Bladder tumors are pathologically stratified based on stage, grade, tumor size, presence of concomitant carcinoma in situ, and multicentricity.1-2-1 The chances of tumor progression are augmented with the increase of these pathological variables. Pathologically, most bladder tumors are transitional cell carcinomas. There is, however, increasing recognition of the prognostic importance associated with the metaplastic variants displaying squamous and glandular differentiation as part of their clonal evolution. The power of these histopathological variables and the tumor node metastases (TNM) categorization, in defining the clinical subtypes of bladder cancer and predicting the clinical outcome of individual patients, has certain limitations. Within each stage, it has been very difficult to identify clinically useful parameters that can predict risk of disease recurrence or progression. Numerous biological markers have been described for bladder cancer, some correlating with tumor stage and prognosis in patients affected with these neoplasms. Phenotypic features associated with tumor aggressiveness include cell cycle and apoptosis regulators, as studied by appropriate sensitive molecular techniques.1-2-5-1 Remaining challenges are not only the identification of bio-markers of early diagnostic utility combining high sensitivity and specificity, but also progression and outcome-predictive markers in bladder cancer.
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