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Introduction:
Superficial
transitional cell carcinoma of the urinary bladder account for
more than 70% of all newly diagnosed bladder cancer cases.
Superficial bladder cancer includes noninvasive
papillary carcinoma, superficial invasive carcinoma, and carcinoma
in situ (CIS). CIS
of the urinary bladder is defined as a noninvasive, flat, and
high-grade cancerous lesion confined to the superficial lining of the
bladder. Unlike
most malignant tumors, carcinoma in situ (CIS) of the urinary
bladder is a highly malignant and aggressive cancerous lesion.
Diagnosis
A
definitive diagnosis of CIS is made by cystoscopy, which is
generally performed under general anesthesia, together with a
biopsy of the bladder, but CIS can be difficult to diagnose.
It may have a characteristic red, velvety appearance
when viewed in cystoscopy.
But not all cases of CIS are visible under visualization.
At times CIS is not visible, the diagnosis is made from
cytologic analysis of the urine or by obtaining random bladder
biopsies. Malignant cells are present in patients’ urine in
more than 90% of the cases.
Bladder
carcinoma in situ can be localized or diffuse.
Diffuse CIS may occur in multiple areas in the urinary
bladder. CIS may
be an isolated finding that occurs without a concurrent
exophytic tumor, but it may also occur simultaneously with
papillary or invasive bladder cancer.
The chances for cancer recurrence, invasion, and
progression are greatly increase when CIS is present.
Treatment
Patients CIS of
the urinary bladder are usually treated conservatively.
Most patients are treated with transurethral resection
of the exophytic tumor(s) followed by intravesical treatment
with bacillus Calmette-Guerin (BCG).
The majority of patients (more than 50%) will develop
invasive disease after conservative surgery alone.
The addition of intravesical BCG can significantly
reduce the rate of recurrence and may increase the overall
survival rate. Actually,
intravesical BCG therapy is the first line treatment for
diffuse CIS, and it can produce > 70% complete response
rate for more than one year.
The five-year control rate after BCG treatment is more
than 60%. In order for BCG to be effective, the tumor burden
should be relatively small, and there must be direct contact
between the medication and the tumor.
The patient should be immunocompetent.
Radical
cystectomy (removal of the urinary bladder and other organs
near the bladder) is not commonly used for treatment of
carcinoma in situ of the urinary bladder.
Cystectomy is necessary for patients with progressive
and uncontrollable bladder CIS.
The overall survival rates after such surgery for
patients who failed BCG therapy is approximately 90% if the
tumor is not invasive. However, cystectomy is related to major
morbidities and complications.
For
more information about Bladder Cancer or its treatment, please
visit the Bladder Cancer Guide of The
Cancer Information Network.
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