The Management of Superficial Bladder Cancer

Superficial bladder cancer includes tumors confined to the mucosa and lamina propria. They may be papillary or sessile. Tumors confined to the mucosa include papillomas, papillary carcinomas, or carcinoma in situ. Therapy must be individualized for each patient taking into consideration the histologic type, cytologic grade, location, number, prior history, and presence of atypia or carcinoma in situ in other areas of the bladder. Although the five-year survival rates are good (62-88 percent), the 48-70 percent incidence of subsequent tumors requires constant surveillance. This high incidence is primarily due to the multifocal origin of urothelial tumors, but implantation of tumor cells following local resection may be a contributing factor. Current efforts to reduce this recurrence rate emphasize intravesical chemotherapy. Thio-tepa and epodyl are effective in eradicating one-third of tumors when used for definitive therapy. Most studies demonstrate a reduction in the recurrence rate when they are initiated following endoscopic resection of all visible tumor. A number of other drugs are being investigated for both definitive and prophylactic intravesical chemotherapy. Surgical procedures consist of transurethral resection, transvesical radium implantation, segmental cystectomy, and cystoprostatectomy. Each procedure has its own indications, and the surgeon must be discriminating in their use.