and as an option in patients medically unfit for surgery. C Utilize a tri-modality combination of transurethral resection of the bladder tumor, radiotherapy, and chemotherapy in contemporary organ-preservation protocols. B As per SUO/ASTRO/ASCO/AUA 2017 guidelines, offer bladder-preserving therapy, if clinically appropriate, in patients with newly diagnosed non-metastatic muscle-invasive BC desiring retaining their bladder and in patients with significant comorbidities when radical cystectomy is not a treatment option. B Show 3 more Management of muscle-invasive cancer, chemotherapy: As per EAU 2023 guidelines, offer neoadjuvant cisplatin-based combination chemotherapy in cisplatin-eligible patients with muscle-invasive BC (T2-T4a, cN0 M0). A Show 4 more As per ESMO 2022 guidelines, offer 3-4 cycles of cisplatin-based neoadjuvant chemotherapy in patients with muscle-invasive BC. A Obtain cross-sectional imaging after chemotherapy before radical cystectomy. B Show 3 more As per SUO/ASTRO/ASCO/AUA 2017 guidelines, offer cisplatin-based neoadjuvant chemotherapy utilizing a multidisciplinary approach in patients eligible for radial cystectomy. B Show 2 more Management of muscle-invasive cancer, radiotherapy: As per EAU 2023 guidelines, do not offer preoperative radiotherapy in patients with operable muscle-invasive BC, as it will only result in downstaging but will not improve survival. D Show 3 more As per ESMO 2022 guidelines, do not offer adjuvant radiotherapy (with or without radiosensitizing chemotherapy) as a standard treatment in patients with muscle-invasive BC. D As per SUO/ASTRO/ASCO/AUA 2017 guidelines, do not offer radiotherapy alone as a curative treatment in patients with muscle-invasive BC. D Management of muscle-invasive cancer, palliative therapy: As per EAU 2023 guidelines, offer radical cystectomy as a palliative treatment in patients with locally-advanced tumors (T4b). B Show 3 more As per ESMO 2022 guidelines, consider offering palliative radiotherapy for palliation (bleeding, pain). C Management of metastatic cancer: As per EAU 2023 guidelines, offer cisplatin-containing combination chemotherapy with gemcitabine and cisplatin regimen or high-dose intensity methotrexate, vinblastine, adriamycin, and cisplatin regimen as first-line therapy in platinum-fit patients with metastatic cancer. A Show 7 more https://web.pathway.md/diseases/recvI2mkZpuJOXOaw 7/13 6/29/23, 3:18 AM Bladder cancer Pathway As per ESMO 2022 guidelines, offer cisplatin-based chemotherapy followed by maintenance avelumab as first-line therapy in patients with advanced or metastatic urothelial carcinoma not progressing on chemotherapy and fit enough to tolerate cisplatin-based combination chemotherapy. A Show 2 more Management of persistent/recurrent disease (general principles): offer pembrolizumab in patients with progression of disease after platinum-based chemotherapy. A Consider offering other immune checkpoint inhibitors, such as atezolizumab. B Show 5 more Management of persistent/recurrent disease, non-muscle-invasive cancer: As per EAU 2021 guidelines, consider performing outpatient fulguration or laser vaporization in patients with small papillary recurrences with a history of TaG1/LG tumors. C As per SUO/AUA 2016 guidelines, consider performing prostatic urethral biopsy and an upper tract evaluation before administration of additional intravesical therapy in intermediate- or high- risk patients with persistent or recurrent disease or positive cytology following intravesical therapy. C Show 6 more As per ESMO 2014 guidelines, perform cystoscopy as the most cost-effective method to detect BC recurrence in patients with non-muscle-invasive BC, despite the fact that it is an invasive and relatively expensive procedure. B Management of persistent/recurrent disease, muscle-invasive cancer: As per EAU 2023 guidelines, offer radiotherapy, chemotherapy and possibly surgery as options of treatment, either alone or in combination, in patients with local recurrence. A As per SUO/ASTRO/ASCO/AUA 2017 guidelines: Offer cystectomy with bilateral pelvic lymphadenectomy in medically fit patients with residual or recurrent muscle-invasive disease after bladder-preserving therapy. B Consider offering either local procedures, such as transurethral resection of bladder tumor with intravesical therapy or radical cystectomy with bilateral pelvic lymphadenectomy in patients with non-muscle-invasive BC recurrence after bladder-preserving therapy. C As per ESMO 2014 guidelines, perform prompt salvage cystectomy in patients received bladder-preserving therapy, when possible, if persistent or recurrent disease is observed at response evaluation or during follow-up (cystoscopy and urinary cytology every 3 months during the first 2 years, and every 6 months thereafter). B Management of persistent/recurrent disease, metastatic cancer: As per EAU 2023 guidelines, offer chemotherapy