Introduction and overview of intravesical therapy for superficial bladder cancer

The initial and subsequent management of patients with transitional cell carcinoma of the urinary bladder requires the cooperative effort of the urologist, pathologist, and cytologist. The initial endoscopic session should provide sufficient material to assess accurately the extent of tumor. The tumor is termed superficial if it is confined to the mucosa (Stage Ta and CIS) or lamina propria (T1). Based on the prognostic factors, the clinician decides whether or not intravesical therapy should be incorporated into the treatment plan that is designed to eradicate any remaining postresection tumor(s) as well as retard the development of subsequent tumors. The clinician who chooses to utilize intravesical therapy should be knowledgeable regarding the frequently used drugs: thiotepa, mitomycin C, doxorubicin, and bacillus Calmette-Guérin (BCG). Each has established efficacy in the treatment and prophylaxis of transitional cell carcinoma. Each also has a different spectrum and incidence of local and systemic toxicity.