Diagnosis and Therapy of Superficial Bladder Cancer

Overview

Among patients with bladder carcinoma, 70-80 % present with superficial bladder tumors. This group is composed of papillary tumors Ta, Tl and of flat nonpapillary high-grade carcinoma in situ (Tis). Typical features of superficial tumors are their multifocal origin and high recurrence-rafe after initial therapy. The hrst and most important step in diagnosis and treatment of the bladder cancer is urethrocystoscopy under general or spínal anesthesia with resection of papillary lesions and biopsy of suspicious areas followed by pathologic examination of the surgical specimen. This approach enables total resection of all visible tumors, classification of the tumor and determination of prognostic factors. The aims of intravesical therapy are treatment of Tis and prevention of recurrence and progression after TUR. The most often used agents for intravesical chemotherapy are mitomycin C and adriamycin. This treatment modality prolongs tumor-free interval and reduces early recurrence-rafe in about 14 % of patients, but cannot reduke late recurrence-rafe and progression-rafe. BCG intravesical immunotherapy is with 73-87 % response rafe the most effective treatment modality in Tis. It is also more effective than chemotherapy in prevention of recurrence, but is connected with more frequent side effects. Radical cystectomy is considered in patients who do not respond to local therapy.

Key words:
superficial bladder transitional cell carcinoma, intravesical chemotherapy, intravesical BCG immunotherapy.