as the first option in patients with distant recurrence. Consider offering metastasectomy or radiotherapy in case of unique metastasis site. A As per ESMO 2014 guidelines, consider offering vinflunine as second-line therapy in patients progressing after first-line treatment with platinum-containing combination chemotherapy for metastatic disease. B https://web.pathway.md/diseases/recvI2mkZpuJOXOaw 8/13 6/29/23, 3:18 AM Bladder cancer Pathway 6. Nonpharmacologic interventions Smoking cessation: As per EAU 2023 guidelines, counsel patients to stop active smoking and avoid passive smoking. A As per EAU 2021 guidelines, advise smoking cessations in smoker patients with confirmed non- muscle-invasive bladder. A 7. Perioperative care Perioperative care: As per EAU 2023 guidelines, do not offer preoperative bowel preparation. D Show 2 more As per ASTRO 2017 guidelines, attempt to optimize patient performance status in the perioperative setting. E Show 2 more 8. Surgical interventions Transurethral resection of tumor, non-muscle invasive cancer: As per EAU 2021 guidelines, perform transurethral resection of bladder tumor and pathology investigation of the obtained specimens as a diagnostic procedure and initial treatment step in patients with suspected BC. A Show 17 more As per SUO/AUA 2016 guidelines, perform complete visual resection of the bladder tumor at initial diagnosis in patients with BC, if technically feasible. B Show 4 more As per ESMO 2014 guidelines: Perform transurethral resection of the bladder tumor as the treatment of choice in patients with any initial non-muscle-invasive bladder tumor, followed by instillations according to risk stratification of non-muscle-invasive BC. A Consider performing a second transurethral resection of the bladder tumor in patients with high-risk non-muscle-invasive BC, either before intravesical therapy C or thereafter. C Transurethral resection of tumor (muscle invasive cancer): do not perform transurethral resection of bladder tumor alone as a curative treatment option, as most patients will not benefit. D Radical cystectomy, non-muscle-invasive cancer: As per ESMO 2022 guidelines, offer radical cystectomy in patients with very high-risk disease. Perform radical cystectomy in patients with carcinoma in situ or high-grade T1 unresponsive to BCG due to the high risk of progression. B https://web.pathway.md/diseases/recvI2mkZpuJOXOaw 9/13 6/29/23, 3:18 AM Bladder cancer Pathway As per EAU 2021 guidelines: Perform immediate radical cystectomy in patients with very high-risk tumors. Offer intravesical full-dose BCG instillations for 1-3 years in patients with very-high risk tumors refusing or unfit for radical cystectomy. A Offer radical cystectomy in patients with BCG unresponsive tumors. A View treatments other than radical cystectomy as oncologically inferior in patients with BCG unresponsive tumors. B As per SUO/AUA 2016 guidelines, consider offering initial radical cystectomy in patients with variant histology because of the high rate of associated upstaging. E Show 2 more Radical cystectomy, muscle-invasive cancer: As per EAU 2023 guidelines, inform patients of the advantages and disadvantages of open radical cystectomy and robot-assisted radical cystectomy to allow selection of the proper procedure. A Show 7 more As per ESMO 2022 guidelines, offer radical cystectomy with standard pelvic lymph node dissection as first-line treatment in patients with muscle-invasive BC (T2-T4a, N0, M0). A As per SUO/ASTRO/ASCO/AUA 2017 guidelines, perform radical cystectomy as soon as possible following completion of and recovery from neoadjuvant chemotherapy. E Show 3 more Pelvic lymphadenectomy: As per EAU 2023 guidelines, perform lymph node dissection as an integral part of radical cystectomy in patients with muscle-invasive BC. A As per ASTRO 2017 guidelines: Perform bilateral pelvic lymphadenectomy at the time of any surgery with curative intent. B Remove at a minimum the external and internal iliac and obturator lymph nodes (standard lymphadenectomy) during bilateral pelvic lymphadenectomy. B As per ESMO 2014 guidelines, consider performing extended lymphadenectomy in patients with metastasis or micro-metastasis to a few nodes. B Urinary diversion: discuss the type of urinary diversion, taking into account the patient preference, existing comorbidities, tumor variables, and coping abilities. A Show 4 more Transurethral resection of the prostate: offer TURP, followed by intravesical instillation of BCG in patients with carcinoma in situ in the epithelial lining of the prostatic urethra. B Sexual-preserving surgery: As per EAU 2023 guidelines, offer sexual-preserving techniques in eligible male patients very motivated to preserve their sexual function. A Show 3 more https://web.pathway.md/diseases/recvI2mkZpuJOXOaw 10/13 6/29/23, 3:18 AM Bladder cancer Pathway As per ASTRO 2017 guidelines, discuss and offer sexual