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  • Review Article
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The management of superficial bladder cancer

Nature Clinical Practice Urology volume 4, pages 254–260 (2007)Cite this article

Abstract

From review of the currently available trial evidence, several clinical recommendations for bladder tumor management become apparent. Transurethral resection should be done, but this procedure is prone to both overestimating and underestimating staging. Restaging transurethral resection for patients with T1 tumors should, therefore, be performed. Data support the immediate postoperative instillation of a chemotherapeutic agent for patients with solitary, low-grade papillary tumors, whereas patients with multiple lesions might benefit from a more intensive adjuvant regimen. Although the use of intravesical immunotherapy for reducing tumor progression or as maintenance therapy is controversial, bacillus Calmette–Guérin has demonstrated significant benefit for tumor prophylaxis when no obvious residual disease is present. Early radical cystectomy can be beneficial and should be performed in patients with refractory T1 tumors or carcinoma in situ before progression to muscle invasion. In this Review I present an overview of the management of nonmuscle invasive bladder cancer. The most common intravesical chemotherapeutic agents are described as well as the impact of chemotherapy on the recurrence and progression of tumors. The effect of intravesical immunotherapy in bladder cancer is explored as well as the role of early cystectomy.

Key Points

  • Single transurethral resections are prone to both overestimating and underestimating staging and, therefore, restaging transurethral resection for patients with T1 tumors should be performed

  • Data support the immediate postoperative instillation of a chemotherapeutic agent for patients with solitary, low-grade papillary tumors, while patients with multiple lesions may benefit from a more intensive adjuvant regimen

  • The use of bacillus Calmette–Guérin has demonstrated significant benefits for tumor prophylaxis

  • Patients with refractory T1 tumors or carcinoma in situ should be treated by radical cystectomy before progression to muscle invasion

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Figure 1: Algorithm for the management of superficial bladder cancer

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Author notes

  1. Memorial Sloan–Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA dalbagng@mskcc.org

Authors and Affiliations

  1. G Dalbagni is Associate Attending in the Department of Surgery, Division of Urology, Memorial Sloan–Kettering Cancer Center, New York, and Associate Professor of Urology, Weil Cornell Medical College, New York, NY, USA.,

    Guido Dalbagni

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  1. Guido Dalbagni
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Dalbagni, G. The management of superficial bladder cancer. Nat Rev Urol 4, 254–260 (2007). https://doi.org/10.1038/ncpuro0784

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