Muscle-invasive bladder cancer (MIBC) management is evolving beyond traditional clinicopathologic staging to include integration of molecular biomarkers. DNA damage repair gene alterations predict cisplatin sensitivity, while fibroblast growth factor receptor mutations identify candidates for targeted therapy. Transcriptomic subtypes reveal tumor phenotypes with variable treatment responses. Most significantly, circulating tumor DNA (ctDNA) enables dynamic disease monitoring, with postoperative ctDNA detection identifying high-risk patients who benefit from adjuvant immunotherapy while ctDNA-negative patients can safely avoid overtreatment. Despite promising advances, challenges including prospective validation, standardization, and accessibility limit widespread clinical adoption. This article examines current evidence and future directions for biomarker-driven MIBC management.

Adjuvant cisplatin-based chemotherapy is standard of care for patients with muscle-invasive bladder cancer who have received no prior neoadjuvant therapy, are cisplatin-eligible, and have at least pT3 or lymph node-positive disease at the time of radical cystectomy. Carboplatin is inferior to cisplatin in bladder cancer and has not been extensively studied in the adjuvant setting. Adjuvant nivolumab and adjuvant pembrolizumab are recommended by National Comprehensive Cancer Network (NCCN) guidelines for patients with high-risk pathology on radical cystectomy.

Radical cystectomy is the standard curative treatment for muscle-invasive and selected high-risk nonmuscle-invasive bladder cancer yet is frequently associated with persistent sexual dysfunction and impaired health-related quality of life. This review summarizes contemporary sexual function preservation strategies for men and women, including preoperative assessment and counseling, validated patient-reported outcome measures, evolving nerve-sparing and organ-sparing surgical techniques, and postoperative rehabilitation while also highlighting emerging concepts.

Advancements in the management of muscle-invasive bladder cancer have increasingly focused on strategies that balance oncologic control with preservation of quality of life. The therapeutic landscape for neoadjuvant therapy is rapidly evolving as immunotherapy and novel agents are integrated into systemic therapy regimens. The utility of tumor tissue, plasma, and urine biomarkers in selecting patients for bladder preservation remains uncertain and warrants further evaluation in prospective clinical trials before incorporation into routine clinical practice. Clinicians should consider both tumor-specific factors and patient-specific factors when engaging in shared decision-making.

Palliative cancer rehabilitation plays a critical role in optimizing function, alleviating symptom burden, and enhancing quality of life for individuals with serious or terminal illness. Despite its benefits, rehabilitation and other supportive care services remain underutilized, often due to the lack of ongoing need assessments throughout the survivorship continuum. Physiatrists are uniquely positioned to lead palliative rehabilitation across diverse care settings, using a multidisciplinary approach to address physical decline, psychosocial distress, and caregiver burden. These interventions can improve the quality of survival, support goal-concordant care, and bridge gaps in end-of-life care by aligning functional needs with comfort-focused goals.

Peripheral nervous system dysfunction in cancer may arise from tumor invasion, treatment toxicities, surgery, infections, or nutritional deficits, leading to significant sensory, motor, and autonomic impairments. This article outlines the epidemiology, pathophysiology, and clinical presentation of cancer-related peripheral neuropathies, emphasizing diagnostic and functional assessment strategies. Rehabilitation interventions, including physical and occupational therapy, pain management, assistive technologies, and emerging modalities such as neuromuscular stimulation and virtual rehabilitation are discussed within an interdisciplinary framework. Special considerations during active treatment and survivorship are highlighted. Early integration of rehabilitation and continued research are essential to optimize outcomes and quality of life.

Cancer-related fatigue (CRF) is a highly prevalent and functionally disabling symptom across the cancer continuum. Unlike typical fatigue, CRF is persistent, not proportional to recent activity, and rarely relieved by rest. Its etiology is multifactorial, involving immune dysregulation, mitochondrial dysfunction, neuroendocrine alterations, psychosocial stressors, and behavioral deconditioning. This article reviews the epidemiology, mechanisms, assessment tools, and rehabilitation strategies for CRF, with emphasis on the evidence base for exercise interventions. It also highlights emerging directions, including biomarker-driven therapy, tele-rehabilitation, and equity-focused models.

Pelvic rehabilitation is an essential component of cancer care, addressing pelvic disorders such as urinary, bowel, sexual, pain, and neuromusculoskeletal dysfunction arising from cancer and/or its treatments, including surgery, radiation, and systemic therapy. Early, individualized, and continuous intervention helps prevent chronic dysfunction and improves quality of life. Comprehensive evaluation across neuromusculoskeletal, bladder, bowel, and sexual domains guides targeted management. Treatment integrates patient education, behavioral strategies, pelvic physical therapy, pharmacologic therapy, and procedural interventions. Multidisciplinary collaboration among oncologists, physiatrists, pelvic physical therapists, and pain specialists optimizes pelvic function, symptom control, and psychosocial well-being throughout survivorship.

Peripheral edema is a recognized and can be a disabling complication in patients with advanced cancer, leading to reduced mobility, discomfort, and diminished quality of life. This article outlines the multifactorial pathophysiology of edema and approaches to its management in this population. Interventions such as medication, exercise, positioning, compression therapy, manual techniques, and patient education are discussed as strategies to alleviate symptoms, preserve function, and support independence. The article highlights the importance of multidisciplinary collaboration, early prevention, and individualized care planning to optimize outcomes. By addressing edema proactively, rehabilitation professionals play a pivotal role in enhancing patients' function and overall well-being.

Cancer pain is a complex, multifactorial phenomenon that significantly impairs function and quality of life. It may arise from tumor burden, treatment-related injury, or comorbid conditions.

This review provides a comprehensive, system-based framework for the evaluation and management of cancer pain, emphasizing the physiatrist's role in integrating rehabilitative, pharmacologic, and interventional strategies to optimize function and quality of life across the cancer continuum.

Effective cancer pain management requires a multimodal and interdisciplinary approach.

Cancer pain should be treated with clinical urgency. Collaborative, system-based management led by physiatrists within a multidisciplinary team ensures comprehensive, patient-centered care.