function-preserving procedures in patients with organ-confined disease and absence of bladder neck, urethra and prostate involvement. B 9. Specific circumstances Elderly patients: screen for frailty and cognitive impairment and provide a Comprehensive Geriatric Assessment where optimization is needed. B Show 2 more Patients with upper urinary tract cancer: offer kidney-sparing management in patients with low- risk upper urinary tract urothelial carcinoma and radical nephroureterectomy with bladder cuff excision in patients with high-risk upper urinary tract urothelial carcinoma. B Show 5 more 10. Patient education General counseling: As per EAU 2023 guidelines, inform patients of the advantages and disadvantages of open radical cystectomy and robot-assisted radical cystectomy to allow selection of the proper procedure. A Show 2 more As per ASTRO 2017 guidelines, counsel patients regarding complications and the implications of treatment on quality of life (such as impact on continence, sexual function, fertility, bowel dysfunction, metabolic problems) before treatment. B Show 3 more 11. Preventative measures Avoidance of carcinogenic substances: Inform workers in potentially hazardous workplaces of the potential carcinogenic effects of a number of recognized substances, including duration of exposure and latency periods. Advise protective measures. A Do not prescribe pioglitazone in patients with active BC or a history of BC. D 12. Follow-up and surveillance Surveillance, non-muscle-invasive cancer: As per EAU 2021 guidelines, use the 2006 EORTC scoring model to predict the risk of tumor recurrence in individual patients not treated with BCG. A Show 9 more https://web.pathway.md/diseases/recvI2mkZpuJOXOaw 11/13 6/29/23, 3:18 AM Bladder cancer Pathway As per SUO/AUA 2016 guidelines, consider obtaining surveillance upper tract imaging at 1-2 year intervals in intermediate- or high-risk patients. E Show 8 more Surveillance, muscle-invasive cancer: As per EAU 2023 guidelines, obtain regular follow-up in patients after curative radical cystectomy. E Show 13 more As per SUO/ASTRO/ASCO/AUA 2017 guidelines, obtain regular surveillance with CT, cystoscopy and urine cytology after completion of bladder-preserving therapy. B Show 3 more Surveillance (metastatic cancer): do not offer preventative brain radiation to avoid brain recurrence in patients with muscle-invasive small cell neuroendocrine variant of bladder urothelial carcinoma. D Clinical findings Symptoms Past medical history Abdominal pain Bladder schistosomiasis Dysuria Bone metastasis Feeling of incomplete bladder emptying Liver metastasis Lung metastasis Flank pain Pelvic radiation therapy Hematuria Prostate cancer Loss of appetite UTI Pelvic pain Vascular exam Urinary frequency Urinary hesitancy Lower extremity edema Urinary straining Urinary urgency Genitourinary exam Weak urine stream Macroscopic hematuria Weight loss Social history Tobacco use Abdominal exam Palpable pelvic mass Integument exam Pallor https://web.pathway.md/diseases/recvI2mkZpuJOXOaw 12/13 6/29/23, 3:18 AM Bladder cancer Pathway References 1. J.A. Witjes Chair), H.M. Bruins, A. Carri n et al. EAU Guidelines on Muscle-invasive and Metastatic Bladder Cancer. EAU. 2023 Mar. Open 2. Sam S Chang, Bernard H Bochner, Roger Chou et al. Treatment of Non-Metastatic Muscle-Invasive Bladder Cancer: AUA/ASCO/ASTRO/SUO Guideline. J Urol. 2017 Sep;198 3 552 559. Open 3. M Moschini, G Gandaglia, F Deh et al. Bladder cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol. 2022 May;33 5 561. Open 4. J Bellmunt, A Orsola, J J Leow et al. Bladder cancer: ESMO Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2014 Sep;25 Suppl 3:iii40 8. Open 5. Sam S Chang, Stephen A Boorjian, Roger Chou et al. Diagnosis and Treatment of Non-Muscle Invasive Bladder Cancer: AUA/SUO Guideline. J Urol. 2016 Oct;196 4 1021 9. Open 6. M. Babjuk, M. Burger, E. Comp rat et al. EAU Guidelines on non-muscle-invasive bladder cancer TaT1 and CIS . EAU Guidelines. 2021 Mar. Open 7. Moyer VA, U.S. Preventive Services Task Force. Screening USPSTF for bladder cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2011 Aug 16;155 4 246 51. Open 8. van Hooft JE, van Halsema EE, Vanbiervliet G et al. Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy ESGE Clinical Guideline. Endoscopy. 2014 Nov;46 11 990 1053. Open 9. Coleman R, Body JJ, Aapro M et al. Bone health in cancer patients: ESMO Clinical Practice Guidelines. Ann Oncol. 2014 Sep;25 Suppl 3:iii124 37. Open 10. Koren G, Carey N, Gagnon R et al. Cancer chemotherapy and pregnancy. J Obstet Gynaecol Can. 2013 Mar;35 3 263 278. Open 11. Flank J, Robinson PD, Holdsworth M et al. Guideline for the Treatment of Breakthrough and the Prevention of Refractory Chemotherapy-Induced Nausea and Vomiting in Children With Cancer. Pediatr Blood Cancer. 2016 Jul;63 7 1144 51. Open https://web.pathway.md/diseases/recvI2mkZpuJOXOaw 13/13