Instillation Therapy in Superficial Urinary Bladder Cancer

Abstract

Carcinoma in situ (TIS) is a special dilemma. Controversial diagnostic and therapeutic attitudes prevail in the literature. Mild dysplasia grad 1 seems to be a condition where ‘wait-and-see policy’ might be justified according to our series of 60 patients with a TIS whereas, both the TISG2 and TISG3 are real malignancies which need a more aggressive treatment than a transurethral resection (TUR) alone. Under a close control, intravesical chemo-and immunotherapy offer an alternative to cystectomy. On the other hand, for a visible superficial (Ta-Tl) cancer TUR is the principal treatment, which can easily be repeated. Anyhow, the high frequency of recurring tumours and the tendency to simultaneous progression in a specific category of patients have led to adjuvant prophylactic treatments. Currently, both intravesical cytostatics and intravesical bacillus Calmette-Guérin have been proven safe with much the same effect. Adjuvant prophylaxis of a primary, single superficial tumour is not indicated, even though the treatment of TIG3 cancer is under discussion.

Key words:

• Superficial bladder cancer
• Instillation therapy
• Intravesical chemotherapy
• Intravesical immunotherapy
• Doxorubicin
• Mitomycin C
• Bacillus Calmette-Guérin (BCG)